Calm. It didn't work. I got out of bed. "This must end, today, " I thought. "I can't sleep. I can't eat. I can't teach. I can't even read or write." After taking a walk around our farm, I brewed coffee for my wife, Diane, and me, and then helped get our 16-year-old daughter, Alexa, off to high school. Diane asked if she should cancel her appointment to go horseback riding. "No, " I said. "I'm a little less depressed, and you can't just sit around here day after day and take care of me like I'm a baby. By the time I get a haircut, you'll be back." As soon as she had driven away, I put all the antidepressants and sleeping pills I had into a small satchel, added a full quart bottle of vodka, and headed my car toward Highway 95. I didn't know where I was going, but it certainly was not to the barber. As I crossed the bridge into Pennsylvania, I vaguely remember seeing the sign for Highway 32, and I exited. The sun was shimmering on the Delaware River, which only made keeping my eyes on the road more difficult. I saw a sign for New Hope or was it No Hope? ; and drove into town. I wandered up one street and down another until I saw a sign for the Wedgewood Inn. I had never been there before, but I was too agitated to look further. The Wedgewood it would be. The proprietress looked askance at the luggage I carried but showed me to a small room anyway. "This will be fine, " I think I said and closed the door. I sat down on the double bed with its chenille spread and put the pills and the vodka on the bedside table. Slowly, almost ritually, I took one or two pills at a time, washed down with a generous swig of vodka. By the time all the pills and more than half the vodka were gone, I started to feel less wired--even quiet. As I lay down and sank toward what I believed would be death, I found myself thinking of a relative who had committed suicide this way some years earlier. Perhaps I connected with him because my jumbled brain thought he, and only he, might comprehend what I was doing. I woke up 12 hours later with a headache, dizziness, nausea, and hiccups. I stumbled out to my car in the darkness, and called my wife from the cell phone. I remember being so relieved to hear her voice. "We've been looking all over for you, " she said, "where are you?" I told her what I had done, where I was, and that I wanted to come home. "Stay right where you are, " she said. About 30 minutes later, a Pennsylvania state policeman pulled his car into the parking lot. I got into the backseat and was told we were going to New Jersey. A short while later, we rendezvoused with Diane's car on the Jersey side of the river. "Thank you, Officer, " I muttered as I changed cars. We drove in silence for a time. Then Diane asked in a strained, calm voice, "Why did you do it, dear?" I replied with my usual professorial certitude, "I thought it would be best for everyone. I couldn't go on the way I was." Once home, I proclaimed to Diane and Alexa that I loved them very much, that they needed to do a better job of looking after each other, and that each of us must figure out how to take better care of ourselves. They laughed at the incongruity of this advice. "That's it!" they said in unison, and whisked me to the emergency room of the Princeton Medical Center. For the next couple of hours, I was subjected to the usual pre-admission process. My height, weight, blood pressure, and insurance status were checked. Samples of blood and urine were collected. Finally, I was taken to the psychiatric service, called Princeton House, and admitted to the highest security wing. I exchanged my clothes and toilet kit.
1 2 Central Bureau of Statistics. 1979 Census Reports, Nairobi, Kenya National Council for Population and Development, Central Bureau of Statistics, and Macro International Inc. Kenya Demographic Health Survey, 1993. NCPD, Nairobi, 1994. Centre for African Family Studies, John Snow Inc Seats Project and Center for Population and Family Health, Columbia University. Findings from the Sub-Saharan Africa Urban Family Planning Study: Mombasa City Report. March 1995, for example, zocor and liver.
Table 1. Major Types of Anxiety Disorders by NIMH Classification.
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Address for reprint requests and other correspondence: J. A. Brock, Prince of Wales Medical Research Institute, Barker St., Randwick, NSW 2031, Australia e-mail: j ock unsw .au ; . H398.
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2. Epivir HBV A reverse step therapy requirement has been added Rationale: - The review of pharmacy data showed that many patients are prescribed Hepsera or Baraclude concurrently with Epivir HBV for treatment of Hepatitis B. At the present time, both Hepsera and Baraclude require prior authorization, while Epivir HBV does not. The combination therapy of Epivir HBV together with either Hepsera or Baraclude is not currently FDA-approved for management of Hepatitis B. To ensure that Hepatitis B patients are being treated in accordance with the evidencebased clinical guidelines and FDA-approved recommendations for available drugs, a reverse step therapy has been implemented for Epivir HBV, whereby if there is a claim in the system for either Hepsera or Baraclude, Epivir HBV prescription will be blocked If Epivir HBV is prescribed as monotherapy, no prior authorization or step therapy restrictions would apply If combination therapy e.g., Hepsera and Epivir HBV, or Baraclude and Epivir HBV ; is required, please follow the same process for requesting approval of drugs requiring prior authorization 3. Januvia Added to the formulary with step therapy requirement Rationale: - Sitagliptin Januvia ; is the first drug in a new class of anti-diabetic agents which work through inhibition of dipeptidyl peptidase-4 DPP-4 ; . It is indicated for management of diabetes type 2 in addition to diet and exercise, either as monotherapy, or in combination with either a thiazolidinedione TZD ; or metformin. It is administered once a day, and provides a reduction of A1C levels between 0.6% to 1.5%, with higher reductions seen in members with higher baseline A1C levels. The most common side effects include upper respiratory tract infections, headache and nasopharyngitis. It is essentially weight-neutral, and does not appear to increase hypoglycemia risk. However, dosage adjustments are necessary in moderate-to-severe renal insufficiency. To allow providers greater flexibility in stepping their patients from monotherapy with metformin first line drug of choice according to evidence-based guidelines ; to combination oral therapy, Januvia was added to the formulary with the step therapy requirement, which would require the use of at least a 30-day supply of metformin in the previous 120 days before a Januvia prescription would be approved as having satisfied the step therapy criteria ; The step therapy criteria will ensure that patients have already tried and failed treatment with metformin as monotherapy If Januvia is being prescribed without a previous trial of metformin as per above-described step therapy protocol ; , prior authorization would be required 4. Zetia A reverse step therapy requirement has been added Rationale: -The review of pharmacy data showed that some members receive both Vytorin which contains Zoco4 and Zetia ; and Zetia concurrently, resulting in their taking 20 mg of Zetia per day twice the maximum daily dose ; . To ensure appropriate utilization of both agents, and to prevent overdoses with Zetia, a reverse step therapy has been implemented for Zetia, whereby if there is a claim in the system for Vytorin, Zetia prescription will be blocked If Vytorin is being discontinued and a provider wishes to place a member only on Zetia monotherapy, please follow the same process for requesting approval of drugs requiring prior authorization and zyprexa.
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1 From the Department of Pathophysiology, Medical University of Vienna IS, EU, FW, GB-N, OS, and EJ-J the Department of Dermatology, Hetenyi Geza Hospital, Szolnok, Hungary NB and the Department of Medical Computer Sciences, Medical University of Vienna AG ; . 2 Supported by the Austrian Science Fund SFB F018, Project 8. FR-W was supported by Biomay, Vienna. 3 Address reprint requests to E Jensen-Jarolim, Department of Pathophysiology, Medical University of Vienna, AKH-EB03.Q, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail: erika.jensen-jarolim meduniwien . Received January 21, 2004. Accepted for publication September 21, 2004 and zyrtec.
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Introduction Indian Inc. and the stock markets seems to be a late starter and is now waking up to liven the horrors of the IP regime, which is going to affect all the industries directly and indirectly in the future. The case becomes severe when the economy is moving towards oligopoly. The structure and the impact of the IP regime as anticipated was felt to be by pharma industry, which had been proved true by the recent backlashings on the Ranbaxy's share. Why is IP so important, how will it impact are some of the questions that need to be answered. We will take the recent case of Ranbaxy to illustrate the above raised question? Ranbaxy Laboratories Limited RLL ; share price fell by almost by 6 % on 13th October, just on the news that the Ranbaxy had lost the case in UK. Why losing a case on IP across seven seas is so important? It is because of the fact that the companies revenues depend on the stage in which the IP is and then only the potential of a drug can be ascertained. This case had been particularly referred to as `mother of all patent challenges'. The reasons for which are listed below: About Lipitor `Lipitor' Atorvastatin ; belongs to the class of statins, which include Zkcor Simvastatin ; , Pravachol Pravastatin ; and Lovastatin. These statins are part of the cholesterol reducing class, which is currently the highest therapeutic class in the world with revenues to the tune of US$ 30 billion in 2004.2 Pfizer's drug `Lipitor' has earned the distinction of being the pharmaceutical industry's first US$ 10 billion product garnering revenues to the tune of US$ 12 billion in 2004, which translates to 23% of Pfizer's revenues. The drug held approximately 40% of the worldwide sales in the lipid-lowering market and more than 42% of the US market in total prescriptions. With its ability to bring the vast majority of patients to target cholesterol goals, with an excellent safety profile and proven range of unparalleled cardiovascular benefits.
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This information is for educational purposes only and should not substitute for the care of a medically trained physician. Please consult your doctor before starting any type of nutritional program for your child. After 22 years and $100 million, we don't know the incidence, the cause or the cure for autism. But we'll definitely "look into it." And, oh yes, it's definitely "not vaccines." This is the thinking that passes as logic. The key point here that no one seems to be pointing out is that research should be done before mandating a vaccine into the bloodstream of American children! You don't just start mass-injecting something into a population and then stand back and defy independent scientists to prove it isn't safe! That's exactly what we've done here. As a nation, as a government, and as parents, Americans should be very certain, beyond a reasonable doubt, that any substance being injected into an unformed little nervous system is absolutely safe and does no harm. That should be the minimum requirement. Drs. Wakefield, O'Leary, and Megson have shown startling results from some of the only scientific research on autism and vaccines in the entire world that has not been funded by the vaccine manufacturers. This research also shows a high likelihood that MMR and DPT vaccines may cause permanent intestinal destruction, liver damage, and autism. It presents a very plausible hypothesis for the horrific increase of autism since 1978. So, until we know for certain if they're right, why are the vaccines not suspended? Researcher Gary Null's pert answer comes swimming to the surface; "It's the money, stupid." By the end of the hearing, Burton's room was polarized into three groups: those who were convinced of a connection between autism and vaccines those who admitted the possibility those who angrily denied the possibility, affronted that anyone would question their "scientific" opinions.
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Up, or when you do and it doesn't come across, that's a 20mg of Zocor, 40mg of Pravachol or lovastatin and 80mg pretty ugly feeling, " Hope says. of Lescol--and it will reduce LDL up to 39 percent. That Then there's the physical pain. For the past five means your doctor's happy, your insurer's happy, and your years, Hope has been at war with his muscles. They form arteries are tickled pink. knots in his shoulders, keep him awake till dawn and It gets even better. Lowering cholesterol reduces the cramp so severely that Sharon has to straighten his arms risk of coronary heart disease, the chief cause of death in each afternoon. the Western World. Put simply, statins save lives. Though Hope tries to laugh off his memory problem Tell that to Mike and Sharon Hope. They say Lipitor as "the village idiot syndrome, " he knows it has tormentruined theirs. ed his family. Sharon, a software engineer, spends her At first, when Mike's doctor prescribed 10mg of Lipimorning commute on her cell phone, calling neuropsytor in January 1998, the Hopes saw the statin as a neceschologists, clinical researchers, anyone who will listen. sity. Total cholesterol under 200 is considered desirable, She keeps records of all the doctor appointments--52 last but Mike's was a scary 350. Within a few months his choyear alone--the brain scans and the MRIs. The doctors lesterol was under control. But he suffered some aches and don't detect dementia or Alzheimer's pains, and started misplacing things, or anything else. So what's causing like his keys. By 2001, his muscles this misery? were so weak that his legs would colSharon keeps coming back to one lapse under him. Just after the New Mike and fateful day in January 1998--the day Year in 2002, a bewildered Mike Sharon Mike took his first dose of Lipitor. called Sharon from Home Depot. Hope "Do you know why I'm here?" he Since starting on Lipitor in 1998, Mike THE FAST-FOOD NATION HAS asked. has significantly met its match. Forty-two million "I freaked out, " Sharon says. On reduced his bad Americans have high cholesterol, and the Internet she found message cholesterol. But in 16 million of them already pop Lipiboards linking statins to memory the process he has tor or a similar cholesterol-fighting loss. She took Mike for neuropsybeen hampered by extreme muscle pain, pill. Prescriptions for these drugs, chological exams, and his scores on frustrating memory called statins, have jumped 22 perseveral tests were in the bottom 1 lapses--and the loss cent in the past two years, propelled percent. of his business. in part by new federal cholesterol Mike also saw Beatrice Golomb, guidelines published in 2001. A rea neurobiologist conducting extencent Newsweek cover story prosive statin research at the University claimed this "the age of statins." Though AstraZeneca's of CaliforniaSan Diego. She believes it's likely that LipiCrestor, a "super-statin" more powerful than any comtor caused Hope's problems. His symptoms, Golomb says, petitor, was launched in September, Lipitor is the most poare "compatible with the spectrum and character of probtent of the five established statins sold in the U.S. Last year lems we see on statins." Hope's condition has improved U.S. pharmacies dispensed nearly 66 million Lipitor presince he came off Lipitor in January 2002. He'll no longer scriptions, according to pharmaceutical market researcher collapse on the floor. But he's far from a full recovery. He IMS Health--which is more than rivals Zocor, Pravachol also has plenty of company. and Lescol combined. Fifty-six-year-old John Mortin, a former California For many doctors, prescribing Lipitor or another statin rancher, took 40mg of Lipitor a day for three years. Now, is easier than babysitting patients as they choke down anoff the drug since 2002, he suffers severe cognitive probother bowl of oat bran in hopes of lowering their LDL, or lems, and he's on total disability. "He has trouble buckling "bad cholesterol." The statins all work the same way, his sandals, " says his wife, Mari. "For a week and a half, blocking the body's production of HMG-CoA reductase, we've been trying to teach him how to make a sandwich." an enzyme that's a key ingredient in cholesterol. But LipiMerline Maynard, also 56, has suffered crippling muscle tor's superior potency has made it the statin of choice. The pain since a two-week period in late 2001 when she took smallest dose of Lipitor, 10mg, is about as powerful as 10mg of Lipitor a day. "If I continued taking it for a and acomplia.
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As an agreement between Member countries of the WTO, the August 30th decision does not apply to countries not party to that organization. Nevertheless, Canada has chosen to implement the decision in a manner that enables both developing and least developed non-WTO Member countries to participate as importers of eligible patented pharmaceutical products. While this technically exceeds the boundaries of TRIPS and the WTO General Council's August 30th decision, Parliament was of the view that, in so far as least developed countries are concerned, the moral and actonel and zocor, for example, cheap zocor.
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