There was this little tidbit, too:


I worry about gene migration by introducing all these not-native-to-humans viruses into the food chain on a large scale, even more so now that the gentically-engineered parts of genetically-engineered plants have been getting loose into unrelated species.

There's always irradiation.

That worries me as well. Big corporations are playing with genes not just to help humanity, but to make crops with bigger profit margins and proprietary rights they can use to keep the profits for themselves. The overuse of antibiotics is bad enough, now they may pollute our very genes.

And now for the good news
Progress is being made in the fight against AIDS in Africa, thanks in no small part to the president's aid program. But that's not what some people want to hear.



By John Donnelly | August 20, 2006

FIVE YEARS AGO, in Jos, Nigeria, a city on the country's central plateau, Dr. John Idoko regularly made rounds in a hospital packed with people dying from AIDS because they couldn't pay for the antiretroviral drugs necessary to keep them alive. Three years ago, as the price of the drugs plummeted, the Nigerian doctor was able to deliver the life-extending medication to 700 patients-until his government's supply ran out for several months.

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Today, the change for the better is astonishing: Idoko now treats nearly 6,000 HIV-positive patients. He has expanded his clinic three times in five years, and his waiting room once again is too crowded. ``Now, we are eyeing an abandoned building nearby," he said last week, chuckling.

The major reason for Idoko's success is the Bush administration's AIDS program, which in the last three years has sent billions of dollars to Africa and helped save the lives of hundreds of thousands of people. When I moved to Africa three years ago, the President's Emergency Plan for AIDS Relief, or PEPFAR, was just getting off the ground. As I return to Washington this month, the $15 billion program is just hitting its stride, and many Africans believe it has become the single most effective initiative in fighting the deadly scourge.

Idoko said.

Only you wouldn't know it in America-or Canada, or Europe, for that matter-given the tenor of the AIDS debate in Washington and the nature of the international media coverage.
That debate was on full view last week at the International AIDS Conference in Toronto, which ended Thursday. While the AIDS epidemic in Africa is as urgent a crisis as it ever was-an estimated 24 million are infected on the continent and as many as 2 million died last year from AIDS-related illnesses-there are now at least some hopeful signs, though few activists in Toronto wanted to give the United States any of the credit. Indeed, the politically polarized bickering, according to those in Washington AIDS policy circles, could have effects far beyond the Beltway, threatening to impede national and international funding for AIDS programs.

. . .

One telling moment in Toronto came last Sunday when Bill Gates, whose foundation has spent billions on global health in recent years, praised PEPFAR, prompting a chorus of boos from the audience. Earlier, Stephen Lewis, the passionate United Nations special envoy on AIDS in Africa, said that the Bush administration's push for abstinence programs as part of its ABC policy-which calls for abstinence until marriage, being faithful to one's partner, and failing that, using condoms-amounts to ``incipient neocolonialism."

For three years, a wide range of AIDS activists, including Lewis, have been hammering at what they perceive as faults of the US AIDS program, creating the perception that the program is riddled with trouble. They have criticized the administration for funneling its billions into PEPFAR rather than the Global Fund to Fight AIDS, Tuberculosis, and Malaria, another new initiative based in Geneva. They have claimed that the US-funded treatment programs were moving far too slowly. They have questioned the wisdom of the US preference for funding faith-based groups, and have complained that Congress's mandate to spend one-third of all money targeted for prevention on abstinence programs is excessive and counterproductive.

Click Here to continue

Yes, yes it is. But I give credit to Bush for the 2/3 of the money that is spent on drugs and condom education.

Cancer Breakthrough Reported

Government scientists saved two men dying of melanoma by genetically altering their own white blood cells to attack their tumors -- deemed the first major success in battling cancer with gene therapy.
Though the men appear disease-free almost two years after the experimental therapy, it wasn't a panacea. Fifteen other melanoma victims weren't helped. The National Cancer Institute is trying to strengthen the shots.
Still, specialists proclaimed the work, published today by the journal Science, an important advance -- gene therapy with the potential to fight cancer's worst stage, when it has spread through the body. The NCI hopes to begin testing it soon against cancers more common than melanoma, such as advanced breast or colon cancer.
Doctors can't predict how the two men will fare long-term. Melanoma, the most aggressive skin cancer and killer of almost 8,000 Americans annually, is notorious for returning years after patients think they've subdued it.
"I'm cured for now," is how a grateful Mark Origer, 53, of Watertown, Wis., put it after a checkup from NCI doctors this week.
The approach remains highly experimental, requiring years of additional research.
"Clearly this is a first step," cautioned Dr. Len Lichtenfeld of the American Cancer Society. "We have to be very cautious about not raising hopes too much."
Nevertheless, "it is exciting," he added. "It certainly is a proof of [the] concept that this approach will work."
"It's one of the first documented, effective cases of cancer gene therapy working," added Dr. Patrick Hwu, melanoma chairman at the University of Texas M.D. Anderson Cancer Center, who once worked with the NCI team.
The NCI's Dr. Steven Rosenberg has long led the tantalizing research field of how the body's immune system might be harnessed to fight cancer. White blood cells called T-lymphocytes hunt down germs and other foreign tissue. Unfortunately, cancerous cells look a lot like healthy cells, making it hard for those T-cells to spot a problem.
By 2002, Dr. Rosenberg had made a breakthrough when he found small numbers of cancer-fighting T-cells inside some patients with advanced melanoma. He literally pulled those cells out of their blood and grew billions more of them in laboratory dishes, enough to have a chance at overwhelming a tumor. By suppressing the patients' normal immune system to make room for the extra T-cells and then pumping them into the patients´ bodies, about half significantly improve.
Few melanoma patients make enough cancer-fighting T-cells naturally for scientists to cull any from their bloodstream, and T-cells that attack more common cancers are virtually impossible to find, so Dr. Rosenberg and colleagues set out to create tumor fighters from scratch.
The scientists took normal lymphocytes -- ones that don't recognize cancer -- out of 17 patients with advanced melanoma who had exhausted their treatment options. In the lab, they infected those cells with a virus carrying genes that create T-cell receptors, essentially homing devices for, in this case, melanoma. (Different genes create receptors for other cancers.)
"We can take a normal cell from you or me or any patient and ... convert that cell into a cell that recognizes the cancer," Dr. Rosenberg explained.
In 15 of the patients, the reinfused, newly armed cells took root and grew at low levels for a few months, but Mr. Origer and a second patient grew superhigh T-cell levels for more than a year as their tumors gradually faded.
"It's not like chemotherapy or radiation, where as soon as you're done, you're done," said Dr. Rosenberg, who is modifying the treatment to root better in more patients. "We're giving living cells, which continue to grow and function in the body."
Mr. Origer had hoped just to survive for his daughter's wedding when he was treated in December 2004. A month later, he recalls, NCI doctors broke into wide grins as they saw his tumors already shrinking. By the time Mr. Origer walked his daughter down the aisle last fall, only a small cancerous spot remained visible in his liver. Surgeons later removed that spot.
"I know how fortunate I am to have gone through this and responded to this. Not everybody's that lucky," he said in an interview.

http://www.washingtontimes.com/functions/p...31-010615-5533r

Alright now. Finally, a party I can join. "incipient neocolonialism."


INCIPIENT NEO-COLONIALISTS UNITE!!!!

New TB strain detected in South Africa


London - A new, deadly strain of tuberculosis has killed 52 of 53 people infected in the last year in South Africa, the World Health Organisation said on Friday, calling for improved measures to treat and diagnose the bacteria.

The strain was discovered in Kwazulu-Natal, and is classified as extremely drug-resistant. Drugs from three of the six second-line medicines, used as a last line of defence against TB, proved useless against the new strain.

"We are extremely worried about the issue of extreme drug resistance," said Paul Nunn, coordinator of the WHO's drug resistance department. "If countries don't have the diagnostic capacity to find these patients, they will die without proper treatment."

Though even the most drug-resistant strains of TB have proven to be treatable with three classes of drugs, those drugs are more expensive and are toxic to the human body.

The WHO and its partners, including the US Centres for Disease Control and Prevention, planned a two-day meeting next week in South Africa to discuss the new TB strain in Africa and better ways to diagnose and treat it, Nunn said.

Tuberculosis is a respiratory illness spread by coughing and sneezing. Nearly 2 billion people worldwide are thought to be infected.

High mortality rates among TB patients in South Africa, however, prompted medical researchers to survey the cases, and ultimately to find the new strain.

Drug resistance is a common problem in TB treatment, but the new strain appears particularly virulent: 52 of the 53 patients infected all died within about three weeks of being tested for drug resistance.

Tuberculosis bacteria

"Genetic processes are constantly throwing up mutations of tuberculosis viruses, so this may have arisen due to some particular quirk of the environment or the way they were treated or their genetic background," said Paul Fine, a professor of communicable diseases at the London School of Hygiene and Tropical Medicine.

In general, drug-resistant viruses are not as easily transmitted as those that are drug-sensitive.

Worldwide, about 2% of TB cases are classified as being extremely drug-resistant. Little information is available on extreme drug resistance in Africa, but it is believed to be increasing.

The high prevalence of HIV/AIDS in Africa also complicates the issue of treating extremely drug-resistant TB.

"It's urgent to make the diagnosis when HIV is involved, because if you don't make it, the combination of HIV and TB will kill," Nunn said

http://www.news24.com/News24/South_Africa/...1992229,00.html

Australian scientists begin human tests on 'bionic eye'
Sep 02 8:23 PM US/Eastern





Australian researchers developing a "bionic eye" say early tests have succeeded in stimulating limited visual sensation in people suffering a rare form of genetic blindness.

Scientists from the Bionic Eye Foundation at Sydney's Prince of Wales Hospital have launched human clinical trials of the device, which employs the same technology now routinely used in cochlear implants to restore hearing.


Professor Minas Coroneo said the trials involved placing small electrodes on the surface of the eye then using an electric current to stimulate the retina, the thin layer of cells in the back of the eye that respond to light.

Coroneo said a video camera attached to a pair of glasses was used to pick up images and transfer them to the electrodes via a computer.

The electrodes then stimulate the retina to send messages down the optic nerve to the visual area of the brain.

While it does not offer full sight, Coroneo said it could one day provide blind people with enough "functional vision" to negotiate their way across a room without bumping into objects.

"The patient will see a pattern of flashes that will outline objects," he told AFP.

"The aim is getting seeing-eye dogs back to being just pets."

The stimulation achieved so far is extremely limited, but researcher Vivek Chowdhury said it was enough to spark a tearful response from his first successful patient when she saw a single spot of light after years of darkness.

"It's a combination of excitement and surprise and shock, it's quite scary to be seeing these things that they haven't seen before," Chowdhury told ABC television.

Coroneo said the prototype bionic eye was a low-risk device for patients because it sat on the eye's surface and did not require invasive surgery.

He said it was an exciting development for people suffering conditions such as retinitis pigmentosa, an irreversible genetic condition where the retina's cells gradually die but the optic nerve survives.

The researchers are also developing a second type of bionic eye that involves electrodes implanted directly onto the brain's visual area, meaning it could help patients whose optic nerve has been destroyed.

http://www.breitbart.com/news/2006/09/02/0...6.xuonso2v.html


What a wonderful breakthrough!

Wal-Mart to Sell Generic Drugs for $4


Sep 21, 10:38 AM (ET)

By ANNE D'INNOCENZIO

TAMPA, Fla. (AP) - Wal-Mart announced today that it will start a test program in Florida, where it will sell generic prescription drugs for $4 for a 30-day supply. The test will start tomorrow in 65 Tampa Bay-area stores and is to expand to the whole state by January.

In a statement, CEO Lee Scott says the world's largest retailer intends to "take the program to as many states as possible next year."

On average, generic drugs tend to cost between $10 and $30 for a month-long supply.

The world's biggest retailer said that it will test the program in Florida that will make 291 generic drugs available, which are used to treat a variety of condition from allergies to high-blood pressure. It will also be available to the uninsured.

The program will be launched on Friday at 65 Wal-Mart, Neighborhood Market and Sams' Club pharmacies in the Tampa Bay area in Florida and will be expanded to the entire state in January.

The company said it plans to take the program to as many states as possible next year.

"Each day in our pharmacies we see customers struggle with the cost of prescription drugs," said Wal-Mart CEO H. Lee Scott, Jr., in a statement. "By cutting the cost of many generics to $4, we are helping to ensure that our customers and associates get the medicines they need at a price they can afford."

The initiative would be the fourth time since last October that Wal-Mart has moved to improve health benefits.

Wal-Mart's recent moves to improve its health care plan include relaxing eligibility requirements for its part-time employees who want health insurance, and extending coverage for the first time to the children of those employees. Part-time employees, who had to work for Wal-Mart for two years to qualify, now have to work at the company for one year. This year, Wal-Mart also expanded a trial run of in-store clinics, aimed at providing lower cost non-emergency health care to the public.

Last October, Wal-Mart offered a new lower-premium insurance aimed at getting more of its work force on company plans.

But critics argue that Wal-Mart's coverage calls for a deductible that requires workers to pick up the first $1,000 in medical expenses, and the deductible rises to a maximum of $3,000 for families.

Union-backed Wake Up Wal-Mart, one of its most vociferous critics, have called upon Bentonville, Ark.-based Wal-Mart to offer better health care coverage and higher pay to employees.

Critics contend that the company's benefits are too stingy, forcing taxpayers to absorb more of the cost as the workers lacking coverage turn to state-funded health care programs.

This past summer, Wal-Mart won a successful fight against a first-of-its-kind state law that would have required the retailer to spend more on employee health care in Maryland. A federal judge ruled in July that it was invalid under federal law. But other states are considering similar legislation aimed at the company.

I heard about it on the radio. Sounds a bit like they're looking for good PR, but that works out well for everyone.

I did notice on the WalMart ad they tout how cheap their medical insurance is for QUALIFIED employees, but my bet is a lot of people don't qualify.

The Slippery Slope

Assisted Suicide: It's Not Just For The Ill Anymore



Over the last decade, Americans have debated whether to legalize certain forms of assisted suicide. Proponents focus on the terminally ill, those people whose prognoses hold no hope whatsoever for recovery, pain-free living, and dignity in their last days. Opponents have warned of slippery slopes and speculated that social acceptance of the act would lead to expanded use.

The Times of London reports that Switzerland has proven the slippery-slope argument. Dignitas, a Swiss right-to-die organization, has announced that it will press legislators to allow the chronically depressed to choose assisted suicide as a permanent cure:

BRITONS suffering from depression could soon be legally helped to die in Switzerland if a test case in the country’s Supreme Court is successful next month.

Ludwig Minelli, the founder of Dignitas, the Zurich-based organisation that has helped 54 Britons to die, revealed yesterday that his group was seeking to overturn the Swiss law that allows them to assist only people with a terminal illness.

In his first visit to the country since setting up Dignitas, the lawyer blamed religion for stigmatising suicide, attacking this “stupid ecclesiastical superstition” and said that he believed assisted suicide should be open to everyone.

“We should see in principle suicide as a marvellous possibility given to human beings because they have a conscience . . . If you accept the idea of personal autonomy, you can’t make conditions that only terminally ill people should have this right,” he told a fringe meeting at the Liberal Democrat conference in Brighton.

“We should accept generally the right of a human being to say, ‘Right, I would like to end my life’, without any pre-condition, as long as this person has capacity of discernment.”

Those of us who opposed assisted suicide for precisely this reason will soon get the opportunity to say "we told you so". This organization wants to turn suicide into an industry, apparently akin to abortion. Just as with the gateway arguments about life-and-death decisions for killing a fetus led to laws and court decisions creating a right to abortion on demand for any reason, assisted suicide is now being cast as a "choice" that only "stupid ecclesiastical superstition" would oppose.

Human society developed limits on actions over millenia for reasons tied to the survival of the society. In the case of suicide, most civiliations understand this as a blow to the community, not just the family, and those "superstitions" existed to ensure that human life could sustain itself. At the heart of the issue, it springs from the value of human life and its sacred nature. When societies stopped believing in those concepts, life became just another commodity measured on its convenience to those around it.

The effort by Dignitas seems especially cruel. The chronically depressed need treatment, not an easy way to deliver what they often attempt without assistance. Freeing them from societal constraints against taking their own lives will certainly put a lot of money into the pockets of clinic owners. It will also allow men and women to end treatment that could eventually make them whole and healthy -- or avoid trying treatment at all.

It would devalue humanity and human life to that of a throwaway consumer product.

We have been down this road before. Those of us who believe in the spiritual value of human life have predicted this development for some time. Eventually the limits our ancestors applied in their wisdom will disappear, and assisted suicides will start claiming hundreds, then thousands, then tens of thousands each year as we are scolded to respect a person's "right to choose". And then what happens? When the government keeps increasing health-care benefits to its citizens, when does it start to take the decision for "suicide" out of the hands of the chronically depressed and impose it upon them, using the excuse of non compus mentis?
Source

Depressed people ought to be physically able to off themselves.

What about assistance? Should they have that?

They shouldn't need it.

What makes you think that they aren't already doing it?

Anyone that commits suicide would have to be really depressed.

In fact, suicidal thoughts (ideation) are a symtom of severe depression. It's strange to think that an imbalance in brain chemistry can cause specific thoughts, but it does.

Yes... and aren't rational enough to make that decision.

Glad that it wasn't CHOCOLATE!

I wouldn't think they'd be happy about it...unless they've been brainwashed like the suicide bombers.

My aunt's husband had a severe crippling condition - irreversible and progressively getting worse. He was a proud man who had made his own way all his life. He talked to my aunt about a time that would come when he would decide that he didn't want to go on anymore and she understood what he was saying. She didn't know when that time would be, but she knew it was coming - that it was his decision and he would handle it his own way - ON HIS OWN, HIS OWN WAY, not involving anyone else. One afternoon, after some of his family had visited and left, he went out into the back yard and my aunt heard the sound that would haunt her forever. He had shot himself. Of course, he had been sad, and frustrated over his condition, but his mind was clear and sound. He knew how he wanted to end his life and he did it.

I don't think anyone has a RIGHT to ask someone to assist them in their suicide. And I don't think assisted suicide should have ever been made legal in Oregon. It shouldn't be legal anywhere, IMO. And I'm not talking about restricting pain medication. I've seen people die from cancer and they were giving ample medication for pain - and, rightfully should be given all the medication they need. That's not suicide, IMO.

That's a sad story, Carol. I'm sorry to hear it. It's such a complex situation with so many variables that it's difficult to discuss on this forum.... so I won't.

Thanks for you expression of sympathy. It does possess many different avenues of thought.

A sad story, but some people may prefer to be in on the decision and timing rather than be forced to deal with the sudden surprise of a bloody corpse in the yard. Not to mention the horrible possibility of a botched attempt at suicide.

Assisted suicide is humane and a decent way to die if you have a terminal illness under certain circumstances.

Enlightened good citizenship for the greater gain. No prob.



Ah si. Not homocide. Assisted suicide. Fine hair split, even Solomanatic IMO.

http://www.careerbuilder.com/monk-e-mail/?mid=13935230

FO redneck.

Be specific.

I don't agree. You indulge in semantics. Suicide is when you take your own life.

Deliberately assisting someone's death is murder in my book.

You are entitled to your opinion.


If I have advanced melanoma (or another terminal illness) with no chance of survival I believe I should have the option of ending my life before the illness reduces me to a shell with nothing but extreme pain and suffering.

That is the most personal decision one can make.

You're damn right it's personal and no one else should be involved in your suicide. It's your decision and it's up to you to kill yourself, if that's what you want. Don't put that on anyone else.

I answered you politely and you say that? There are other opinions and positions out there not based on your religion that are perfectly valid.

Health Care Premiums

How Quiet Moves by a Publisher Sway Billions in Drug Spending

Lawsuit Forces Hearst Unit To Lower Prices on List Widely Used as Benchmark
A 'Survey' of One Company
By BARBARA MARTINEZ
October 6, 2006; WSJ Page A1

For years, a little-known unit of publishing giant Hearst Corp. called First DataBank has played a powerful role in determining what Americans pay for prescription drugs. First DataBank doesn't buy or sell drugs -- it publishes lists of drug prices. Health plans and state Medicaid programs use those prices as a benchmark in determining what they pay pharmacies.

If the benchmark goes up, so do costs for these payers. That's what happened in 2002, when First DataBank suddenly made broad revisions to its key published list. The new prices had the effect of fattening the profits of pharmacies, out of the view of patients and companies who pay for the soaring cost of health care.

A 2002 email by a manager at one of the nation's largest drug wholesalers, San Francisco-based McKesson Corp., describes how pharmacies would be able to more than double their profit for dispensing the cholesterol drug Lipitor and adds, "that is awesome!!"

Now a tentative legal settlement, reached quietly this week in a Boston court, could reduce annual U.S. drug costs by billions of dollars. An economist hired by the plaintiffs puts the savings in 2007 alone at $4 billion. The actual amount could be lower if pharmacies negotiate higher fees to make up for what they are losing.

In the settlement, which is awaiting approval by a judge, First DataBank, of San Bruno, Calif., agrees to reduce many of the prices on its published list by five percentage points. It denies any wrongdoing and isn't paying any damages to the plaintiffs.

Documents made public as part of the litigation suggest that McKesson had a key part in the rise of the published benchmark prices in 2002. The documents suggest that McKesson's motive was to resolve an administrative headache. The McKesson manager's emails later noted a side benefit: The company's pharmacy customers would enjoy bigger profits.

First DataBank had long said its prices reflected a survey of national wholesalers. But a manager at the publisher said in a deposition that from 2003 only one company, McKesson, participated in the survey. In the litigation, First DataBank also said that only two of its 225 employees were trained to collect and update pricing information.

One of the most important parts of the proposed settlement in U.S. District Court involves the benchmark price at issue in the litigation, known as average wholesale price or AWP. The term is a misnomer because it no longer represents a price paid to wholesalers and is not an average of anything. An old industry joke holds that AWP stands for "ain't what's paid." First DataBank agreed that two years after the settlement is final it will stop publishing the AWP.


As AWP loses sway, employers, Medicaid programs and other drug payers may need to find new ways to figure out how much pharmacies are paying for drugs so that the pharmacies can be reimbursed at a fair, but not excessive, profit margin.

Mark Erlich, executive secretary-treasurer of the New England Regional Council of Carpenters, is one of the plaintiffs settling the case with First DataBank. He expects the settlement will save about $400,000 a year for his union's health fund, which covers 22,000 people and spent $10 million on prescription drugs last year. Mr. Erlich calls the earlier rise in First DataBank's published prices "a rip-off of consumers across the country." It affects the union, he says, because its contract with the company managing its pharmacy benefits specifies that the drug prices the union pays will be based on First DataBank's AWP benchmarks.

In a statement, First DataBank said it isn't responsible for what companies involved in drug distribution do with its data. "First DataBank does not set pharmaceutical prices. First DataBank is a reporter and publisher of information that is collected from third parties," the statement said. Hearst is a major media company whose holdings include the San Francisco Chronicle and Good Housekeeping magazine. It is a partner with Dow Jones & Co., publisher of The Wall Street Journal, in publishing SmartMoney magazine.

The changes in First DataBank's published prices are responsible for only a portion of the increase in drug prices in recent years. The prices of drugs are set, first and foremost, by drug manufacturers. From 2000 to 2005, manufacturer prices on the most popular brand drugs grew by about 40.5%, according to a study by AARP, the advocacy group for Americans over age 50.

Between the manufacturer and the end user stand a variety of middlemen who take their cuts. These include wholesalers such as McKesson, who distribute drugs obtained from manufacturers, and pharmacies where patients go to get prescriptions filled. First DataBank plays a key but little-noticed role in drug pricing as a source of data used by middlemen to set their prices.

Another group of middlemen are pharmacy benefit managers or PBMs, which manage employers' drug benefits and often act as pharmacies themselves by filling employees' prescriptions through mail order. PBMs also frequently use AWP as a benchmark. Changes in AWP may also affect people without insurance who pay out of pocket because pharmacies sometimes use AWP in setting their cash prices.

Even as patients face higher co-payments and other out-of-pocket medical costs, many pharmacies and PBMs are prospering. The Dow Jones index of U.S. drug-retailer stocks has risen about 40% since the beginning of 2002, roughly in line with major indexes. A few big chains are doing especially well: Walgreen Co.'s net income has nearly doubled in the past five years and CVS Corp.'s has tripled. Share prices of the three major PBMs are also sharply up over the past few years.

Vestige of Old System

Average wholesale price "is a vestige of a drug-distribution system that disappeared in the early 1980s," says E.M. Kolassa of Medical Marketing Economics, an Oxford, Miss., consulting firm. In the late 1960s, the California Medicaid program needed a standardized way to reimburse pharmacies for drugs because "every claim was a paper claim based on whatever the pharmacist was charging," Dr. Kolassa says. Two consultants came up with "average wholesale price" after surmising that drug wholesalers generally charged retail pharmacies about 20% more than they paid manufacturers for drugs. California decided to pay pharmacies this new AWP, plus an additional dispensing fee.

Within a few years, Medicaid systems throughout the country had adopted AWP, and publishers such as First DataBank made a business of disseminating the pricing data. When commercial health insurers and employers began to reimburse for drugs and demand discounts from pharmacies in the 1980s and 1990s, they too adopted Medicaid's AWP system.


Gradually the 20% estimated markup became an anachronism. Wholesalers consolidated and became more efficient amid competition. They were selling drugs to pharmacies for just 2% to 3% more than what they paid. The compilers of AWPs, however, continued to report a 20% markup. States and employers adjusted by demanding discounts of 5% to 15% off the AWP.

First DataBank, founded in 1977, was bought by Hearst in 1980. Hearst bought another major publisher of AWPs, Medi-Span, for $38 million in 1998, but had to sell Medi-Span to Wolters Kluwer NV of the Netherlands in 2001 after a complaint by the Federal Trade Commission. The FTC said the acquisition gave Hearst "monopoly power" in drug data and led to "drastic price increases to customers, and reductions in product quality and customer service."

Thomson Corp.'s Red Book also publishes AWPs but First DataBank's figures are most commonly used in the industry, says Sean Brandle, a pharmacy benefits consultant to major employers and unions at Segal Co. in New York.

The trigger for litigation was a sudden rise in First DataBank's AWPs in 2002. Previously the 20% markup beyond the wholesaler's acquisition cost was common, although not universal. Suddenly First DataBank started revising its AWPs so that the markup was almost always 25%. According to internal McKesson documents, by 2004 nearly 99% of drugs carried the larger 25% markup. The cumulative effect, according to the plaintiffs, was that employers and others paid an extra $7 billion between August 2001 and March 2005 on drugs covered by the suit.

Documents from the period make clear that McKesson influenced the shift to an across-the-board 25% markup. The drug wholesaler's motivation was to simplify its system: Its computers recorded a "suggested sales price" for each drug that corresponded to the AWP, and it was easier if the markup was always the same. But McKesson managers also recognized that if the markup were to be standardized, it would be beneficial to standardize it at a high level -- that is, at 25%. The result would be higher margins for its pharmacy customers.

In an internal email on Jan. 7, 2002, McKesson's director of brand pharmaceutical product management, Robert James, wrote that "our successes recently and during this past year include raising the AWP spreads" on many drugs. As a result, he wrote, "we have an opportunity to 'market' our efforts now" to retail pharmacies who would appreciate that McKesson was working on their behalf. In a competitive market where pharmacies have a choice among wholesalers, such marketing could give McKesson an edge.

Mr. James wrote that in his discussions with customers, "one of the comments that was made was 'this would certainly be a good reason to renew our agreement with McKesson when it's time.' Talk about being good partners, wow!"

In an April 2002 email, Mr. James explained to colleagues that while pharmacies previously made a $6.86 profit dispensing Lipitor, with the new AWP they "will enjoy $17.18 profit...and that is awesome!!"

As Mr. James noted in his emails, many pharmacies say their profit margins have been squeezed in recent years. That is largely the result of efforts by the pharmacy-benefit managers hired by employers. PBMs have driven down reimbursements to pharmacies, passing on the savings to employers or keeping some of it for themselves.

Douglas Hoey, chief operating officer of the National Community Pharmacists Association, says any extra money pharmacies might have gained from the changes in First DataBank's prices meant little amid their woes. "We don't know where [the extra profits] went -- we just know where it did not go and that's to the community pharmacies," Mr. Hoey says. The association says many small pharmacists have closed down or are considering doing so because of slim profit margins.

In a statement, McKesson says setting the AWPs was First DataBank's job. "A full reading of McKesson documents, including e-mails, demonstrates that McKesson did not enter into any agreement with First DataBank to raise published AWPs," the statement says.

McKesson, which is named in the lawsuit, isn't a party to the settlement. "We intend to continue to press the case against McKesson," said Thomas Sobol, the plaintiffs' attorney at Hagens Berman Sobol Shapiro LLP.

'Really Mad'

The price rises published by First DataBank met with anger among some in the industry. "We were really mad," says Tim Heady, head of the pharmacy-benefits division at health insurer UnitedHealth Group Inc. UnitedHealth called First DataBank for an explanation but couldn't get a satisfactory one, Mr. Heady says.

A vice president at drug maker GlaxoSmithKline PLC wrote to the president of First Data Bank in March 2002 asking why the publisher had increased the AWP for the asthma medication Advair even though Glaxo hadn't raised its prices. He complained that "First DataBank has not been willing to share any information" about the change.

Plaintiffs' lawyers first suspected that drug manufacturers were behind the AWP increase and sued them. The drug companies denied any role, and in 2004 both sides started inundating First DataBank with subpoenas looking for answers.

Many employers and other payers for drugs didn't notice the rise in First DataBank's benchmark prices and didn't attempt to roll them back. Drug manufacturers were raising their own prices frequently during the period. The escalating prices prompted employers to shift some costs to employees through higher co-payments. Employers often have difficulty learning what they are paying for specific drugs and what factors determine prices.

For years, First DataBank described its AWPs as the results of a survey of national wholesalers. The supposed survey didn't gather the actual prices the wholesalers were charging but rather their suggested markup based on the decades-old wholesaler margins.

It emerged in the litigation that the only wholesaler in the "survey," at least in its final years, was McKesson. There are three national wholesalers. Spokesmen for two of them -- AmerisourceBergen Corp. and Cardinal Health Inc. -- say their companies didn't participate in any First DataBank surveys during the period when the price increases were occurring and still don't.

In a January 2005 deposition, Kay Morgan, who was in charge of AWPs at First DataBank, was asked: "Was First DataBank receiving any information regarding markups from any other company other than McKesson?" Ms. Morgan answered: "No, sir, we were not." However, she said she believed the McKesson-only survey started toward the end of 2003. That contradicted the accounts of AmerisourceBergen and Cardinal Health, who say they didn't provide pricing information in earlier years either.

McKesson says it never knew it was the only wholesaler being surveyed. "First DataBank has testified under oath in an earlier lawsuit involving other parties that it never told McKesson that at times McKesson was the only wholesaler being surveyed," a McKesson spokesman says.

Two months after Ms. Morgan's deposition, First DataBank sent a letter to its customers announcing an end to the survey. It said from that point forward it would "freeze" the last markup "provided through the wholesaler survey process."

What I'd really like to see is someone keeping track of the Average Wholesale Price paid by other countries and reimbursements based on THAT.

So would I!

It will soon be RIP to the NHS

Sunday Times (UK), by Gillian Bowditch


10/7/2006 6:58:34 PM

When David Cameron, in his speech to the Tory party conference, summed up his priority with the three letters NHS, my initial response was: “What NHS?” There is nothing national about the health service these days. The past decade has seen the balkanisation of healthcare and for many that means living in the medical equivalent of Albania.

Self-assembling gel stops bleeding in seconds
New Scientist, by Robert Adler

10/11/2006 1:20:12 AM

Swab a clear liquid onto a gaping wound and watch the bleeding stop in seconds. An international team of researchers has accomplished just that in animals, using a solution of protein molecules that self-organise on the nanoscale into a biodegradable gel that stops bleeding. If the material works as well in humans, it could save thousands of lives and make surgery far easier in many cases,

Heard about this yesterday when docs were talking about it!

Too cool. I used to use super glue on small cuts, but now they have liquid bandage. Looks like this will be even better.

When I had my most recent operation (a hernia repair), they used stitches internally, of course, but for the outside, they used some kind of new surgical glue to close the incision. Made a much neater, prettier scar than the original!

cool stuff

Yes, that's what the docs used on mine a couple years ago and also the weak tissue area is reinforced with a netting which the good tissue attaches to and the whole area is much stronger and does not tear out again as so many have done - or so the very young and seemingly sharp surgeon said.

Some dentists question proposed dental school at East Carolina

I had an email question read on CSPAN Journal this am. Guest topic was Eurpopean Health Care Systems. I asked guest to discuss Swiss Health Care System. He did and said that he thought it was the best of the European Systems although it too has some problems...

Swiss Health Care System is Canton (State) organized system where individuals buy their health care policy directly from private insurer and the Canton provides premium support for low income citizens. Health care coverage is mandatory and business does not (cannot) pay employee premium. Siginficant Canton regulation of basic policy provisions and of health care providers and products. Overall costs among highest in Europe per citizen but lower than US...

Dentists. Looking to drive up profits and prices. Screw the patients.

Dentists should be plentiful and cheap. It ain't really rocket science.

It's very depressing work (look at the suicide rate) and the dexterity required is up there with surgeons. You really don't want a clumsy dentist.

The more there are the more good ones there will be...

I don't understand why the employer should be involved for any reason. His best interest is his own profit, not health past getting employees into work. If they don't show up he can always get more employees, depending on how important they or their knowledge is.