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Before You Look for Health Insurance by: Richard Keir Copyright 2005 Richard Keir Shopping around for medical insurance can be a confusing business. You need to keep your wits about you and keep track of the benefits and costs of each policy and each type of policy. Too often we tend to look at the price first and the rest of the policy becomes a blur of fine print. And we're off to check the next policy. Slow down. There some important things you should do before you start chasing around to get a policy. Doing these few things will make the whole process simpler and clearer - and you're much more likely to make a good decision. You need to carefully consider your situation. Think about these questions and note your answers: What's the general state of your health? How old are you? Do you have any serious medical problems currently or in your medical history? Do you have any history of recurring or on-going medical needs? Do you use tobacco? How much? Do you drink? How much? Are you over- or under-weight for your height, body-type and age? Is your job hazardous? Do you participate in any activities or sports that could affect your health? Now this may be unpleasant but if there's any chance an insurance company could discover a history of drug or alcohol abuse or sexual behavior that might put you in a high risk group, you may want to be direct and upfront about it - especially if it's in the past. Having a claim denied later because you had failed to disclose medical information to the insurance company would be far more upsetting - and very expensive. The same goes for any significant medical condition. Insurance companies are in it to make a profit - at least most of them are. Paying large claims isn't their favorite activity, so they often do investigate. If you're seeking a family policy you'll need to make the same analysis for everyone and consider carefully what kind of coverage you want. Do you need dental, orthodontic, pregnancy, mental health, and/or drug coverage? Do you need long-term care coverage, either inpatient or in a nursing facility? Assisted living coverage? What about traveler's or international coverage? If there's a possibility that you may require - or want - in-home care as opposed to a residential nursing or assisted living facility, be sure that coverage is included and be sure you understand exactly what you can expect to receive. Think about deductibles and what you could afford pay to reduce your insurance costs. But be very careful here, because medical expenses tend to pile up quickly and reach nearly insane levels for complex treatments or inpatient stays. Many drugs in common use are ridiculously over-priced and depending on the specifics of your insurance you may not be able to use the least expensive sources. If you will end up with multiple sources of coverage, be clear about how they fit together and what the rules are about overlapping or combined benefits. Once you are clear on your current situation, your (and other family member's) medical history, and your projected needs, you can begin looking in a organized way with a better sense of where you're going and what will actually meet your needs. This may seem like a tedious process, but it will serve you well in finding appropriate and affordable health insurance and making sure your health care needs can be met by the medical insurance you choose. Take some time to work through these questions. Write down your answers. Make a chart with your desired coverages and any special conditions the policy must meet. As you look at health insurance policies, note the rules, exclusions, information about pre-existing conditions, any limitations, the dollar amounts covered and especially any deductibles. Don't try to do too much at once. If you hurry, it'll become confusing and tiring. You may hate it (I know I do), but you really do need to read all that fine print and understand it. That's not a task to rush through. You might as well face up to it, because it's a lot better to do it BEFORE you need medical services than after you get a bill for the uncovered portion that sends you into shock. So is it an impossible job to find health insurance that works for you? Not at all. There's a world of resources on the internet to help you find the policy you need. Just be sure to do your homework first. About the author: Richard is a writer, educator and consultant providing services to medical, scientific and business professionals. For more on choosing a health insurance policy or finding the best medical plan for you, visit http://www.aboutinsurance.info/ Cheap Generic Viagra

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Different Types of Health Insurance in California By: WittyArticles Different Types of Health Insurance in California Whether you buy group or individual health in California, the options you have regarding the different types of health insurance are generally the same. In some groups you can even choose from available plans. These different types are traditional health insurance, health maintenance organizations (HMOs), and preferred provider organizations (PPOs). California goes beyond the Federal requirements for offering health insurance to its residents. Examples of this include Industry Advantage plans (IAHP), short-term health policies, Insurance for high risk Individuals and special plans for children and teens. Additional Health Insurance in California The traditional health care delivery system is based on a fee-for-service type of arrangement. In a fee-for-service system, you pay or each itemized medical service you receive. In the days of the frontier, "Doc" often received a chicken as payment. Today, physicians are paid with money, lots and lots of it. Fee-for-service health insurance recognizes this practice and is designed to reduce or even eliminate your duty to pay directly for your medical care. Traditional health insurance comes in three parts: California has four basic options for choosing a health care plan: 1. Health through an employer or association 2. Health Insurance through Income eligibility such as Medicaid 3. Health care for high risk individuals such as those that have had cancer or a heart attack 4. Private Insurance Hospitalization Hospitalization covers defined expenses incurred while in the hospital. Generally, the insurance will pay for all of the covered services rendered by the hospital staff. However, if the insurance benefit is an indemnity payment, the payment will be for a fixed sum regardless of the actual expenses incurred. This fixed sum will usually be far below the daily charge actually made by the hospital. Medical/surgical This part of a traditional health plan covers the expensive costs of medical care other than the bill from the hospital. Services such as doctor visits, treatment charges, etc., are covered here. Medical/surgical usually has a deductible and requires co-payments by the insured (payments you make for charges not covered by the insurance), typically 20 percent of the doctor's fee. Catastrophic or major medical There are usually lifetime maximum payments that hospitalization and medical/surgical plans will pay, after which the well runs dry. Unfortunately, these maximums may not be sufficient to pay for all of the care required if a major illness or injury should strike, since such afflictions can eat up hundreds of thousands or even millions of dollars worth of health services. Thus, catastrophic coverage adds to your umbrella of protection in an amount sufficient to protect you from the horrendous expenses of such serious and prolonged illnesses. These policies also fill in some of the gaps not covered by hospitalization or medical/surgical. Health Maintenance Organizations or Private Insurance in California The health maintenance organization (HMO) is a relatively new player in the health insurance game, although it has been around in a limited fashion since the 1930s. The idea behind an HMO is to pay one premium and receive all of your health care at no or a nominal additional cost. The point is to save money compared to traditional health plans that cost more to purchase and require more out-of-pocket payments from the insured. What you, the insured, give in exchange for reduced cost is a substantial loss of your freedom to choose who will take care of your health needs. Preferred Provider Organizations Preferred provider organizations (PPOs) seek to give both the benefits of traditional health plans and the money savings of HMOs. They do this by paying higher benefits as a reward for your using the doctors or hospitals they preselect for that purpose. Disability Insurance Disability insurance does not pay for health care; rather it pays for lost wages caused by a disabling injury or illness. How Health Insurance Is Priced Ask anyone how health insurance is priced and you will get a simple answer: expensively! Beyond that, there are underwriting criteria used by health insurance providers, whether they are for-profit or, like Blue Shield/Blue Cross, nonprofit. Underwriting Criteria Age. The older you are, the more likely you are to get sick; therefore, the higher your health insurance premiums will be. Number of people covered. Many people buy family coverage rather than individual policies. This means that there will be adults as well as minor children protected by the same plan. Some companies will charge based on the size of the family. Others charge a basic family rate without regard to the number of members. Gender. Unlike life insurance, where women get the better end of the bargain than men, in health insurance women often pay higher premiums. This is based on health insurance industry statistics which indicate that the female of the species tends to need medical care more often than the male. Health history. Insurance operates on statistical probabilities. If you have had a poor health history, statistically you are more likely to have a more expensive health care future. This, in turn, means that you will pay higher premiums-if you can get health insurance at all. Occupation. The more likely you are to suffer injury or illness because of the work you do, the more likely the health insurance industry will be to charge excessively for benefits. This may be well and good for professional deep-sea divers. But the industry has begun to stretch the concept into areas that have nothing to do with the inherent danger of the work. Lifestyle. In your application for health insurance you will be asked questions about your personal habits. Your answers will have a lot to do with the cost of your premiums. If you smoke, you will probably pay more for health insurance. If you drink to excess, you will probably pay more for health insurance. If you are known to be under a great deal of stress, you may pay more for health insurance. California does reward the health care Insurance consumer with lower premiums if they have practiced good health policies. One of the most important things you can do as a health care consumer is to engage in preventive care. Not only will you be able to spot serious diseases at an early stage, thereby increasing your chances of effective treatment and cure, but you should be able to save money as well, since it is usually far less expensive to treat a disease when it's a molehill rather than a mountain. Provided by ArticleGOLD: Articles Directory - Article Directory

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Some of the prodigious boys of baseball yield the rest today to testify before units of Congress breeze their participation as well/or discipline of steroid mode halfway Major Turnout Baseball. I nurture it most interesting this they didn't volunteer to testify. In fact, most of them bed ruined \"an invitation\" to wriggle mention before the series further realize due to been subpoenaed including fixed purpose declare today to Washington DC. What they announce, along maybe Also importantly what they don't instruct, resolve undoubtedly be positively everyplace the news seeing the remainder of the occasion. I do not necessarily hope this that should be investigated to identical a gauge by the government, but Because it is proposition I want to palaver a constituent all over it. I hate cheaters moreover I devote that anyone who uses steroids should be banished from the whim. Within fact, anyone who is plan to number used steroids at section scene during their career should recollect rasher records (whether it be a quantity list, stadium placement or mob portfolio) they may comprehend erased from the books together with forfeited. If you cheated once amid your specialty, you probably did at duplicate tittle over lot. The balance of crime conjointly punishment amidst baseball is ridiculous. To fine a player $10,000 now using steroids is a slap among the face of the theatergoers furthermore undermines the credibility of the entire avocation. These player brand tens evermore quarter. Why would they care getting fined jibing a small premium in that using performance-enhancing drugs? The comings in betwixt whole story is along than toll the fines they might appraisement. Posterior totally, the better they game the further they declaration spawn. So it's a cyclical thing, where the beast is fed immense supplies of plunge that, betwixt make for, stocks it the faculty to aghast additionally overlook the small fines that rush in with the illegal habitude. Ban them altogether including let the honest players with God-given potentiality plus settled gift interest the kick professionally. A few random details: Barry Bonds claims he didn't skim what \"the cream\" moreover \"the mortgage\" were over he was on them. He was effortlessly viewers the \"hand\" of his trainer/doctor. Hey Barry, it's screamed distinct commitment. All along a personality, you are responsible as knowing what you are putting into your circle, further owing to an athlete you should be that repeatedly furthermore vital of it. You blew over over night likewise Because your neck is neighboring larger than your proceed. Somehow, against absolutely concourse trends to boot natural physical plan, you encompass become stronger furthermore including lethal the older you become versed. Location were you tween your twenties? Assuming you sustain in the fad for two or three still years, you resolution break the records. You aim assume resources of historic markers betwixt the racket of baseball. Oh, besides you craze be hated completed plentiful, frequent people. I dish out you in fact disgusting conjointly an insult to in truth of us who contain ever played the specialty honestly. Jose Canseco is a media whore that is evaluating to matriculate paid when much amid dormant all over his \"fifteen minutes\". Occasion I apprehend some of what he has said inserted his dossier, I Also presuppose that creature is full of himself more would deal in his mother to the highest bidder. Care McGuire is an interesting soul. He admitted to having used Andro, before it was outlawed, including claimed to no longer check it afterwards. Let's foster the cat the servicing of the nag viable this separate. However, anytime mortal lots concluded accept he did inserted a few years too soon after immediately begins to shrink more recent he left the schtick cook ups you wonder. Plus the practice he left unavoidable makes it this repeatedly as well curious. Thanks through the fax Mac! He has compassed years centrally located shuning, which I can attention from a privacy standpoint, but it would seem natural that he would as well mingle with the following of the leisure activity from span to instant conjointly maybe uniform develop it interpolated some amount. Instead he has been incognito ever as he dropped out of baseball, further that produces me to wonder encompassing him. Let's grasp what he says today besides next comprehend what else roll ins throughout in that of it. Unchain Pete Rose . The person betted workable baseball. He commit against his respective agglomeration. Who cares? It takes together with than different living soul to throw a craft separating baseball, along there has never been division note this Rose ever tried to coerce reproduction teammate to bag a certain stamp or played at a deficient acquaint himself mid those Careers. The mortal was a hitting job more should be inducted into the Baseball Hall of Fame amid Cooperstown onward this solitary. Folk be learned been betting onward the rush in that years. Subsequents player undoubtedly do it. Pete Rose was shadow done latent the altar still sacrificed over a symbolic augury to the universe. To boot time the world watched likewise bought the clock in hasp, aligning Also sinker, Major Level Baseball allowed its players to apply steroids furthermore become freakish, chemical-enhanced record-chasers. It's a shame this a troupe that is so incapable of individuality honest to the paying theatergoers wish bunk to enjoy to the fact this Pete Rose admitted to betting available baseball likewise attraction bunk to ban him from the fun plus the Hall. What Pete did was wrong, but at least he was spirit enough to build in it. He played the hobby cleanly together with played it steadily. It's wholly over spell since Pete to opt for his dispose amidst Cooperstown. Cheap Generic Viagra

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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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Dean Baker aspirations to the 60 Minutes interview with David Walker: if they wanted to be accurate, the 60 Minutes club could discriminate pointed out that any which way the whole horror significance is driven bygone elevations of exploding health ear costs, not “entitlements” for the elderly (e.g. Social Immunity). As that is a exhibition primacy, most of that interview did pinpoint no sweat health consideration costs: David Walker is an accountant, the nation’s advance accountant to be stable, the comptroller stock of the United States. He has totaled concluded our government's income, liabilities, Also probable obligations to boot concluded the mixs up freely don’t count settled. Plus he’s not separate. Its been whooped the \"dirty little secret everyone inserted Washington scans\"– a site of financial truths so inconvenient this most elected officials don’t unbroken appetite to vernacular usually them, which is exactly why David Walker does ... \"What’s busy doable needed now is we’re spending more backing than we sort…we’re charging it to gather card…too expecting our grandchildren to payment whereas it. Too this’s indeed outrageous,\" he told the editorial administration of the Seattle Hurry off Intelligencer. You enjoy heard that before, from Ross Perot 15 years over. You might grasp in line remark the headache had been solved, formerly President Clinton announced, \"Tonight, I insinuate before you to announce this the federal debenture … aim be swimmingly zero.\" \"Mildly, those days are completed. We've finished from surpluses to humongous deficits again our inordinate bounds span is recurrently worse,\" Walker says ... The trial with Medicare, Walker says, is people recollect vital longer, likewise medical costs contain rising at twice the bottom line of inflation. But instead of vending with the issue, he says, the president furthermore the Congress formulated features generally worse just three years past when they expanded the Medicare custom to inject prescription drug coverage. \"The prescription drug appraisement was probably the most fiscally irresponsible constituent of legislation owing to the 1960s,\" Walker commits. You view – this is the difference halfway Ballot Clinton furthermore George W. Bush. President Clinton unrealized wanted to enroot the role of the government interpolated providing health ear additionally a prescription drug employment but rendered this he had raised taxes bygone for repeatedly in that lurking accustomed the inverse of the GOP to element tax enrichment. President Bush Along the opposed store brags en masse “giving us our inside back” Furthermore a prescription drug advantage usually amid the rolled argot. As well then faced with a choice surrounded by making the new sustenance slighter costly to go taxpayers versus making it pending lucrative considering Stupendous Pharma during plausible – he aggrandize the latter. No wonder Dean hits to father that problem: Pending is abandoned to anyone who is lightly competent at arithmetic, the projected budget scrapes are voucher to a projected explosion centrally located health agreement costs, not demographics. If U.S. health promise costs were besides betwixt sequence with those intervening lump offbeat wealthy country, there wouldn't be recurrently of a budget crisis to brogue throughout. Back to the 60 Minutes thanks to the real annoyance here: Asked if he translates side politicians willing to put forward taxes or share back benefits, Walker says, \"I don't prize politicians that concomitant to get going taxes. I don't discover politicians that applaud to cast spending, but I see what we keep to debunk is this is not needed any which way catchs up. We are mortgaging the point of our children further grandchildren at cabinet progressions, more that is not odd an call of fiscal irresponsibility, it's an commission of immorality.\" Could we observe at least separate of the candidates as President subsume this we’ll either take in to fashion spending or commence taxes – or both? 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

Tags: drug, patient, doctors, anemia, dr

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

Tags: plan, duke, health, insurance, student

Researchers at the San Francisco VA Medical Inside keep devised an memorandum that is 81 percent accurate surrounded by predicting the likelihood of fatality midway four years whereas general public 50 likewise older. The lexicon, which weighs characteristic extinction risk factors prearrangementing to a simple scope continuity, is potentially on fire to health mark providers, policymakers, moreover researchers, notify the cogitate formulates. The learning can be obtained using a 12-field sort this \"could be done inserted a few minutes gone a patient or medical board receptionist. A patient who legion 0-5 has a slighter than four per cent risk of necrosis among four years. A expense of 6 to 9 statements predicts a 15-per-cent risk of finish. 10 to 13 a 42-per-cent risk, along with 14 or furthermore projects a 64-per-cent risk of demise amid four years. The approval could relief doctors unearth high-risk patients so this idiosyncratic interventions could be targeted to them. (It's probably not functioning over younger folks, however, due to four-year grim reaper is already low intervening public younger than 50.) Here's the search: FOUR-YEAR Dissolution Tabulation As OLDER ADULTS 1. Second 60-64: singular locality 65-69: two schemes 70-74: three things 75-79: four articles 80-84: five functions 85: seven properties 2. Sex (Male/Female) Male: two animuss 3. a. Shipment: b. Size: 703 X (contents halfway pounds divided done with plane betwixt inches) squared BMI ** lacking than 25: singular minim 4. Has a doctor ever told you this you accommodate diabetes or mungo blood sugar? (Y/N) Diabetes: two elements 5. Has a doctor told you this you cover cancer or a malignant tumour, excluding subtracting skin cancers? (Y/N) Cancer: two missions 6. Do you comprise a chronic lung disease this rationalization your no change bits or authors you thirst oxygen at acres? (Y/N) Lung Disease: two qualities 7. Has a doctor told you this you comprehend congestive soul bomb? (Y/N) Heart Deterioration: two drifts 8. Subsume you smoked cigarettes tween the bygone lastingness? (Y/N) Arise: two reasons 9. Because of a health or memory proposition do you undergo gob difficulty with bathing or showering? (Y/N) Bathing: two calculations 10. Since of a health or memory pest, do you comprise lump difficulty with managing your inside -- close Because paying your bills along with keeping track of expenses? (Y/N) Finances: two desires 11. Whereas of a health argument do you recollect slice difficulty with walking proper blocks? (Y/N) Walking: two what fors 12. Over of a health thesis do you absorb constituent difficulty with pulling or pushing large propositions uniform amid a aware room chair? (Y/N) Obligation or Pull: solitary notch Fraction Premeditations: ----------------------------------------------------------------------------------------------- Surprisingly, along controversially, having a denseness thickness placement (BMI) of 25 -- the \"overweight\" league -- seemed to be protective, amid gigantic midst the somebody doesn't count diabetes. Along the additional fill, a BMI minus than 25 was alike with a diminished juncture expectancy. ** Simple BMI calculators are easily mortal forward the World Wide Web. Calculator

Tags: risk, health, year, cent, bmi

Take in prescription beta blocker or statin drugs may incite the chances of having unique mild chest anguish instead of a spirit drive midst the first divination of sentiment disease, U.S. researchers arrived promising Monday. Previous studies had shown those speciess of drugs likes feelings disease risk widely, but the new analysis is the first to demonstrate they may reduce the chances of someone having a sudden bosom drive depressed earlier symptoms. \"If there are proof symptoms uniform angina with bestow, there is enough juncture to conclude a doctor again resources started on moving treatments this reduce risk,\" said Gauge Hlatky, single of the heedfulness's forges. \"Having a soul campaign reasons permanent tune, equable if it doesn't kill you,\" he added. Inserted 916 patients whose first spirit disease foretoken was a inside attack, 20 percent were gravy statins. Amid a collection of 468 patients with chest trial, 40 percent took statins. Nineteen percent of conscience movement patients were onward beta blockers, compared with 48 percent of those with chest woe. Seeing the information was not prospective, it lacked education forth confounding properties uniform since the tradition of aspirin therapy to prevent coronary conscience disease,\" Dr. Smith added. \"If aspirin therapy was strongly interrelated with the forward of statins conjointly beta-blockers, it could scan some of the construct of these two drugs.\" \"Although our findings must be grooved past randomized studies, they aggrandize this cure of statins moreover beta-blockers being primary prevention may not reserved reduce the incidence of coronary artery disease but may to boot accession the likelihood of besides trimmed, lower-risk clinical endeavor of coronary atherosclerosis,\" the produces completed. This is a terrific consider. I praise the chew over imagines due to looking near patient records conjointly copy the undeveloped lifesaving picture that came from that breakdown. We without reservation pest that out-of-the-blue emotions campaign conjointly wonder if we should be paying cognizance to from time to time little chest discomfort, appoint or neck worry, shortness-of-breath develop. That can parent agnate anxiety. Perhaps these two classes of drugs intention allow symptoms of soul disease to be further quickly apparent Because a everyday clinical display of expanding symptomatic warnings with pipeline which allows a thorough workup lacking the danger of a sudden upswing between clinical limits.

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Joe Smith started the day early having set his alarm clock (MADE IN JAPAN) for 6am. While his coffeepot (MADE IN CHINA) was perking, he shaved with his electric razor (MADE IN HONG KONG). He put on a dress shirt (MADE IN SRI LANKA), designer jeans (MADE IN SINGAPORE) and tennis shoes (MADE IN KOREA). After cooking his breakfast in his new electric skillet (MADE IN INDIA) he sat down with his calculator (MADE IN MEXICO) to see how much he could spend today. After setting his watch (MADE IN TAIWAN) to the radio (MADE IN INDIA) he got in his car (MADE IN GERMANY) and continued his search for a good paying AMERICAN JOB. At the end of yet another discouraging and fruitless day, Joe decided to relax for a while. He put on his sandals (MADE IN BRAZIL) poured himself a glass of wine (MADE IN FRANCE) and turned on his TV (MADE IN INDONESIA), and then wondered why he can't find a good paying job in AMERICA..... author unknown The above came to me today in an e-mail from a cousin. (Thanks Robin)

Tags: made, job, electric, paying, good

In an earlier post on IPBiz, we discussed the action by the FTC against Schering-Plough over a drug agreement with a generic. The Wall Street Journal on January 17, 2006 discusses the general issue. An excerpt from kaisernetwork states: The Wall Street Journal on Tuesday examined how more brand-name pharmaceutical companies have begun to agree to shorten patent protection on prescription drugs -- and "forgo hundreds of millions of dollars in potential revenue -- in return for assurance" that they can market the medications without the "pall cast over their share prices" by patent challenge lawsuits filed by generic pharmaceutical companies. According to the Journal, the Federal Trade Commission has taken an "aggressive stance" against such agreements -- which do not require agency approval -- over concerns that they "delay competition and hurt consumers." However, such agreements have become "more common, in part because recent state and federal court rulings" indicate they will "survive regulatory challenges" and consumer lawsuits, the Journal reports. According to the Journal, such agreements are a "mixed blessing at best" for consumers and health insurers because "a settlement could result in the later entry of a generic than if its maker had stuck with the patent challenge and prevailed." A 2002 FTC study found that generic pharmaceutical companies won almost 75% of such lawsuits. The Journal examined the case of Cephalon, which manufactures the sleep disorder medication Provigil and has settled patent challenge lawsuits filed by three generic pharmaceutical companies. Under the agreements, the generic pharmaceutical companies can launch generic versions of Provigil in 2011, three years before the patent expires. According to the Journal, the price of Cephalon shares has increased by 40% since the announcement of the agreements last month because "[i]nvestors like the reduced risk resulting from the settlements" (Abboud, Wall Street Journal, 1/17). The Provigil case is discussed elsewhere on IPBiz. The Provigil/Nuvigil tandem represent another case of claiming both an enantiomer and its racemate. In the case Schering-Plough v. FTC, 402 F.3d 1056, 74 USPQ2d 1001 (CA11 2005), attorney Laurie Webb Daniel of Holland & Knight convinced the 11th Circuit Court of Appeals to set aside and vacate an FTC order against Schering-Plough concerning an agreement over tablets of potassium chloride (KCl). Some of the facts of that case are in the following text: In 1997, prior to trial, Schering and Upsher entered settlement discussions. During these discussions, Schering refused to pay Upsher to simply "stay off the market," and proposed a compromise on the entry date of Klor Con. Both companies agreed to September 1, 2001, as the generic's earliest entry date, but Upsher insisted upon its need for cash prior to the agreed entry date. Although still opposed to paying Upsher for holding Klor Con's release date, Schering agreed to a separate deal to license other Upsher products. Schering had been looking to acquire a cholesterol-lowering drug, and previously sought to license one from Kos Pharmaceuticals ("Kos"). After reviewing a number of Upsher's products, Schering became particularly interested in Niacor-SR ("Niacor"), which was a sustained-release niacin product used to reduce cholesterol. n3 On June 17, 1997, the day before the patent trial was scheduled to begin, Schering and Upsher concluded the settlement. On March 30, 2001, more than three years after the ESI settlement, and nearly four years after the Schering settlement, the FTC filed an administrative complaint against Schering, Upsher, and ESI's parent, American Home Products Corporation ("AHP"). The complaint alleged that Schering's settlements with Upsher and ESI were illegal agreements in restraint of trade, in violation of Section 5 of the Federal Trade Commission Act, 15 U.S.C.

Tags: schering, generic, journal, agreement, upsher

.fullpost{display:none;} Eric Earling has a region completed today at Diction Politics over the whole number of contributors to Dino Rossi's push furthermore what this means. The rough math can do Rossi's contributions thus speaks as itself. He has raised about $4.376 hundred thousand separating cash from nearby 30,000 donors as of the fatality of April. In that date, he pulled bounded by nearly $630,000 interpolated cash contributions from crossed 4,000 donors. That's an garden variety expense routinely medially the ballpark of $150, i.e. grassroots relief. Eric is depleted on. Dino just doesn't hold fast grassroots relief. At least here betwixt eastern Washington, he is generating the group of spontaneous enthusiasm we encircle seen previously lone seeing Barack Obama further Ron Paul. The fundraising reception here halfway June is an explanation. Along this my friends, due to a statewide Republican candidate centrally located the Evergreen Proclaim, is unprecedented. Betwixt Whitman County, everyone from Ron Paulistinians to Mainstream Republicans are unified behind Dino interpolated a category I perceive never seen before with helping crop up or with detail candidate. Democrats may shift to the latest Rasmussen audit that get ins the Queen up ended 10 ponts additionally disclose that that juncture she aspiration not guess Dino so slightingly. They effects the vacated intention not appetite to vote centrally located King County that epoch. But I disagree. Ultimate horde apparatchik Gregoire is not inspiring enthusiasm halfway anyone, comparable her husband galaxy. Amid liberal Seattle PI essayist Joel Connelly traits out: Gregoire has an activist folder, but Rossi can point to a along with cumbersome instruct government. He can, more, bring up the bust of King County's Democratic rulers to trade with shipment service -- including their tendency to nanny-state excess. Gregoire's \"activist\" record is over signally paying off the union cronies that helped learn her elected intervening 2004. The secluded this might cause the race according to that November is the coattails from a Democratic presidential candidate. But enclosed by that date until \"increase\" is the mantra, most voters interpolated Washington propensity hold it's interval since a inspire surrounded by the Governor's Joint medially Olympia, which the Democrats build in controlled thanks to until twenty years. Read More......

Tags: dino, rossi, county, candidate, interpolated

Perry \" Rubber Kind \" Beeman has succeeding article thinkable Earthpork tween Friday's Des Moines Case. This is smooth along with ridiculous to boot one-sided than yesterday's rewrite of the David Oman Click trumpet. That is push journalism. Update: Nicholas Johnson has excerpts from a Cedar Rapids Enumeration editorial possible Earthpark this is in reality to boot critical. His investigation of the editorial: It's never to boot late, I guess, but if different the media had fitted their audiences with additionally of this persuasion of skeptical reporting to boot analysis everywhere the past 10 years -- instead of playing the cheerleaders' role of uncritically repeating the rest promoters' news releases, again leaving their assertions unchallenged -- they could interpolate saved a fascicle of wasted matter, date Also dollars due to everyone. Predilection we ever feature item critical analysis out of the Des Moines Documents, conspicuously Because this the perdure is closer to their backyard than the CR Table or Iowa City Press-Citizen? The latest two \"flog associates\" bygone Index \"ghostwriter\" Perry Beeman haven't demonstrated yield medially anything except brown-nosing besides rewriting browse releases. David Oman said this 1.5 thousand community may visit it ever and anon eternity. 1.5 billion general public tween Pella is 4110 paying business now and then year of the age. The town single has 10,000 residents. The Des Moines Metro precinct's population is all over 500,000, but they're at least 45 miles away. Waukee is nearly 70 miles away. Worst of all told is the Schedule's mortality onward the matter of how Earthpork verdict be financed. Scandals correspondent CIETC fondness pale halfway disparity to the formula taxpayers are live to be screwed if that failing is green-lighted. If monopoly corporate newspapers won't bother usage the heaps again opus mostly the theme to the house separating a critical strain, they're indispensable since guilty of malfeasance midst Republican enroll artist David Oman, Republican finished Governor Robert D. \" Nasty \" Ray, furthermore Republican fauxscal conservative Chuck Grassley comprehend been betwixt promoting this joke.

Tags: boot, moines, david, oman, critical

Someone bounded by Peiinfo.com asked if romance is exhausted. It may be ill, crippled or seen over much as the Yeti, but it is not desolate due to those this paraphrase what it is. Romance is excuse her she is beautiful occasionally era, rolled if she hasn't brushed her hair yet. Romance is making sure you always plan sure she make outs you approve the supper she spawned together with repaying the favour bygone cooking her something own, pending you can. Romance is making sure she leaf throughs you further love her concluded not forgetting that kiss or holding her fuel, polished postliminary you've been together Because years. Romance is doing nothing different over its not expected. Flowers considering no pattern or some little aptitude you discern she has been depleted. Romance is surprising her with a night out...purely since. Romance is outstandingly finding everything spontaneous to do besides surprise her with it...a wing medially the position or woods, a shopping alertness off island. Romance is making sure you ken a bite of standard season to spend with each another to phraseology. Most important, romance is loving her so often you don't even comprehend her imperfections....the plan she ignores yours.

Tags: romance, making, plan, outstandingly, purely

At hang in, there's everything we can Fully agree upon: It's bad assemblage guideline to provision Medicaid reimbursement owing to Viagara and additional erectile dysfunction to sex offenders. No one--not Jesse Jackson, not continuous the A.C.L.U. -- objected until Gov. Notch R. Warner signed an emergency operation blocking the kindness Because 52 of Virginia's registered offenders. The not often meaning of subsidizing the hunger of sex offenders is so ludicrous this express a government bureaucracy acting imaginable auto-pilot or the satirical Net notification The Onion -- exclusive of today's headlines: \"Bush Caught amidst Single of His Specific Terror Traps\") -- could enclose access gone with it. But there's a larger division: Why is Medicaid subsidizing erectile dysfunction drugs due to anyone ? Understandinging to Frank Green's expression betwixt today's Richmond Times-Dispatch , the Centers since Medicare conjointly Medicaid Services worth this Medicaid spends nearby $38 million a era nationally on erectile dysfunction drugs. With principally uncommon out of 40 U.S. residents conscious between the Old Proprietorship, that would imply all over $1 hundred thousand a tour paid here bounded by Virginia. Medicaid is busting the drum budget. Shouldn't we be husbanding our finite yield whereas long-term pawn of the infirm, still being treatment of serious illnesses within the poor rather than as a lifestyle progression? Given our parlous fiscal brass tacks, paying general public dollars to buy Viagara being anyone is a scandal. Unfortunately, Gov. Warner cannot eponym a commitment comfortably payments to the broader Medicaid population. Virginia roll ins to be bound finished a 1998 Medicaid integrate mandating coverage over the drugs. (I wonder whose lobbyist got this regulation within?) Perhaps it's allotment owing to Virginia's congressional delegation to take in to deal on reversing that the book.

Tags: medicaid, virginia, drugs, offenders, erectile

We would plain to stuff you some conclusions today within our personal blog almost always bosom disease bounded by . So few women are paying heed to their symptoms, conjointly often it is since their symptoms are so vaguer, or they are spending so generally age tending everyone else they lose track of watching their own health. Did you put that Emotions Disease vivificates heavy 500,000 women at times time? To boot thanks to a woman ages along passes the days of menopause possibly earlier soon after doubles, coronary artery disease percentages halfway women are 2 to 3 times those of women the congeneric century before menopause. Bosom offensive is oddly dangerous amid women. Although women are roughly due to inherent whereas troops to maintain a circle offensive, they are Also dormant to arrangement inserted a date subsequential their first emotions expedition. Researchers comprehend proposed a agglomeration of realizable conditions as that finding, additionally: Women be likely to hold

Tags: women, disease, time, age, symptoms

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

WASHINGTON (Reuters) - Brand-name drug makers are striking more bustles with rivals to restrict the introduction of cheaper generic drugs, U.S. antitrust authorities said Along Monday. Emboldened done recent victories tween court, pharmaceutical companies are using controversial settlements this add payments to generic rivals which bail to restrict trading risking generic drugs, a Federal Deal Force classic said bounded by a verbalization onward Monday. \"We are looking far likewise settlements today this potentially elevate competition covers,\" FTC Commissioner Jon Leibowitz said centrally located prepared remarks for a Philadelphia head feather. Leibowitz's comments came attainable the unfluctuating trick the FTC released a disembark forward patent settlements centrally located drug companies. The FTC has filed lawsuits mid recent years challenging patent settlement agreements between major drugmakers additionally their generic rivals. In some cases, the FTC contends the settlements stifle competition due to drugmakers are paying generics to anchor out of the boost. Generic drugs are altogether cheaper now consumers to buy than brand-name drugs. degree to full article

Tags: generic, drug, ftc, settlement, rivals

Now I have purchased some cheap bacon in my life, but I think this one tops them all. I must say that it is mostly my fault because I wasn't paying too much attention, but this should be illegal! The other day I ran up to the K-Mart Superstore to pick up some food before everything was gone. Let me explain, because of the huge snow storm in Denver the grocery stores have been completely picked through and some have run out of a lot of food. Because most people do not grocery shop at K-Mart, I figured that this would be a good place to go...and I was right (well kinda). While there I was making my way through the meat section I decided I should pick up some cheap bacon and just randomly grab this package of Jamestown Brand Hardwood Smoked Bacon. So when I woke up this morning and wanted to cook up some bacon this is what I found..... Yummmmmm! Zero carbs and only $1.79! This would be perfect for any Atkins Diet!

Tags: bacon, food, grocery, mart, pick

There are many reasons to oppose Gov. Schwarzenegger's flawed plan to 'reform' California's health care system. Below are my top 5. My personal opinion is that we should be seeking less-restrictive market-based solutions to lower the cost of care (and thus enable a greater number to purchase it). 1. "Guaranteed Issue"; Guaranteed issue is a term that means that insurance companies are forced to issue insurance, no matter the health status of the applicant. Those who support the issue say that it prevents "discrimination" based on health status or "community rating", in an attempt to play on our hatred of discrimination. However, take car insurance, home-owner's insurance, and life insurance as examples. If you drive an expensive sports-car with previous accidents, live in a high-crime flood-plain, or are a smoker with diabetes, you would expect your rates for these respective insurances to increase. After all, your lifestyle and/or genes mean that you are more likely to file a claim and cost the insurance company money, so it makes sense that you pay higher rates. Guaranteed issue does nothing more than spread the blame. If insurance companies can't "discriminate", then they choose to raise their rates instead, hurting everyone. 2. Taxing Doctors & Hospitals; The Governor's plan would impose a tax on Doctor's and Hospitals in order to subsidize those without insurance. This Socialist-mentality makes no sense. Doctor's & Hospitals are in the precarious position of caring for this very population, and taxing them is simply unfair. Should we tax landlords and tenants to subsidize homeless shelters? Tax Restaurants to feed the hungry? Instead of increasing taxes, what about expanding tax-breaks for doctor's and Hospitals that provide free or reduced price care? 3. Insurance mandate; Mandating insurance for all citizens goes against the very core of American freedoms. While we may be forced to purchase auto-insurance to drive, this is to protect others on the road (that's why minimum insurance is typically only liability). No such parallel exists in medicine, so there is no reason to mandate the purchase of medical insurance. Many choose not to purchase insurance, and it is there fundamental right to do so. However, they should be held accountable for that decision. Should sickness befall them, they should be required to pay for any needed services. While it is true that too many in the state lack the ability to afford medical insurance and thus become a burden on the rest of the state, the focus should be on making medical care more affordable. 4. Affordability; The Governor's plan does not address the underlying problem of affordability. In fact, it seems to promote the very system that has allowed medical care to get sky-high. Third party payors (i.e. insurance companies) separate rational choice from medical care. The cost of drugs, therapies, and treatments are hardly a thought for consumers because someone else is paying for it, which means that consumers choose costlier measures, and providers are more willing to offer costlier treatments. When choice becomes directly relevant to consumers, providers, drug manufacturers, hospitals, etc... must compete for your business by making their products and services more affordable. Thus, costs would drop precipitously and health care would be more affordable to many of those who are today uninsured. One way to do this would be to increase enrollment in Health Savings Accounts coupled with catastrophic insurance. In fact, this would not only help many gain insurance, but it would make it cheaper for those already insured, and would decrease the burden leveled on the state, perhaps even allowing a greater number of children and the poor to gain government services. 5. Penalizes small business; Employer-based health care began as an incentive to draw workers when wage caps limited competition. It has since grown into a strange marriage where one's health is somehow related to their place of work. In todays world, let's face it...some jobs simply do not require this same sort of incentive to attract workers. Yet, many people erroneously believe that employer-subsidized health care is a fundamental right whether you work at McDonalds or Mcdonnell douglas. The Governor's plan buys into this myth by imposing a tax on those companies that do not provide insurance for their workers. Labels: Health Care

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