tag:blogger.com,1999:blog-65297747464743719442024-03-13T05:52:08.969-07:00Musings of ScoobydoobeachA look at current events, travel, books and whatever catches my fancy, with pictures!Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.comBlogger253125tag:blogger.com,1999:blog-6529774746474371944.post-30855492908222064032012-09-16T15:30:00.000-07:002012-09-16T16:51:53.982-07:00No Trouble in TromsoThis year, after my annual July business trip to London, I planned for a trip with my husband to Europe somewhere so we could celebrate with travel our 30th wedding anniversary on July 10. He wanted to retrace our honeymoon which was a three week trip. I could not take that much time from work and I proposed we just go to Paris. He did not want to go museum hopping so I proposed Grenada in Spain to see Alhambra and possibly a side trip to Morocco. He hemmed and hawed about that proposal, in part because of the heat. So next I suggested Scandinavia and we agreed we would go to Norway to see fjords.<br />
<br />
I also wanted to see the midnight sun so I located a city in northern Norway called Tromso Tromso is locate about 250 miles above the Arctic Circle and seemed to have decent hotels, midnight sun and events for a 24 hour in the light life style. In particular I wanted to go to the Arctic Cathedral which had a midnight concert everyday and is bathed in light through the many church windows. My husband thought that would be fabulous, although I discovered later that he thought the cathedral was made of ice. His interest waned when I told him it was a regular building.<br />
<br />
We left London for Tromso on July 13, a Friday for those of you who believe in that sort of thing. After five days of rain in London, and the beginnings of a cold, I was not too keen to see the weather report of rain for the entire time we planned to be in Tromso. So much for the midnight sun, I thought.<br />
But the Nordic gods smiled upon us because when we arrived in Tromso after traveling all day (it is over a 1000 miles from Oslo, where we had to change planes from London) the sun was trying to emerge. <br />
<br />
Our hotel, the <a href="https://www.rica-hotels.com/hotels/norway/northern-norway/tromso/rica-ishavshotel/">Rica Ishavshotel</a>, sat right on the water and is built to resemble a ship. The waterway outside the hotel eventually leads to the Arctic Ocean. It is a prime landing place for cruise ships.<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-Abk3d6wf220/UCndtyichhI/AAAAAAAABDI/TqFGdFQMsfw/s1600/Norway2012+050hotel.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="255" src="http://1.bp.blogspot.com/-Abk3d6wf220/UCndtyichhI/AAAAAAAABDI/TqFGdFQMsfw/s400/Norway2012+050hotel.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rica Ishavshotel</td></tr>
</tbody></table>
<br />
<br />
Here is our view from our window at the Rica Inshavshotel at 9:00 p.m .<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://3.bp.blogspot.com/-cdEDIqtQ2VY/UCnWEMtFmLI/AAAAAAAABCg/LT_80mzekSw/s1600/Norway2012+037sf.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="330" src="http://3.bp.blogspot.com/-cdEDIqtQ2VY/UCnWEMtFmLI/AAAAAAAABCg/LT_80mzekSw/s400/Norway2012+037sf.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The sun was out just at about midnight. This was the view from our room at 1:00 am:</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://1.bp.blogspot.com/-HTK3PwvJ7Qg/UCnY6Nyo_PI/AAAAAAAABCw/FNtUBtbbxic/s1600/DSC_0444.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="http://1.bp.blogspot.com/-HTK3PwvJ7Qg/UCnY6Nyo_PI/AAAAAAAABCw/FNtUBtbbxic/s400/DSC_0444.JPG" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
The church to the left in the above pictures is the Arctic Cathedral described above and the light from the midnight sun in the west shines through the windows into the church. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-EAWU8qgLQao/UCnd_MmOS8I/AAAAAAAABDQ/OHBxCM0y4bc/s1600/DSC_0437.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://2.bp.blogspot.com/-EAWU8qgLQao/UCnd_MmOS8I/AAAAAAAABDQ/OHBxCM0y4bc/s400/DSC_0437.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Arctic Cathedral</td></tr>
</tbody></table>
<br />
We missed the concert because we went up the cable car on the lower hill to the right in the pictures above. From there we got views of the midnight sun in the west, as shown below. The pictures above are looking east.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-7lLY4qrP3sA/UCnbkFMuqtI/AAAAAAAABDA/nM3yt8kq-XE/s1600/576067_3735797952148_1922279952_n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="http://3.bp.blogspot.com/-7lLY4qrP3sA/UCnbkFMuqtI/AAAAAAAABDA/nM3yt8kq-XE/s400/576067_3735797952148_1922279952_n.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">View of Tromso and Midnight Sun</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-pb85VGSl33g/UCnbbnxwsMI/AAAAAAAABC4/FyK8cWdK0PQ/s1600/552721_3737725160327_1203521484_n-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="http://3.bp.blogspot.com/-pb85VGSl33g/UCnbbnxwsMI/AAAAAAAABC4/FyK8cWdK0PQ/s400/552721_3737725160327_1203521484_n-1.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Looking north at glow of Midnight Sun</td></tr>
</tbody></table>
We woke up for breakfast which was an amazing buffet feast but could not stay awake thanks to the return of the dreary rain. Late in the afternoon, when the rain had stopped for a while, we finally dragged ourselves out to see some sights in Tromso. We visited Polaria, which has as its claim to fame, bearded arctic seals. We watched a short film about the northern lights, which do not occur during the summer due to the position of the earth around the sun. Otherwise electric impulses generate the green tinged northern lights near the Northern Pole, which is not too far from Tromso. Then we spent some time with the seals, who were much more fun to watch than I expected.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-2ByFIFRrgIU/UFZJdZyGWmI/AAAAAAAABD4/L3yt2E1nfLg/s1600/DSC_0465.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-2ByFIFRrgIU/UFZJdZyGWmI/AAAAAAAABD4/L3yt2E1nfLg/s400/DSC_0465.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Polaria</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-R5_j-NyJzE4/UFZJ2RSsQSI/AAAAAAAABEA/mrgSUoEKkfA/s1600/DSC_0478.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://2.bp.blogspot.com/-R5_j-NyJzE4/UFZJ2RSsQSI/AAAAAAAABEA/mrgSUoEKkfA/s400/DSC_0478.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bearded Seal</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-V7cujjFfqQ4/UFZKSN6uKII/AAAAAAAABEI/Fng6xIVe3S4/s1600/DSC_0495.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://1.bp.blogspot.com/-V7cujjFfqQ4/UFZKSN6uKII/AAAAAAAABEI/Fng6xIVe3S4/s400/DSC_0495.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Clean shaven seal</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-7GEQEC1RUsI/UFZKVHsmq0I/AAAAAAAABEQ/94920_HqNAY/s1600/DSC_0514.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-7GEQEC1RUsI/UFZKVHsmq0I/AAAAAAAABEQ/94920_HqNAY/s400/DSC_0514.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Seal at play</td></tr>
</tbody></table>
<br />
We finished our time in Tromso having dinner at Aunegården, which features a cafe and restaurant in a historic building that was a butcher shop. We got into the restaurant without a reservation by promising to vacate our table in an hour which turned out to be a challenge even for us, the original speed eaters. I tried their vegetarian dish which was not that good but my husband had fish soup and some other fish that he proclaimed fabulous. It is hard to be vegetarian in Tromso because there are not great vegetable dishes but there are wonderful fish dishes. I did have one of the proclaimed cakes which met its reputation. The atmosphere was wonderful, including the large pictures from the early 20th century on the wall.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-Ipyy0De6V_4/UFZQr-D7vJI/AAAAAAAABFE/rvk5LinhPpw/s1600/DSC_0521.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://3.bp.blogspot.com/-Ipyy0De6V_4/UFZQr-D7vJI/AAAAAAAABFE/rvk5LinhPpw/s400/DSC_0521.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Interior of Aunegården</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-x9xRN6GW-Uc/UFZQvEH3MkI/AAAAAAAABFU/8l7-JzT3Dks/s1600/DSC_0525.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-x9xRN6GW-Uc/UFZQvEH3MkI/AAAAAAAABFU/8l7-JzT3Dks/s400/DSC_0525.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aunegården Restaurant</td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-5MeKtgyDJLY/UFZQpnfo0zI/AAAAAAAABE8/Z9376sCOPyw/s1600/DSC_0520.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="287" src="http://1.bp.blogspot.com/-5MeKtgyDJLY/UFZQpnfo0zI/AAAAAAAABE8/Z9376sCOPyw/s400/DSC_0520.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Picture of entrance to what is now Aunegården</td></tr>
</tbody></table>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-X-3eXqxXhfI/UFZQttwvGLI/AAAAAAAABFM/B3WNOAGqjB0/s1600/DSC_0523.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-X-3eXqxXhfI/UFZQttwvGLI/AAAAAAAABFM/B3WNOAGqjB0/s400/DSC_0523.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Aunegården building on left</td></tr>
</tbody></table>
<br />
<br />
<br />Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com5tag:blogger.com,1999:blog-6529774746474371944.post-48887974827779618122012-07-17T14:08:00.002-07:002012-07-17T14:08:28.539-07:00Drug Shortages Part 2- the Scramble Continues<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.wylio.com/credits/flickr/2655381454" style="margin-left: 1em; margin-right: 1em;" title="license: http://creativecommons.org/licenses/by-sa/2.0/ - click to view more info about 'Drug Free Zone? Free Drug Zone?' or find free pictures via Wylio"><img alt="'Drug Free Zone? Free Drug Zone?' photo (c) 2008, Byung Kyu Park - license: http://creativecommons.org/licenses/by-sa/2.0/" height="200" src="http://lh3.ggpht.com/-AIH4fnidowE/TkM_ZBqXLtI/AAAAAAAAA40/wskxRVfKRMk/Flickr-2655381454.jpg" style="float: left; margin-bottom: 0px; margin-left: 10px; margin-right: 10px; margin-top: 0px;" width="150" /></a></div>
REPUBLISHING A POST FROM AUGUST 10, 2011 with New Postscript<br />
<br />
I have written about the nationwide shortage of Doxil, a drug used primarily to treat recurrent ovarian cancer. In turns out that not only is there a Doxil shortage. <a href="http://www.cbsnews.com/stories/2011/08/03/eveningnews/main20087796.shtml">Three other mainline chemotherapies </a>for ovarian cancer, carboplatin, cisplatin and taxol, are in short supply. I learned about the taxol shortage from a new friend on an ovarian cancer website. Her clinic, not too far from where I live, has run out of taxol. Luckily I get my infusions at a major medical center which still has a supply of these three drugs even though it does not have Doxil.<br />
<br />
<a href="http://www.doxil.com/sites/default/files/popup_08052011_3.html">Doxil is available again for special cases</a>, which unfortunately do not include me because I have not yet started treatment with Doxil. <br />
<blockquote>
<br />
<span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><b><u>Important Updates on DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> Shortage (8/5/2011)</u></b></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><br />
</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">We remain committed to restoring the availability of DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">(doxorubicin HCl liposome injection). A modest supply is now available through the DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">C.A.R.E.S. (Creating Awareness & Reinforcing Education Support) Physician Access Program.</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><br />
</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">To help ensure that patients currently on DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">receive the amount of DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">necessary to continue their course of therapy, we have set up the DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">C.A.R.E.S. Physician Access Program, a physician allocation process to obtain newly available DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;">supply.</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><br />
</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;">As DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;">supply will remain intermittently available in the coming months, first priority will be given to patients currently on DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;">. We continue to recommend that no new patients start therapy with DOXIL</span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;"><sup class="reg-sup" style="font-family: arial; font-size: 9px; position: relative; top: 1px; vertical-align: text-top;">®</sup></span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; font-weight: bold; line-height: 16px;"> </span><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><b>until adequate supply becomes available. </b>(emphasis added)</span></blockquote>
<span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 16px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; line-height: 16px;">So I could go for an indeterminate time not getting the drug that my oncologist says best increases my odds for a decent remission. I am starting to feel the need to scramble myself.</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; line-height: 16px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; line-height: 16px;">According to the American Society of Health System Pharmacists, drug shortages currently affect <a href="http://www.ashp.org/drugshortages/current/">about 200 medications</a> in the United States, including antibiotics. <a href="http://money.cnn.com/2011/06/10/news/economy/drug_shortages_fda/index.htm">The FDA reports</a> record shortages for 2010 and projects more record shortages for 2011. But the <a href="http://www.fda.gov/drugs/drugsafety/drugshortages/ucm050792.htm">FDA has no power</a> to require drug manufacturers to explain why there are shortages and effectively must beg the manufacturers to keep it informed.</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; line-height: 16px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif; line-height: 16px;">The only real reason for these shortages is the economics for Big Pharma, which makes more money from new drugs, antidepressants and potency pills than generic chemotherapy drugs. Dr. Ezekiel Emmanuel in the <a href="http://www.nytimes.com/2011/08/07/opinion/sunday/ezekiel-emanuel-cancer-patients.html">New York Times (August 7, 2011)</a> explains:<br />
</span><br />
<blockquote>
<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span class="Apple-style-span" style="line-height: 16px;"> Only the older but curative cancer drugs — drugs that can cost as little as $3 per dose — have become unavailable. Most of these drugs have no substitutes, but, crazy as it seems, in some cases these shortages are forcing doctors to use brand-name drugs at more than 100 times the cost.</span><span class="Apple-style-span" style="line-height: 16px;"> Only about 10 percent of the shortages can be attributed to a lack of raw materials and essential ingredients to manufacture the drugs. Most shortages appear instead to be the consequence of corporate decisions to cease production, or interruptions in production caused by money or quality problems, which manufacturers do not appear to be in a rush to fix.</span></span></blockquote>
<br />
Senators Schumer and Klobucher have introduced <a href="http://www.blogger.com/goog_707914088">a </a><a href="http://thomas.loc.gov/cgi-bin/query/z?c112:S.296:">bill</a><span style="color: black;">, </span><span style="color: black;"><i>Preserving Access to Life-Saving Medications Act</i>, which would require manufacturers to report shortages and reasons for the shortages to the FDA. A<span class="apple-converted-space"> </span></span><a href="http://www.opencongress.org/bill/112-h2245/text">similar bill<span class="apple-converted-space"> </span></a><span style="color: black;">has been introduced in the House. See comparison of the two bills<span class="apple-converted-space"> </span></span><a href="http://www.ashp.org/DocLibrary/News/August-1-table.aspx">here</a><span style="color: black;">. Hearings are planned for the fall and hopefully manufacturers will become more accountable for their profit driven decisions about what drugs to produce. I hope so. My fellow cancer warriors and I cannot fight the good fight if the drugs aren't even available.</span><br />
<span style="color: black;"><br /></span><br />
<span style="color: black;"><b>Postscript July 16, 2012</b> Drug shortages still continue but have become "old news", i.e, not news worth covering. For example there are still shortages of Taxol (paclitaxel) which will <a href="http://www.ncbi.nlm.nih.gov/pubmed/22446408">cost patients more</a> if taxotere (docetaxel) is substituted. And drugs shortages<a href="http://www.oncologystat.com/news/Fight_Against_Cancer_Drug_Shortages_Goes_Global_US.html"> continue to grow as an international problem</a> including shortages of drugs to treat leukemia and myeloma, as well as first line ovarian cancer treatment, cisplatin. However, the issue is not covered anymore by main stream media and only finds its way into print in specialized medical publications. The bills I mention above never passed, although one part of the bills requiring six months notice of expected shortages to the FDA did pass in June 2012 as part of another bill. Worst of all, we are starting to hear <a href="http://www.inspire.com/groups/ovarian-cancer-national-alliance/discussion/doxil-shortage-strikes-im-angry-and-sad/">anecdotally</a> about people dying from the Doxil shortage. Why doesn't the media care anymore???</span><br />
<div class="MsoNormal">
<br /></div>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-68205333272080370552012-02-20T19:16:00.000-08:002012-02-20T19:16:59.155-08:00Just a Little JunkYesterday, an article appeared in the New York Times that echoed my feelings about reading these days. <a href="http://travel.nytimes.com/2012/02/19/travel/high-brow-lit-for-high-fliers-not-me.html?pagewanted=2&ref=travel">Dominique Browning writes</a> that she has discovered that she does better on airplane trips reading "junk books" instead of Great Literature or even nonfiction. She finds that works of George R. R. Martin, Sara Paretsky, Patricia Cornwell, P. D. James, Sue Grafton, Faye Kellerman, John Mortimer and Ruth Rendell allow her to avoid or deal with the unpleasantness of modern air travel characterized by its "herding, shuffling, squeezing, starving, sitting and suffocating". <br />
<br />
I too have guiltily discovered the joys of junk books recently. I too can get immersed in Ruth Rendell and feel somewhat empty at the end although I enjoyed it as I was consuming it. My other recent junk books of choice include Michael Connolly books, particularly the Harry Bosch books which were recommended to me by a former California Supreme Court justice, and a Ken Follett book, <i>Eye of the Needle. </i>I have also dabbled in John LeCarre books and raced through the <i>Hunger Games </i>series (not to be confused with another junk series that started with <i>Game of Thrones</i>).<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-l7R81Qqbwgo/T0MK-wP8whI/AAAAAAAABCQ/nRxROsEAR0o/s1600/3543944775.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-l7R81Qqbwgo/T0MK-wP8whI/AAAAAAAABCQ/nRxROsEAR0o/s320/3543944775.jpg" width="209" /></a></div>However, where I deviate from Browning is the location for reading these books. I tend to consume junk books either at home or in the car. In fact, I find that I am able to read more serious books on an airplane, probably because I can not be distracted by the siren call of the internet. I used to try to listen to nonfiction in the car but soon discovered that it is harder to follow nonfiction while driving than a well narrated fiction book. And when I am home at night after reading "serious stuff" all day at work, a nice mystery can take the edge off and keep me away from the internet.<br />
<br />
I know it is pejorative to call some of these books "junk". I do not mean to offend those who read these as a steady diet. Understand that this is my problem. I feel the need to educate and enrich myself all the time and quite frankly the junk books are just good entertainment rather than enrichment. Thus I feel guilty, which Browning also seems to feel, about too much indulgence in junk books which leave you feeling full but not really nourished. So I continue to slog through complicated nonfiction and sometimes even Literature but occasionally I crave a visit with Harry Bosch. Oh, and if John Mortimer's Rumpole books qualify as junk, I should look into taking those up again.<br />
<br />
P.S. I am listening to Don Quixote (Edith Grossman translation) on audio disc in the car these days. Sometimes I yearn for Ruth Rendell but I am enjoying the book for the most part. It makes me laugh at times. Not bad for what is reportedly the <a href="http://www.guardian.co.uk/world/2002/may/08/humanities.books">most meaningful book ever written and the one novel you should read before you die.</a> Substance and entertainment. What a concept.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-71359728256940912602012-01-22T11:37:00.000-08:002012-01-27T07:02:19.261-08:00Bottomless Bucket List and Beauty of NatureWhen one has a serious disease, one thinks about creating bucket lists. In my opinion everyone should have the bucket list anyway and try to live life as though the amount of time you have left is uncertain. I did not adhere to that dictum myself for most of my life but now I have an endless list of things I want to do, or perhaps more appropriately, a bottomless bucket.<br />
<br />
Incidentally, oxforddictionaries.com <a href="http://oxforddictionaries.com/definition/bucket+list?region=us">says that bucket list</a> is a very recent term, popularized by the <a href="http://www.imdb.com/title/tt0825232/">2007 movie </a>of the same name. However,<a href="http://www.slate.com/blogs/browbeat/2011/11/09/bucket_list_what_s_the_origin_of_the_term_.html"> June Thomas in Slate </a>traces the term back to 2004 from a book and even finds a use as early as 1993 in a NLRB report. I seem to remember hearing the phrase before the 2007 movie but certainly it is likely that the movie helped the term become ubiquitous.<br />
<br />
In any event, I decided with the Better Half that we would see Yosemite National Park in all four seasons this year. We actually started in early June 2010 after my first and horrific round of chemotherapy, thereby catching the park in Spring. We returned in late June, early July 2011, October 2011 and last weekend, January 13-16, 2012. We got somewhat representative weather in the first three trips. However, the trip last weekend wound up being very unusual because Yosemite did not have any snow.<br />
<br />
The absence of snow was good news and bad news for me. The bad news was that we really did not get the typical winter pictures at Yosemite and we did not get to see Badger Pass which is only open when there is snow. The good news was that we were able to go on roads that are normally closed during the winter, specifically Glacier Point and Tioga Pass. <br />
<br />
On the first day we were in the Valley, we went to the <a href="http://www.nps.gov/yose/naturescience/scenic-vistas-tunnel-view.htm">Tunnel View</a> on our way to catch sunset at Glacier Point. At Tunnel View, a reporter from channel 2 in San Francisco interviewed us because Yosemite had decided to allow free entrance for the holiday weekend due to the lack of snow. We are in the beginning of the interview. Don't blink or you will miss us.<br />
<br />
<a href="http://www.ktvu.com/videos/news/yosemite-vistors-to-enjoy-free-admission-and/vFmwf/">YOSEMITE: Vistors to enjoy free admission and unseasonable...</a><br />
<br />
We then were able to get to Glacier Point about a half hour before sundown. Here are four pictures of Half Dome taken from roughly the same point in the four different seasons:<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-fx0XDsGIDIw/TxxZTW5zpLI/AAAAAAAABAw/9LNXVXqvFc0/s1600/274halfdome.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="265" src="http://1.bp.blogspot.com/-fx0XDsGIDIw/TxxZTW5zpLI/AAAAAAAABAw/9LNXVXqvFc0/s400/274halfdome.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Late spring 2010</td></tr>
</tbody></table><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-PdQSZlEtkPk/TxxZiWA4G6I/AAAAAAAABBA/VSR8q4WRFN0/s1600/DSC_0056.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="306" src="http://4.bp.blogspot.com/-PdQSZlEtkPk/TxxZiWA4G6I/AAAAAAAABBA/VSR8q4WRFN0/s400/DSC_0056.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Early Summer 2011</td></tr>
</tbody></table><div class="separator" style="clear: both; text-align: center;"><br />
</div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-CItV1akC3ME/TxxZgqJl5uI/AAAAAAAABA4/WljXNFyQOw8/s1600/DSC_0584.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="303" src="http://4.bp.blogspot.com/-CItV1akC3ME/TxxZgqJl5uI/AAAAAAAABA4/WljXNFyQOw8/s400/DSC_0584.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Autumn 2011</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-k84Bhwmc35k/TxxZkiLKibI/AAAAAAAABBI/g4XCHoshREc/s1600/DSC_0861.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-k84Bhwmc35k/TxxZkiLKibI/AAAAAAAABBI/g4XCHoshREc/s400/DSC_0861.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Winter (January) 2012</td></tr>
</tbody></table>The other wonderful place we were able to visit by car was Tioga Road. We were told on our trip there on January 15, 2012 that this year is the first <a href="http://www.nps.gov/yose/planyourvisit/tmconditions.htm">since 1933</a> that the Tioga Road has been open in winter. The road closed two days later on January 17, 2012 as storm systems moved into the area, unfortunately including a <a href="http://www.ktvu.com/ap/ap/california/1-dead-at-yosemite-as-windy-storms-pound-calif/nG536/">deadly storm last night</a> in Yosemite Valley, reminding us that nature can be beautiful and baneful.<br />
<br />
On Tioga Road we stopped at <a href="http://www.yosemitehikes.com/tioga-road/olmstead-point/olmstead-point.htm">Olmsted Point</a> to get a sun-riddled photo of the back side of Half Dome and a distant shot of Tenaya Lake:<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-brs5Mu-crsA/TxxfZdr8IpI/AAAAAAAABBQ/G9tCF2yiqpU/s1600/DSC_0034.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-brs5Mu-crsA/TxxfZdr8IpI/AAAAAAAABBQ/G9tCF2yiqpU/s400/DSC_0034.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">View of Half Dome from Olmsted Point</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-cAtv7xSQLRI/TxxfbUgK-TI/AAAAAAAABBY/ho5YJzAtxos/s1600/DSC_0037.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://3.bp.blogspot.com/-cAtv7xSQLRI/TxxfbUgK-TI/AAAAAAAABBY/ho5YJzAtxos/s400/DSC_0037.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">View of Tenaya Lake from Olmsted Point</td></tr>
</tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-rKfEVeGY2KI/Txxh41sOJqI/AAAAAAAABBg/gmGA_BYj3Bw/s1600/DSC_0040.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://2.bp.blogspot.com/-rKfEVeGY2KI/Txxh41sOJqI/AAAAAAAABBg/gmGA_BYj3Bw/s400/DSC_0040.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tenaya Lake</td></tr>
</tbody></table><br />
<br />
Then we moved on to Tenaya Lake which was frozen solid and <a href="http://sacramento.cbslocal.com/2012/01/15/winter-rarity-ice-skating-at-yosemites-tenaya-lake/">readily suitable for ice skating for the first time since 1930</a>. Based on the tip from our waiter at the Ahwahnee, my daughter bought a pair of used skates from the Curry Village ice rink and took off across the lake in what she described as an unbelievable experience. True, the ice was not as pristine as that in an indoor rink but she said that being able to skate the distance of two olympic rinks in the beautiful outdoors was spectacular. Even I walked out on the ice after discovering that it was less slippery for my UGG boots than the pebbles or leaves on the hills down to the lake. My daughter's dog enjoyed a run as well.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-OQ0HyYtS2j0/Txxjt1Lh0ZI/AAAAAAAABBo/1H80E2u5SlI/s1600/DSC_0057.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-OQ0HyYtS2j0/Txxjt1Lh0ZI/AAAAAAAABBo/1H80E2u5SlI/s400/DSC_0057.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Catch Foot Spiral on Tenaya Lake</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-UFjcQh7wEiQ/TxxjwjHFDmI/AAAAAAAABBw/8-Dx6tLQJmU/s1600/DSC_0059.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://1.bp.blogspot.com/-UFjcQh7wEiQ/TxxjwjHFDmI/AAAAAAAABBw/8-Dx6tLQJmU/s400/DSC_0059.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Taking Off on Tenaya Lake</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-r25s5R09HFQ/TxxjyOFwtUI/AAAAAAAABB4/JcaOY6Xslek/s1600/DSC_0065.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://2.bp.blogspot.com/-r25s5R09HFQ/TxxjyOFwtUI/AAAAAAAABB4/JcaOY6Xslek/s400/DSC_0065.JPG" width="397" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Novella enjoys the ice on Tenaya Lake</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-1vnlUHXP1Ws/TxxjzlBHVTI/AAAAAAAABCA/skdHLiOjAyE/s1600/DSC_0066.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-1vnlUHXP1Ws/TxxjzlBHVTI/AAAAAAAABCA/skdHLiOjAyE/s400/DSC_0066.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A dog and her boy</td></tr>
</tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-j0jT8wpkpss/Txxj2EoeK1I/AAAAAAAABCI/cumwbgTKK5M/s1600/DSC_0076.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="http://4.bp.blogspot.com/-j0jT8wpkpss/Txxj2EoeK1I/AAAAAAAABCI/cumwbgTKK5M/s400/DSC_0076.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Returning from the other side of Tenaya Lake</td></tr>
</tbody></table><br />
<div>ADDENDUM (JANUARY 27, 2012) According to <a href="http://www.latimes.com/news/local/la-me-tioga-pass-20120127,0,225244.story">an article in the Los Angeles Times today</a> (1/27/12) the 1933 date above was the first date records were kept so it may indeed be much longer than 79 years since Tenaya Lake and the Tioga Road were open and clear of snow in mid January. As for the causes of the anomalous weather this year (other than the fact that I wanted snow and thus the weather thwarted me), the article cites both global warming projections and natural volatility of weather in California. All I can say is that I am glad I saw Yosemite two years in a row after record snow fall so that the waterfalls were full and plentiful. </div>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com2tag:blogger.com,1999:blog-6529774746474371944.post-85816013217978763162011-12-30T13:37:00.000-08:002011-12-30T14:14:50.209-08:00Boxing Out the Box Office<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-z40HhJV_B90/Tv4qoCSZ6tI/AAAAAAAABAQ/6GJax3U8yT0/s1600/6405537123.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="http://2.bp.blogspot.com/-z40HhJV_B90/Tv4qoCSZ6tI/AAAAAAAABAQ/6GJax3U8yT0/s400/6405537123.jpg" width="288" /></a></div><br />
Last night I went to a local movie theater for the first time in ages. I had to rely on my daughter to find the theater and where to park at Del Amo mall in Torrance. That area has certainly changed in recent years including the closing of the large Borders store where we spent many weekends for entertainment when our children were young. Another <a href="http://en.wikipedia.org/wiki/Disruptive_technology"><span id="goog_88685209"></span>"disruption"<span id="goog_88685210"></span></a> because of the <a href="http://www.baselinemag.com/c/a/IT-Management/25-Disruptive-Forces/5/">internet.</a><br />
<br />
I remembered why I do not like seeing movies in the theater anymore. The place was packed, which is good given that the movie we saw was made by my studio. But, even though the movie was adult fare, teenagers still were there, being their teenage selves. One couple talked out loud throughout the movie and laughed at two violent scenes where laughter was particularly inappropriate. And at one of the more dramatic parts of the movie near the end, the house lights came up making it very difficult to see what was happening on the screen. The air was filled with the odor of popcorn and chemicals meant to simulate "butter flavor". The previews were embarrassingly violent and silly.<br />
<br />
In contrast, I watched another recent movie, a Golden Globe contender, on my HD home flat screen the other night. That experience was much more enjoyable. I do not watch as many movies as I once did because strangely I do not have the patience to sit through most of them anymore. This movie at home however started slow but captured my interest as it went on. Perhaps I will watch more movies on demand now.<br />
<br />
Box office receipts are down this year after a few years of rebound. However, in the past 10 years, as <a href="http://www.latimes.com/entertainment/news/movies/la-fi-ct-box-office-wrap-20111230,0,2205189.story">reported by Ben Fritz and Amy Kaufman in the LA Times today</a>, box office attendance has been regularly dropping, now about 20% lower than its high point in 2003 and lower than anytime since 1995. See also <a href="http://www.the-numbers.com/market/">here</a> and <a href="http://www.mpaa.org/Resources/93bbeb16-0e4d-4b7e-b085-3f41c459f9ac.pdf">here</a> at page 6, both of which suggest the high point was in 2002. Ticket prices are certainly higher than they were ten years ago but still very reasonable in light of inflation and particularly when compared to other forms of entertainment. See <a href="http://www.mpaa.org/Resources/93bbeb16-0e4d-4b7e-b085-3f41c459f9ac.pdf">here</a> at page 12.<br />
<br />
Compared to other industries, the entertainment industry is not a high profit margin industry. In Fortune 500's<a href="http://money.cnn.com/magazines/fortune/fortune500/2009/performers/industries/profits/index.html"> most recent ranking of industries in 2009,</a> the entertainment industry ranked 51 out of 53 in return on revenues. In contrast, the internet industry (e.g. Google, Amazon, eBay) was second and pharmaceuticals was third. This low profitability ranking of the entertainment industry occurred at the same time internet industry <a href="http://www.wired.com/epicenter/2011/02/piracy-once-again-fails-to-get-in-way-of-record-box-office/">supporters </a>were complaining about record box office receipts and the "obvious" <a href="http://www.techdirt.com/articles/20090301/1406403935.shtml">lack of impact</a> on the industry by piracy.<br />
<br />
The La Times article cited above offers that video on demand is the cause of the decline in theatrical attendance. I like video on demand and I am willing to pay legitimately for it. Unauthorized downloads and streams of motion pictures that solely profit the pirate sites are another form of video on demand, either for free to the consumer or at a lower price than legitimate video on demand. If video on demand is indeed driving people away from the theaters, let's not ignore the impact of pirate videos which are another form of video on demand. To say piracy has had no impact on my industry and the average people who work in it is just dumb.<br />
<br />
<br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">DISCLAIMER: THE VIEWS IN THIS POST ARE MY OWN. THEY ARE NOT MEANT TO BE AND SHOULD NOT BE CONSTRUED TO BE STATEMENTS ON BEHALF OF MY EMPLOYER.</div><div><br />
</div>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-59924722423007929632011-12-29T12:56:00.000-08:002011-12-29T12:56:30.788-08:00Useful Gossip<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-11A88YxkY7A/TvKNQV6SY5I/AAAAAAAAA_4/_B-FoqUJtmg/s1600/rogue+cover.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400px" rea="true" src="http://2.bp.blogspot.com/-11A88YxkY7A/TvKNQV6SY5I/AAAAAAAAA_4/_B-FoqUJtmg/s400/rogue+cover.gif" width="267px" /></a></div><span style="font-family: inherit;">In reading</span> <em>The Rogue: Searching For the Real Sarah Palin</em> by Joe McGinniss, I have discovered that I love certain types of gossip. McGinniss' sources for the book, to the person, have some serious issues with Palin. Some seem to engage, at times, in the same "10th grade mean girl" mentality of which Palin is accused. For example, several sources claim that Palin was an absent and neglectful mother. One supported the contention by saying that she never showed up at her son's hockey games, notwithstanding her holding herself out as the ultimate "hockey mom" ferrying her son all the time to games all over the place. As a "soccer mom" myself, I spent most of my weekends for a number of years going to soccer games all over the place, sometimes leaving at ridiculous hours of the morning to get to places two hours away. But I am not sure I could tell you which parents never showed up although I am sure some did not. In a more extreme example, one Palin acquaintance said that Palin's children were "dirty"; no one ever cleaned out their ears. I started to think about whether I regularly cleaned my children's ears. I certainly bathed them every day but ears? As I read about people complaining about Palin's children, I felt as if no one in Alaska must ever get out the high school mentality.<br />
<br />
The book does however provide new information to me about Palin that is quite disturbing, even given my already low opinion of her. Here are some things I have learned:<br />
<br />
<ol><li>Palin had a history of quitting jobs. Before she quit as Governor of Alaska, she quit the job she had with the <a href="http://en.wikipedia.org/wiki/Alaska_Oil_and_Gas_Conservation_Commission">Alaska Oil and Gas Conservation Commission</a>, an appointment she received for her political support of the Governor of Alaska in 2003. Although she made it look like she was resigning to protest ethical problems with one of her fellow commissioners, McGinniss reports that Palin did not like the long commute from Wasilla to Anchorage.</li>
<li>Palin was an uber-evangelical Christian. She belonged to an Assemblies of God church in Wasilla that was a <a href="http://www.talk2action.org/story/2008/9/8/114332/7479">"rogue" church</a> itself. Palin believes in <a href="http://www.talk2action.org/story/2010/9/21/104431/670">witches as a manifestation of evil</a>, and a GPS like system for tracking evil in the world. She also believes that the earth is only 6000 years old and men walked with the dinosaurs. </li>
<li>Palin's son Track, as a teenager, had trouble with the law and used drugs, including cocaine, and did not graduate from high school. Sarah and Todd forced him into the Army, turning him from a political problem into an asset. I stupidly thought that his going into the army was voluntary and grew out of a crazy love of country nurtured in an ultraconservative family.</li>
<li>The circumstances surrounding the birth of her son Trig have been construed to show that Palin may not be his birth mother. She apparently <a href="http://articles.businessinsider.com/2011-05-05/home/29966006_1_photoshop-sarah-palin-digital-photography-and-photo">did not look pregnant</a>, even on the plane trip back from Texas to Alaska where she gave birth over a day after her amniotic fluid reportedly started to leak during the night. McGinniss says that he interviewed doctors about her and Todd's actions in response to the leaking fluid and they opined that if she were pregnant those actions would have been gross negligence. Rather than go to the hospital, Palin gave a speech in the afternoon, flew from Dallas to Seattle , waited for hours in the Seattle airport to continue her flight to Anchorage and then drove to Wasilla where she finally went to the hospital.</li>
<li>Palin was racist as a young woman and acted on her beliefs when she became governor by firing people of color in her administration. </li>
</ol><a href="http://www.nytimes.com/2011/09/15/books/joe-mcginnisss-the-rogue-on-sarah-palin-review.html">Janet Maslin dismisses</a> McGinniss' book by saying that most of it is "dated, petty and easily available to anyone with Internet access". However, she must have followed the nooks and crannies of information about Palin more than I, or anyone I know, did. I am inclined to agree with McGinniss that mainstream media avoided these issues when Palin was running for national office in 2008 and continue to avoid them today. So as far as I am concerned, if you push aside the gossipy tone of the book, the book does a public service by bringing more of this information about Palin into the mainstream. If I wasn't scared before, now I am even more scared.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-19696855781570290522011-12-24T08:29:00.000-08:002011-12-24T09:15:37.119-08:00Have Yourself A Merry Little Christmas<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-YmIE4rO4ghA/TvX9kP1fvkI/AAAAAAAABAE/tKpTXFhsnUE/s1600/332939_2523841333990_1192076398_32232220_260719170_o.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://3.bp.blogspot.com/-YmIE4rO4ghA/TvX9kP1fvkI/AAAAAAAABAE/tKpTXFhsnUE/s400/332939_2523841333990_1192076398_32232220_260719170_o.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Our Christmas Tree 2011</td></tr>
</tbody></table>Yesterday while I was reading an <a href="http://www.telegraph.co.uk/culture/music/classicalmusic/8971491/John-Rutter-a-modern-hero-for-harmony.html">article about John Rutter</a>, I started to feel a bit of the Christmas spirit. I must confess that so far this year I have not felt much like celebrating. Christmas has become a bit of a roller coaster. Two years ago I was in the hospital recovering from major surgery, requiring an emergency blood transfusion. I was starting my cancer odyssey, a journey on which I still travel having just finished another cycle of chemotherapy. Last year, I was in remission and feeling wonderful to be home for the holidays with my family.<br />
<br />
This year, I am missing my son and grandson who just left to return to Micronesia to spend Christmas with my daughter in law and granddaughter. My daughter and her boyfriend are here, having overlapped with my son and grandson for a few days so we could at least have Christmas 1.0 together last Sunday. The tree was delivered last Saturday, a bit late and not as nice as the one I got last year, so I felt a bit disappointed. However, my son stayed up most of the night decorating it and wrapping presents by himself. It reminded me of the many times I was up into the wee hours, either alone or with my husband, wrapping presents and putting them under the tree. <br />
<br />
So it is no surprise that this morning I was flooded with memories of Christmas Eves past. One year my husband and I spent a chunk of Christmas eve in our local mall picking up last minute gifts because we felt we had not gotten enough for people. Our children were teenagers at the time and I remember buying overpriced jeans for my daughter just to see the look on her face when she got something so unexpected. Unfortunately, this year, given our finances, I will have to be satisfied with her adult gratitude, as a poor college student, for anything we get for her.<br />
<br />
On another Christmas Eve, my husband and I found ourselves without a Christmas tree. We drove all over looking for one, either real or artificial, but kept coming up with nothing. After a few hours, we found a small lot with a handful of trees left and got a reasonably decent looking tree, thereby salvaging our tradition.<br />
<br />
Of course, we had one Christmas Eve like the one in the <a href="http://www.imdb.com/title/tt0116705/"><i>Jingle All the Way</i></a>, although not quite as extreme. Let's just say that someone in this family beat out another parent trying to get the last Teddy Ruxpin in Toys R Us on Christmas Eve. Our son, then 3 years old, was one happy boy on Christmas morning.<br />
<br />
I also, for many years, sent out what I hoped was a funny Christmas letter to friends and family, with a picture of our family. The last time I did that was about 6 years ago when my grandson was a baby. These days we don't get many cards anymore at home, and at work I get as many e-cards as I do paper cards. I wish I could still write a funny letter. I had an excuse during the years when things were not going so well but this year I have plenty of good things to report. My daughter has a 4.0 grade point average her first semester at UC Berkeley. My son is off in Micronesia with his beautiful family, including my grandson and 2 year old granddaughter, after spending two months here with us to be treated for back problems. He is applying to masters programs for next year. My husband and I are both in remission from cancer and trying to live life to the fullest. My mother in law, who still lives us, is puttering along at 86 and my son's sister in law, who also lives with us, is finishing a medical assistant training program which will hopefully allow her to get a job next year. All good things, but my days of sending out cards are over, just like my days of going to midnight mass and feeling the need to dress up for most occasions. "When I am an old woman, I shall wear yoga pants and t-shirts, although not in purple" (apologies to <a href="http://labyrinth_3.tripod.com/page59.html">Jenny Joseph</a>)<br />
<br />
John Rutter told the reporter, in the article referenced above, that the World War Two song <i>Have Yourself a Merry Little Christmas </i>"encapsulates the aching nostalgia of separated families and treads the fine line between happiness and heartbreak, which is what being human is all about." Perhaps not so surprising after all that this song should put me finally in the Christmas spirit.<br />
<br />
ADDENDUM The original song was<a href="http://en.wikipedia.org/wiki/Have_Yourself_a_Merry_Little_Christmas"> apparently</a> quite depressing. Judy Garland performed a slightly more positive version in the motion picture <i>Meet Me in St. Louis</i>, and<a href="http://youtu.be/5g4lY8Y3eoo"> this version</a> was popular during WWII. Frank Sinatra asked the songwriter to make the song more "jolly" for his version, which is the one we now hear the most. <br />
<br />
<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/LpPdl0StUVs" width="420"></iframe>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-43944377124480173272011-12-17T08:33:00.000-08:002011-12-17T08:33:22.943-08:00Help Keep Other Sisters AliveTis the season of giving and I am swimming in things I have received as gifts in the past for which I have no space in my house. So I think many times that the best gift we can give is to find a cause to support wholeheartedly. For two years now, I have sponsored a woman's education toward job skills through <a href="http://www.womenforwomen.org/">Women for Women International (WWI).</a> I now have sponsored two women and am adding a third for my daughter to sponsor. The two women I have sponsored are from Africa-- the first from Nigeria was born in 1988, is single and has 1 child . She attended her program in September, 2010 through February 2011. My current "sister" lives in Rwanda, is between 25 and 30 (apparently there are no birth records) and will be supported in the program until August 2012. I love the fact that they call the women our sisters. It gives another meaning to Help Keep a Sister Alive.<br />
<br />
In case you do not think women in most areas of the world need our attention please take a look at this YouTube video. It is not produced by WWI but certainly supports the underlying mission of WWI, as well as many other worthy charities for girl's education. See e.g <a href="http://www.halftheskymovement.org/get-involved">here </a><br />
<br />
<br />
<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/YwEhKu3T51Q" width="560"></iframe>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-81364849760117797632011-12-13T18:20:00.000-08:002011-12-13T18:20:18.612-08:00The Last Dosage-- No More Doxil for the Foreseeable Future<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-iXmwlETfXMs/TubhcCp3VgI/AAAAAAAAADI/cLxrw9W6tyM/s1600/DOXIL.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="110" src="http://4.bp.blogspot.com/-iXmwlETfXMs/TubhcCp3VgI/AAAAAAAAADI/cLxrw9W6tyM/s200/DOXIL.png" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"> <a href="http://doxil.com/">Doxil.com</a></td></tr>
</tbody></table><br />
UPDATED DECEMBER 13, 2011<br />
<br />
Janssen just released the last dosages of Doxil, <a href="http://online.wsj.com/article/BT-CO-20111212-714392.html">reportedly enough to treat </a>1000 people on the waiting list. Of course, it is too late for me. I am finished with this course of chemotherapy and hoping for the best so, if my turn on the waiting list comes up, someone will take my place .<br />
<br />
As I stated in <a href="http://helpkeepasisteralive.blogspot.com/2011/12/update-on-doxil-production-possible.html">my last post</a>, European Medicines Agency asked Janssen three weeks ago to notify doctors to monitor for possible side effects, such as sepsis, in use of Doxil as a result of quality control issues at its contract manufacturer, Ben Venue Laboratories (BVL). Janssen issued <a href="http://www.doxil.com/sites/default/files/DHCP_december2011.pdf">a letter to physicians today, December 12, 2011</a> with the release of the last doses of Doxil. Here is what it says about quality control issues:<br />
<br />
<blockquote class="tr_bq"><br />
We are aware of some recent information about the quality shortcomings at this contracted supplier of DOXIL®. We have performed thorough quality reviews of this additional supply of DOXIL®, which included a review of production procedures and extensive sample testing. Based on these assessments, Janssen Products, LP has now approved release of this supply from BVL for distribution through our patient allocation program.</blockquote><br />
Note that there is no mention of monitoring side effects whatsoever. Janssen instead decided to do "extensive quality reviews . . . and extensive sample testing." I hope they are right. Sepsis is not something to ignore and of course, physicians receiving this letter may not have been following the warning from the EMA so they would not have the heightened level of concern that EMA wanted Janssen to communicate about Doxil.<br />
<br />
Janssen also seems to be softpedaling the "shortcomings" at Ben Venue. The FDA last week issued <a href="http://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofGlobalRegulatoryOperationsandPolicy/ORA/ORAElectronicReadingRoom/UCM282550.pdf">another 483 report</a> dated December 2, 2011 about <a href="http://online.wsj.com/article/SB10001424052970203413304577086432685952686.html">extensive quality control</a> problems at Ben Venue, including <a href="http://online.wsj.com/article/BT-CO-20111208-711022.html">finding</a> urine in a container, leaky roofs still not repaired and metal particles in a product. Indeed <a href="http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2011/12/news_detail_001402.jsp&mid=WC0b01ac058004d5c1">the EMA </a>broadened their recall to include two additional drugs and issued <a href="http://online.wsj.com/article/BT-CO-20111209-714194.html">warnings</a> about another two additional drugs.<br />
<br />
And, confirming what I have been saying for some time now, Janssen acknowledges that there will be no Doxil for the foreseeable future. Janssen states in the <a href="http://www.doxil.com/sites/default/files/DHCP_december2011.pdf">12/12/11 letter to physicians</a> (which is stated in very similar wording in the <a href="http://www.doxil.com/doxil-supply-shortage">Janssen President's letter of the same date</a>):<br />
<br />
<blockquote class="tr_bq"><br />
This limited supply represents all of the remaining DOXIL® that had been previously produced by BVL. Please be advised that this modest supply of DOXIL® will not be sufficient to supply everyone on the wait list. We want to emphasize that this limited product availability does not foreshadow the potential for any additional supply of DOXIL® in the immediate future as we have no further information from BVL on when manufacturing will resume at its facility.</blockquote><br />
The problem, as I also mentioned in earlier blog posts (see e.g. <a href="http://helpkeepasisteralive.blogspot.com/2011/10/shortages-are-getting-worse-new-normal.html">here</a>) and as <a href="http://online.wsj.com/article/BT-CO-20111212-714392.html">Peter Loftus reports</a>, is that other chemotherapies are in shortage. I read over the weekend on an Inspire.com bulletin board for cervical cancer that women are having trouble getting cis-platin, a mainline treatment also of ovarian cancer. Carboplatin is also in short supply and was repeatedly discussed in <a href="http://finance.senate.gov/hearings/hearing/?id=cbf688f1-5056-a032-52aa-5d0c23a44d4f">last week's Senate Finance Committee hearing on drug shortages.</a><br />
<br />
Members of the Finance Committee seemed to be angling to remove the price increase cap from the Medicare Part B drug schedules so that the marketplace would correct for the shortages because financial incentive would be returned. Unfortunately, I think the free marketplace is why this issue has come to a head. <a href="http://aspe.hhs.gov/sp/reports/2011/drugshortages/ib.shtml#">A report issued in October 2011</a> by the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services (HHS) entitled <i>Economic Analysis of the Causes of Drug Shortages</i> suggests that the problem results from generic manufacturers avoiding excess capacity rather than the Medicare Part B cap. Drug shortages only exist in 10% of sterile injectable generics covered by Medicare Part B and, contrary to testimony before the Finance Committee by the conservative American Enterprise Institute representative, consolidation of the sterile injectable generic drug industry did not cause the shortages. The report said in a section entitled Supply:<br />
<br />
<blockquote class="tr_bq"><br />
Consolidation at the corporate level would be a significant contributor to drug shortages only if the consolidations have resulted in closures of manufacturing facilities that reduced production capacity. Conversations with leading generic drug manufacturers, and data from the FDA, indicate that the consolidations have not resulted in decreased production capacity or in the closure of manufacturing facilities.</blockquote><br />
<br />
The ASPE-HHS report concluded that the shortages resulted from long term choices by generic manufacturers to ensure that there would not be surpluses of certain highly specialized drugs for which they got lower prices because of limited demand. The report explained in a section entitled "Market Behavior":<br />
<br />
<blockquote class="tr_bq"><br />
Our analysis suggests that this change in capacity utilization stems from a combination of the effects of the increase in volume of chemotherapy drugs used, the expansion of products available for generic manufacturing because of patent expiration, and the complexity of manufacture and requirements for Current Good Manufacturing Practices. Entry cannot occur quickly in the sterile injectables industry because of the high fixed costs of specialized production and regulatory protections. Furthermore, because shortages are uncommon and occur in drugs for which capacity is highly specialized, and because there are few penalties for failing to supply contracted drugs, there is no financial return to investing in excess capacity — that is, capacity that is not used outside a supply shortage, and thus earns no revenue except during a supply shortage.</blockquote><br />
So, according to HHS this is a market driven phenomenon completely relating to drug companies trying to maximize profits and essentially preferentially choosing to manufacture more of higher price drugs. It is the marketplace at its best and worst, which is why I would advocate that these types of life saving drugs need to be regulated for the long term to ensure their supply when the profit seekers cannot be bothered.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-81089294805148821392011-12-05T08:09:00.000-08:002011-12-05T08:09:14.368-08:00Update on Doxil Production-Possible Quality Issues?<div class="separator" style="clear: both; text-align: center;"><br />
</div><a href="http://1.bp.blogspot.com/-68CFipr6vgU/Ttu08YwFToI/AAAAAAAAADA/jLtXSL1z6bU/s1600/2673535716.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="293" src="http://1.bp.blogspot.com/-68CFipr6vgU/Ttu08YwFToI/AAAAAAAAADA/jLtXSL1z6bU/s400/2673535716.jpg" width="400" /></a><br />
<br />
<br />
According to <a href="http://online.wsj.com/article/BT-CO-20111130-717456.html">the WSJ and our intrepid Doxil shortage reporter, Peter Loftus,</a> the FDA is working with Johnson & Johnson to address the fact the Ben Venue Laboratories <a href="http://www.benvenue.com/pages/release.html">has completely shut down </a>production of Doxil as of two weeks ago (November 19, 2011). However, the chances of Doxil being available anytime soon, in my opinion, are slim to none. I would love to have J&J really explain, other than in the vaguest generalities, why it will take some time to fix this situation but all of these manufacturing processes are shielded by the assertion of confidentiality due to proprietary interests. The FDA knows a little but <a href="http://www.voiceamerica.com/episode/57676/drug-shortage-in-cancer-care">they are not permitted to tell. </a> With something that affects life and death, the lack of transparency is astonishing and disturbing.<br />
<br />
Now however we have something new to worry about in the limited supplies of Doxil that are available. In early November 2011 the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP) as part a joint inspection with UK, French and US regulators found <a href="http://www.fda.gov/Drugs/DrugSafety/ucm281782.htm">"significant"</a> contamination and other quality control problems at Ben Venue. Ben Venue <a href="http://www.fda.gov/Drugs/DrugSafety/ucm281782.htm">"voluntarily"</a> pulled the plug on itself. EMA <a href="http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2011/11/news_detail_001392.jsp&mid=WC0b01ac058004d5c1&jsenabled=true">recommended </a>the recall of three drugs: <a href="http://www.velcade.com/AboutVelcade.aspx?gclid=CO_4lIf06KwCFUvCtgod2nshKw">Velcade</a>, (<a href="http://en.wikipedia.org/wiki/Millennium_Pharmaceuticals">Millennium and J&J</a>) used for multiple myeloma, <a href="http://www.vidaza.com/patient/default.aspx">Vidaza</a> (Celgene) used to treat anemia, leukemia and bone marrow disease (MDS) and <a href="http://www.chemocare.com/bio/busulfan.asp">Busilvex(aka Busulfex</a>), used to treat a form of leukemia. The Hong Kong regulatory agency <a href="http://www.inpharm.com/news/170094/quality-fears-prompt-cancer-drug-recalls">has joined in</a> and expanded this recall. The FDA has <a href="http://www.fda.gov/Drugs/DrugSafety/ucm281782.htm">NOT issued</a> any recall.<br />
<br />
EMA did not recall Doxil (Caelyx) because Ben Venue was the sole source for manufacturing the drug. However, it did recommend that the drug not be used for new patients, an irony given that the drug is essentially not available except for the limited doses that have been distributed. It also asked that doctors monitor patients for side effects like the deadly <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001687/">sepsis</a>. Janssen was asked to circulate a letter to that effect to physicians but nothing has yet been posted on the<a href="http://www.doxil.com/doxil-supply-shortage"> Doxil website </a>as of today, December 4, 2011. Here is <a href="http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2011/11/news_detail_001392.jsp&mid=WC0b01ac058004d5c1&jsenabled=true">what EMA said</a> about Doxil (Caelyx):<br />
<br />
<br />
<blockquote class="tr_bq"><br />
For Caelyx, for which Ben Venue is the only manufacturing source, the CHMP considers the product to be essential only for patients already on treatment. It recommended that supplies should be available to maintain these patients on Caelyx but no new patients should be started on treatment with Caelyx until further notice. The CHMP advised that healthcare professionals should monitor treated patients intensively and immediately notify any relevant safety concerns that could be evidence of a quality assurance problem (particularly any cases of sepsis or suspected sepsis, such as acute pyrexia). The marketing authorisation holder, Janssen, has been asked to circulate a communication to healthcare professionals to reinforce these messages, requesting them to enhance monitoring and report any suspected adverse reaction or complaints that could be evidence of a quality assurance problem with the aseptic filling process. The CHMP will review the situation on a continuous basis.</blockquote><br />
For those of you who may still be taking Doxil, please check with your doctor about this warning. I suspect Janssen has not yet issued the letter even though EMA posted its findings almost two weeks ago. Unfortunately, given that emergency injectable antibiotics are also in shortage (13% of all shortages; see page 14 of <a href="http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM277755.pdf">this FDA report)</a>, it may not be worth the risk to take any Doxil now.<br />
<br />
Originally posted on my other blog on December 4, 2011Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-30383917038514699102011-11-19T16:46:00.001-08:002011-11-21T16:52:37.194-08:00Shortages of Drugs for Life Threatening Illnesses- An Overview<div class="separator" style="clear: both; text-align: center;"><br />
</div><a href="http://4.bp.blogspot.com/-ekd-IDi-NCU/TshNNw4cioI/AAAAAAAAACw/e1cxAi26KwY/s1600/3511579017.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="236" src="http://4.bp.blogspot.com/-ekd-IDi-NCU/TshNNw4cioI/AAAAAAAAACw/e1cxAi26KwY/s320/3511579017.jpg" width="320" /></a><br />
UPDATED NOVEMBER 21, 2011<br />
<br />
If you have followed the news and this blog, you know that there is a nationwide shortage of Doxil, a chemotherapy drug used to treat recurrent ovarian cancer, multiple myeloma and Kaposi’s sarcoma. News of the shortage first surfaced in July 2011 with new supplies expected in mid or late August, 2011. However, that prediction from the drug distributor turned out to be wholly inaccurate.<br />
<br />
The drug is owned and distributed by Janssen Products, LP, a Johnson & Johnson company. Ben Venue Laboratories in Bedford, Ohio, the <a href="http://www.benvenue.com/">manufacturing arm of Bedford Laboratories</a> and a unit of Boehringer Ingelheim GmbH of Germany, manufactures Doxil under contract to Janssen. <br />
<br />
To explain the Doxil shortage, <a href="http://online.wsj.com/article/SB10001424053111903554904576460290484704816.html">Ben Venue’s representative said </a>that the company is facing "manufacturing capacity constraints" that have held up some products, and it is working diligently to prioritize and expedite manufacturing for current orders." However, <a href="http://www.advfn.com/news_Ben-Venue-To-Exit-Drug-Contract-Manufacturing-Business_48897823.html">Ben Venue Labs has decided</a> to exit the Doxil business and other contract manufacturing to focus more on its business as Bedford Laboratories, a producer of generic injectables, and avoid <a href="http://online.wsj.com/article/BT-CO-20110819-712649.html">all the problems that have caused bans </a>from Canada and Europe of Ben Venue products. In the meantime, as Bedford Laboratories, the company has <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=57">discontinued manufacture of mainline cancer drugs cisplatin </a>and <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=659">carboplatin</a> and has significant shortages of Taxol. It appears to <a href="http://www.bedfordlabs.com/our_products/online_catalog/brand.html">focus on commonly prescribed </a>and presumably more profitable drugs such as those that treat migraine (generic Imitrix), indigestion (generic Zantac) and high blood pressure (generic Inderol).<br />
<br />
With Ben Venue moving on to greener pastures, who will J&J find to manufacture Doxil and how hard will they try? Doxil <a href="http://inthesetimes.com/article/11935/u.s._drug_shortage_big_pharma_big_phuck-up/">reportedly</a> represents less than 1% of Johnson & Johnson revenues.<br />
<br />
As of today, there is no indication that the Doxil shortage will end any time soon. Janssen's president, a cancer survivor himself, <a href="http://doxil.com/doxil-supply-shortage">sympathizes</a> with those affected by having treatment plans interrupted or changed. However, in 2010, Janssen chose to rely on one manufacturer to produce Doxil, even though in the past, it had a <a href="http://www.inpharm.com/news/caelyx-rights-revert-back-janssen">second manufacturer abroad</a>, Schering Plough. Doxil also has no generic competition because <a href="http://ovarian-cancer.emedtv.com/doxil/generic-doxil.html">it effectively still has patent protection</a> in the US until 2014. <a href="http://en.wikipedia.org/wiki/Doxorubicin#Doxil_Shortage">Doxil's patent expired in 2009</a> but J&J/Janssen still has the monopoly under the Orphan Drug Act as a reward for acquiring the company which produced a drug for a rare condition-one affecting fewer than 200,000 people.<br />
<br />
In fact, on November 19, 2011, the <a href="http://online.wsj.com/article/BT-CO-20111121-706206.html">Wall Street Journal reported</a> that Ben Venue had stopped manufacturing drugs, including Doxil, altogether:<br />
<blockquote class="tr_bq">A troubled contract manufacturer, whose problems caused a shortage of Johnson & Johnson's (JNJ) cancer drug Doxil, has suspended manufacturing and distribution of products from its Ohio plant, saying routine preventive maintenance and other required actions were overdue. . . . Before its decision to halt production, Ben Venue had strained to balance factory remediation efforts with the need to continue supplying critical drugs, a newly released document shows.</blockquote>See also<a href="http://www.washingtonpost.com/business/industries/report-johnson-and-johnsons-cancer-drug-doxil-faces-more-supply-issues-on-supplier-woes/2011/11/20/gIQAWZsJfN_story.html"> here.</a><br />
<br />
Janssen knew or should have known that Ben Venue had a history of manufacturing and quality control problems that would lead shortages and thus should not have been the sole manufacturer in the world of Doxil (called Caelyx in other parts of the world.) The FDA recently issued an unusually lengthy <a href="http://www.fda.gov/downloads/AboutFDA/CentersOffices/ORA/ORAElectronicReadingRoom/UCM275843.pdf">483 report</a> showing complaints about quality control since 2006 and 48 GMP (good manufacturing practices) <a href="http://www.fiercepharmamanufacturing.com/story/ben-venue-inspection-yields-48-gmp-violations/2011-10-19.">violations</a>. <a href="http://www.accessdata.fda.gov/scripts/warningletters/wlSearchResult.cfm?company=Ben%20Venue%20Laboratories,%20Inc.">Public records of these FDA inspections</a> and <a href="http://findarticles.com/p/articles/mi_hb5677/is_2_11/ai_n32100654/">an earlier 483 report</a> have been available since at least 2007. The European Medicines Agency <a href="http://www.pharmalot.com/2011/06/why-a-boehringer-unit-really-has-drug-shortages/">also inspected Ben Venue</a> and found quality control issues.<br />
<br />
Not only is Doxil currently unavailable for most people who need it, the mainstay chemotherapies for ovarian cancer--cisplatin, carboplatin and taxol (placitaxel) are also in <a href="http://www.ashp.org/drugshortages/current/">shortage</a>. Cervical cancer and endometrial cancer are also disproportionately affected by these shortages. The <a href="http://cancer.about.com/od/chemother3/a/chemocervical.htm">common drugs used to treat cervical cancer</a>, cisplatin, carboplatin, taxol (placitaxel) and fluorouracil, 5-FU, are all in shortage. <a href="http://en.wikipedia.org/wiki/Fluorouracil">Fluorouracil</a> is also used to treat colorectal cancer and pancreatic cancer, which are obviously gender neutral cancers. And do not forget that <a href="http://www.healthcentral.com/breast-cancer/chemo-regimen.html">Taxol is one of the mainstay treatments for breast cancer </a>which is <a href="http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp">diagnosed in about 230,000 women per year in the U.S. with 2.5 million survivors</a>. <a href="http://www.cancer.org/Cancer/EndometrialCancer/DetailedGuide/endometrial-uterine-cancer-treating-by-stage">Endometrial cancer’s mainline chemo treatments</a> are carboplatin, Taxol, doxorubicin and cisplatin, all of which are in short supply. Unfortunately, another cancer whose treatment is seriously affected is testicular cancer, for which <a href="http://tcrc.acor.org/chemo.html">3 of 4 mainline chemo treatments </a>(Bleomycin, Etoposide, and Cisplatin) have shortages. The following generic drug companies have mainline chemo shortages:<br />
<br />
Taxol-- APP, Bedford, Hospira, Sandoz and Teva<br />
Carboplatin-- APP, Bedford, Sandoz and Teva.<br />
Cisplatin-- APP, Bedford, BMS and Teva.<br />
Fluorouracil--APP, Teva, and Mylan<br />
Bleomycin—APP, Bristol-Myers, Hospira and Teva (Bedford ceased manufacture)<br />
Etoposide—APP, Bedford, Teva<br />
<br />
Drug shortages, which <a href="http://www.ashp.org/DrugShortages/Current/">according to the American Society of Health-System Pharmacists (ASHP</a>) as of today exceed 200 drugs, (the <a href="http://www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm">FDA</a>, who receives voluntary reports of shortages from drug companies, lists over 170) do not just affect people with relatively rare cancers or just people with cancer in general. <a href="http://www.npr.org/2011/10/04/141048466/doctors-and-patients-manage-drug-shortages">The shortages include </a>anesthetics, IV propofol used for intubation when someone cannot breathe, injectable antibiotics such as streptomycin,and norepinephrine and <a href="http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs">labetalol </a> which regulate emergency cases of low and high blood pressure respectively. So these shortages may affect any of us and most likely in an emergency setting when you rely on hospitals and medical personnel having the medications necessary to keep you alive. And as shortages of one drug occur, other substitute drugs have increased demand, which then can lead to their shortages. No relief seems to be in sight. As NPR says, drug shortages are "the new normal".<br />
<br />
<a href="http://www.c-spanvideo.org/program/DrugSho">A hearing was held </a>on Friday September 23, 2011 in the <a href="http://energycommerce.house.gov/hearings/hearingdetail.aspx?NewsID=8926">House Energy and Commerce subcommittee on Health about the drug shortages. </a><br />
<br />
FACTS FROM THE HEARING (as <a href="http://www.ovariancancer.org/2011/09/27/update-on-ovarian-cancer-drug-shortages/">reported</a> by Ovarian Cancer National Alliance):<br />
• 54 percent of shortages are due to quality control issues<br />
• 21 percent of shortages are due to delays in manufacturing or capacity issues<br />
• 99 percent of hospitals report experiencing one or more drug shortage in the first six months of 2011<br />
• 66 percent of hospitals report an oncology drug shortage<br />
• In an April 2011 survey, more than 90 percent of anesthesiologists reported at least one drug shortage at the time of the survey and 98 percent reported a shortage at some time during the past year<br />
• The shortages have cost hospitals $415 million in drug and labor costsScoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-89673710346386843062011-11-14T21:49:00.000-08:002011-11-14T21:49:05.853-08:00Money, Money, Money, Money . . . Money- More on the Doxil Shortage<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-CyMGGfFXTGU/TsH4daAFKqI/AAAAAAAAACk/bdRsm3EyBqs/s1600/61056391.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="326" src="http://2.bp.blogspot.com/-CyMGGfFXTGU/TsH4daAFKqI/AAAAAAAAACk/bdRsm3EyBqs/s400/61056391.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">"Some people got to have it."</td></tr>
</tbody></table><br />
J&J company, Janssen Products, LP, posted an <a href="http://www.doxil.com/doxil-supply-shortage">update last week(on 11/9/11)</a> about the Doxil shortage. Unfortunately there is no indication that the shortage will end any time soon. Janssen's president, as a cancer survivor himself, sympathizes with those of us affected by having our treatment plans interrupted or, in my case, changed. But, we are s#!t out of luck because Janssen chose to rely on one manufacturer to produce a drug which has no generic competition because it <a href="http://ovarian-cancer.emedtv.com/doxil/generic-doxil.html">effectively still has patent protection in the US until 2014</a>. (<a href="http://en.wikipedia.org/wiki/Doxorubicin#Doxil_Shortage">Doxil's patent expired in 2009</a> but J&J/Janssen still has the monopoly under the Orphan Drug Act as a reward for acquiring the company which produced a drug for a rare condition-one affecting fewer than 200,000 people).<br />
<br />
According to Janssen, this shortage has nothing to do with profit. Here is Janssen's <a href="http://www.doxil.com/doxil-supply-shortage#supply_ancor">explanation</a>:<br />
<br />
<br />
<h2 id="supply_ancor" style="color: #7a2531; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 15px; font-weight: bold; line-height: 14px; margin-bottom: 3px; margin-left: 0px; margin-right: 0px; margin-top: 1em; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; text-align: center;">Supply Management and Reason for the Current Shortage of DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 11px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup></h2><span class="Apple-style-span" style="color: #666666; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px;"><br />
</span><br />
<blockquote class="tr_bq">It is our practice to provide early warning of any shortage in supply of our medications so that prescribers, pharmacists and authorized distributors have as much lead time as possible to plan and source alternative treatment options where it may be appropriate. We alerted the U.S. Food and Drug Administration (FDA) and the healthcare community in June when we first determined that DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> might be in short supply for a few weeks. When we learned that the shortage would be longer term, we quickly alerted healthcare professionals and directed them not to start new patients on DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup>. We have since continued to provide regular updates on the status of DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> supply. </blockquote><blockquote class="tr_bq"><i>The current short supply situation has been caused, in part, by unplanned downtime due to equipment failures at our independent specialty manufacturer. </i>Some have challenged us, asking if our DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> shortage is financially motivated in any way. We appreciate this opportunity to tell you that this is absolutely not the case. </blockquote><blockquote class="tr_bq">We are working closely with this supplier to restore uninterrupted access to DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> as quickly as possible. Until that time, we expect product supply to remain intermittent over the next several months as this manufacturer works to return production capacity to the levels necessary to supply all patients in need. DOXIL<sup class="reg-sup" style="font-family: arial; font-size: 9px; font-weight: bold; position: relative; top: 1px; vertical-align: text-top;">®</sup> is complex to manufacture -- consisting of multi-step processes that require significant production times – which may add to the time it takes to bring us back up to full supply. (Italics added)</blockquote><div style="color: #666666; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 1em; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"></div><div>I still do not understand how equipment failures would lead to such a long time to restore production. I am inclined to believe Ben Venue's original explanation to the<a href="http://online.wsj.com/article/SB10001424053111903554904576460290484704816.html"> WSJ in July 2011 </a>that Ben Venue had made decisions to "prioritize" drug production in response to a loss of production capacity and other production problems at their facility. To me, this statement makes clear that Ben Venue decided to focus on manufacturing other more profitable drugs than Doxil when production problems arose, which is supported by Ben Venue's decision at about the same time to get out of the Doxil manufacturing business. Given that Janssen had only this one manufacturer and no contingency plan when production stopped, I can only conclude that Janssen did not consider this drug sufficiently important (i.e. profitable), notwithstanding their protestations to the contrary and their orphan drug exclusivity status.<br />
<br />
A recent article in the <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1109772">New England Journal of Medicine (<span class="Apple-style-span" style="border-collapse: collapse; font-family: 'Times New Roman', serif; font-size: 15px; line-height: 18px;">The Shortage of Essential Chemotherapy Drugs in the United States,</span><span class="Apple-style-span" style="border-collapse: collapse; font-family: 'Times New Roman', serif; font-size: 15px; line-height: 18px;">Mandy L. Gatesman, Pharm.D., and Thomas J. Smith, M.D.</span><span class="Apple-style-span" style="border-collapse: collapse; font-family: 'Times New Roman', serif; font-size: 15px; line-height: 18px;">N Engl J Med 2011; 365:1653-1655 November 3, 2011)</span> </a> also agrees that the drug shortages are first and foremost caused by profit motive:<br />
<blockquote class="tr_bq"><span class="Apple-style-span" style="border-collapse: collapse; font-family: 'Times New Roman', serif; font-size: 15px; line-height: 18px;">The main cause of drug shortages is economic. If manufacturers don't make enough profit, they won't make generic drugs. There have been some manufacturing problems, but manufacturers are not required to report any reasons or timetable for discontinuing a product. Contamination and shortages of raw materials probably account for less than 10% of the shortages.</span></blockquote>Janssen still has not told us much of anything about why the Doxil shortage happened and when it will be fixed. To me, that is completely irresponsible and lamentable. However, until the health care system in this country is not solely governed by the profit motive, we can expect no other result.</div><br />
<iframe width="420" height="315" src="http://www.youtube-nocookie.com/embed/Ll3uipTO-4A?rel=0" frameborder="0" allowfullscreen></iframe>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-4493291728014550652011-11-02T15:00:00.000-07:002011-11-12T12:18:50.306-08:00Halloween 3.0My son and grandson are visiting for a while and staying with us. I love having them here even with the chaos that inevitably comes from adding more people, including an active child, to the household. My 6 year old grandson joined me last night to watch an episode of Star Trek TNG which I forced my children to watch when they were growing up during the initial broadcasts. And my grandson dressed up as a Teenage Mutant Ninja Turtle for Halloween just like his Dad did over 20 years ago. Ironically I have the old costume from my son's childhood but it got put into deep storage so my grandson got his choice of a new costume.<br />
<br />
This year on Halloween I did not participate in handing out candy or going trick or treating with the grand-boy. Instead I stayed in my room reading and playing on the computer while others took over these Halloween tasks that I have done for so many years. My son carved a pumpkin which I saw in the kitchen before I went to "hide" in the bedroom. It looked fantastic and much better than anything I ever did when he was a child. I could not find our regular tea candles so, after grousing a while, I gave him a more expensive aromatherapy candle to put in the pumpkin to go outside. A few minutes later I saw the results of his artistry as the candle lit through the etchings on the pumpkin. However, I did not see it in person. Instead I saw a picture of it on Facebook. In addition to clicking "like" I yelled down to my son that the pumpkin looked great! Are we a modern family or what?<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://2.bp.blogspot.com/-POF1Me6Dcqg/TrG8T3p8HGI/AAAAAAAAA_g/jGbXd_qK69s/s1600/paradisepumpkin.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="http://2.bp.blogspot.com/-POF1Me6Dcqg/TrG8T3p8HGI/AAAAAAAAA_g/jGbXd_qK69s/s320/paradisepumpkin.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Paradise Pumpkin 10/31/11</td></tr>
</tbody></table>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-67904002403627686322011-10-26T16:00:00.000-07:002011-10-26T20:55:06.215-07:00I BELIEVE . . .In case you are not a friend of mine on Facebook I wanted to share with you some special writing I did today. My niece posted the following:<br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-m0zJNrKxTx4/TqiP5Jk_VTI/AAAAAAAAA_Q/toek-WC1Qf8/s1600/293572_179084375510000_151206238297814_385170_410200673_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://2.bp.blogspot.com/-m0zJNrKxTx4/TqiP5Jk_VTI/AAAAAAAAA_Q/toek-WC1Qf8/s320/293572_179084375510000_151206238297814_385170_410200673_n.jpg" width="320" /></a></div> My response, which gives you some idea about my mood, was the following:<br />
<blockquote class="tr_bq"><br />
<div style="font-family: Verdana,sans-serif; text-align: center;"><blockquote class="tr_bq"><b><span style="font-size: small;">I believe in black.</span></b><br />
<b><span style="font-size: small;">I believe laughing at people is the best medicine.</span></b><br />
<b><span style="font-size: small;">I believe in telling people to kiss off a lot.</span></b><br />
<b><span style="font-size: small;">I believe in pointing out when everything is going wrong.</span></b><br />
<b><span style="font-size: small;">I believe the prettiest girls are the happiest girls and I believe that tomorrow is another day </span></b><b><span style="font-size: small;">only</span></b><br />
<b><span style="font-size: small;">f</span></b><b><span style="font-size: small;">or Scarlett O"Hara.<br />
<b><span style="font-size: small;"><b><span style="font-size: small;">I believe in martinis, not miracles</span></b></span></b></span></b></blockquote></div></blockquote>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-56980908407382579912011-10-20T12:47:00.000-07:002011-10-20T12:47:20.618-07:00Red Herring re Drug ShortagesNBC Nightly News ran a program on October 17, 2011 about how the current drug shortage problem is being exacerbated by profiteers who are buying up available supplies of drugs in shortage and reselling to hospitals at exorbitant prices. There is no question that this price gauging is deplorable. But it is a red herring in my opinion. It shifts the focus away from the real issue which is why are there such extensive drug shortages in the first place. Why has our drug supply system fallen apart such that seriously ill patients cannot get the drugs they need to survive?<br />
<br />
<object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=10,0,0,0" height="245" id="msnbc79e605" width="420"><param name="movie" value="http://www.msnbc.msn.com/id/32545640" /><param name="FlashVars" value="launch=44938030&width=420&height=245" /><param name="allowScriptAccess" value="always" /><param name="allowFullScreen" value="true" /><param name="wmode" value="transparent" /><embed name="msnbc79e605" src="http://www.msnbc.msn.com/id/32545640" width="420" height="245" FlashVars="launch=44938030&width=420&height=245" allowscriptaccess="always" allowFullScreen="true" wmode="transparent" type="application/x-shockwave-flash" pluginspage="http://www.adobe.com/shockwave/download/download.cgi?P1_Prod_Version=ShockwaveFlash"></embed></object><br />
<div style="background: transparent; color: #999999; font-family: Arial, Helvetica, sans-serif; font-size: 11px; margin-top: 5px; text-align: center; width: 420px;">Visit msnbc.com for <a href="http://www.msnbc.msn.com/" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">breaking news</a>, <a href="http://www.msnbc.msn.com/id/3032507" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">world news</a>, and <a href="http://www.msnbc.msn.com/id/3032072" style="border-bottom: 1px dotted #999 !important; color: #5799DB !important; font-weight: normal !important; height: 13px; text-decoration: none !important;">news about the economy</a></div><br />
The program started with the right message i.e. the current drug shortages are harming children with leukemia as well as other cancer patients. The program properly focused on the fact that shortages will roll back years of progress in survival rates and children's lives (as well as others) will be lost. But NBC Nightly News, like the Congressional response thus far, took the left turn toward focusing on those who would profit from these drug shortages by price gauging rather than keeping the focus on the pharmaceutical companies who have caused the drug shortages in the name of maximizing <b>their</b> profit.<br />
<br />
Price gouging is a much easier target for a solution than the capitalist functioning of the pharmaceutical industry. Only a few diehard conservative economists will justify price gouging but it is a harder sell to talk about regulating an industry to require them to make less profitable drugs solely to save people's lives. It is a particularly hard sell in Washington D.C. where the pharmaceutical industry<a href="http://www.google.com/hostednews/ap/article/ALeqM5jIqmf40GY6nZyGPpFul-tjSYYOsA?docId=df4558bd374845dcb89aa2f741e3b3cc"> trade association PHRMA</a> and <a href="http://finance.yahoo.com/news/JJ-spent-13M-lobbying-in-2Q-apf-191337505.html?x=0">individual drug</a> <a href="http://www.google.com/hostednews/ap/article/ALeqM5gY-fWzsH2lFan-6BU9wjBSuW39xA?docId=058d990c35d74769a228a34185916c83">companies</a> are spending record amounts in lobbying this year.<br />
<br />
So let's not be distracted by the predators who will feed on the horrible situation of the drug shortage. Let's keep our eye on the real problem and try to make the drug companies accountable for the drug shortages that are only getting worse.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-55218507046057407292011-10-16T17:40:00.000-07:002011-10-16T17:40:34.115-07:00In the PinkTwo issues have been bothering me lately. One concerns the development of an "us vs them" mentality in the ovarian cancer community, a mentality that I also share even though I feel bad that I do. I have seen on ovarian cancer bulletin boards and websites a lot of posts of fury and frustration about how much airplay breast cancer gets when ovarian cancer is largely ignored. People are upset, for example, that stores had started putting up the pink breast cancer paraphernalia in September, which was Ovarian Cancer Awareness Month. Now that it is October, Breast Cancer Awareness month, you cannot go anywhere without tripping over pink stuff. It is infuriating given that ovarian cancer is a fairly deadly cancer for American women given its frequency- <a href="http://www.ovariancancer.org/about-ovarian-cancer/statistics/">about 15,000 women in the U.S. will die this year of ovarian cancer out of a population of approximately of approximately 177,000 women </a>who have been diagnosed with the disease. In contrast, breast cancer kills more American women in absolute numbers per year, <a href="http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-key-statistics">about 40,000</a>. However, t<a href="http://www.breastcancer.org/symptoms/understand_bc/statistics.jsp">here are currently 2.5 million breast cancer </a>survivors-- about 14 times as many as ovarian cancer survivors, whereas the number of breast cancer deaths is less than 3 times the number of ovarian cancer deaths. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-7K0UmlZ5o9g/TpsUEtvv64I/AAAAAAAAAB0/BSJ7PpCM3G4/s1600/5135406787.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://4.bp.blogspot.com/-7K0UmlZ5o9g/TpsUEtvv64I/AAAAAAAAAB0/BSJ7PpCM3G4/s400/5135406787.png" width="248" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Cupcakes for the Cure (after you finish your KFC)</td></tr>
</tbody></table><br />
When I am not also feeling annoyed about the prevalence of pink and the absence of teal, I want to urge everyone to focus on the fact that once no one paid any attention to breast cancer either. It has taken over 25 years to build up this much awareness for the disease, largely due to the actions of the Susan G. Komen Foundation ("Komen"). Perhaps teal needs to take a page from the Komen playbook.<br />
<br />
Which brings me to the second issue that has been bothering me. Are the methods worth the outcome of increased attention to the disease and money for research and treatment? Natasha Singer in today's (October 16, 2011) <a href="http://www.nytimes.com/2011/10/16/business/in-the-breast-cancer-fight-the-pinking-of-america.html?pagewanted=1&ref=business">New York Times reports</a> that Komen has raised billions for breast cancer awareness, treatment and research. Komen started with the Race for the Cure in 1983 but under founder Nancy Brinker's (Susan Komen's sister) salesmanship, Komen moved into commercial endorsements. Although pink was associated with Komen from the beginning, the <a href="http://www.livestrong.com/article/123443-history-pink-ribbon/">ubiquitous pink loop ribbon</a> came out in 1992 as part of an Estee Lauder campaign and taken from another cancer advocate, <a href="http://thinkbeforeyoupink.org/?page_id=26">Charlotte Haley, who first used a peach loop ribbon to solicit breast cancer donations</a>. And then the corporate sponsorships cascaded and grew until we find all sorts of interesting items in the pink genre-- such as <a href="http://www.kfc.com/promos/commercial_pinkbucket.asp">KFCs Buckets for the Cure</a>, Yoplait yogurt (<a href="http://blog.fooducate.com/2009/02/13/so-whats-inside-yoplait-yogurt-anyway/">with all its</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/9806115">potentially breast cancer causing sugar</a>), Egglands Best eggs (<a href="http://www.prwatch.org/node/9177">whose "humane" practices have been questioned)</a>, cooking appliances (I myself bought the "pink" Kitchenaid mixer because it was on sale for less than the other mixers) and even <a href="http://www.google.com/hostednews/ap/article/ALeqM5iEn7NakV7WIpjCIaQeONujDErorA?docId=343f7f025bb0404daee94ada015c1d08">potentially carcinogenic perfumes</a>.<br />
<br />
It troubles me that breast cancer awareness has become big business although it is hard to argue with success. For my teal sisters, I think we need to look carefully at the Komen model for raising money and awareness but we need to do something rather than feel sorry for ourselves that pink always seems to trump teal.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-4330482738822556072011-10-08T21:45:00.000-07:002011-10-10T15:48:52.624-07:00Want Not, Waste NotBefore I go in for infusions I do a pass through the house to toss out rotting food so I don't have to deal with it when I am feeling lousy from the chemo. When I did this pass yesterday, I was feeling bad about the fact that I tend to have eyes bigger than my stomach when I shop and inevitably buy food that winds up in the trash. For example, last weekend I bought some tofu spring rolls and heirloom tomatoes that I did not eat this week, and likely now are fodder for the trash can. This week I mostly ate a bean tortilla casserole that I forced myself to make with black beans I cooked last week which otherwise would be destined for the trash. <br />
<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-dnszMmnOW84/TpEmuXkrOCI/AAAAAAAAA-Y/Frx9y5_XKZA/s1600/2305988510.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="235" src="http://2.bp.blogspot.com/-dnszMmnOW84/TpEmuXkrOCI/AAAAAAAAA-Y/Frx9y5_XKZA/s320/2305988510.png" width="320" /></a></div><br />
It seems to me that worrying about overshopping is a luxury that those who do not have enough to eat would envy. However, <a href="http://www.npr.org/blogs/thesalt/2011/10/07/141123243/how-that-food-you-throw-out-is-linked-to-global-warming?sc=fb&cc=fp">NPR has posted a story</a> to make us who waste feel even guiltier. Citing <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007940">a research study</a>, NPR reported we Americans waste about 55 million tons of food a year, or 40 percent of the food supply. This represents about a 50% increase in food waste from 1974 when big Farma was beginning to overtake American agriculture to give us lower food prices. As food prices went down, increased food waste also accounted for 25% more water consumption, 300 million more barrels of oil a year and substantial increases in methane and CO2. Another scientist cited in the NPR story concluded that the average family gave up 1800 pounds of emissions from food wasted at home. Luckily for some of us who mostly eschew animal products, 35% of the wasted food is chicken, fish and fruit while only 15% is nuts and legumes. But, not so lucky for the environment because, as I have said elsewhere, food production and processing is the main source (80%) of greenhouse emissions.<br />
<br />
All of this data leads me to two conclusions. First, we need to cut down on production of animal products in the first instance given how much American food production is polluting the earth. I do my part in trying to eat virtually no animal products, although I am far from perfect in my occasionally use of dairy products and eggs.<br />
<br />
Second, and more difficult for me, is getting a much better sense of how much food to buy and what. I cannot afford the time or energy to go to the store every day. So I stock up on the weekends. Inevitably I buy too many perishable fruits and vegetables. Worse, for 6 months I belonged to a CSA and rarely ate any of the fruits and vegetables I got in my biweekly box. I hate to cut off a customer for the South Central LA CSA, but I am more disturbed by all the rotting vegetables I throw away. <a href="http://www.heifer.org/site/c.edJRKQNiFiG/b.1148753/">I do not see myself able to donate scraps to farms or zoos</a>, neither of which are nearby. Instead I need to figure out some system of what and how much to buy so I can reduce my waste foot print. But with food so colorful, available and inexpensive it is hard to say no when the stomach insists it wants that this week. Self discipline and not wanting would seem to be the best answer I have for reducing household food waste.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-65897763490464853492011-10-06T07:31:00.000-07:002011-10-06T20:11:25.690-07:00Shortages are Getting Worse-- the "New Normal"<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-WT9PKYM0mek/To0AzD7D-AI/AAAAAAAAABw/NMY3d7jgGIE/s1600/skyisfalling.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="http://1.bp.blogspot.com/-WT9PKYM0mek/To0AzD7D-AI/AAAAAAAAABw/NMY3d7jgGIE/s400/skyisfalling.jpg" width="266" /></a></div>In an odd way, I was pleased to see a <a href="http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs">report on NPR on October 3, 2011</a> that the drug shortages are worse than initially reported. I have been shouting "the sky is falling" since August, very concerned about the shortages affecting drugs like carboplatin, cisplatin and taxol, which are mainline treatments for several cancers (including taxol for the ubiquitous Pinks who should join our bandwagon during Breast Cancer Month). The NPR report emphasized that there appears to be only a month's supply left of taxol at Mass General, a major U.S. hospital.<br />
<br />
The NPR report also shone a light on the fact that these shortages, now up to 213 drugs, do not just affect people with relatively rare cancers or just people with cancer in general. <a href="http://www.npr.org/2011/10/04/141048466/doctors-and-patients-manage-drug-shortages">The shortages include anesthetics</a>, IV propofol used for intubation when someone cannot breathe, injectable antibiotics such as streptomycin,and norepinephrine and <a href="http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs">labetalol</a> which regulate emergency cases of low and high blood pressure respectively. So these shortages may affect any of you (or me if I develop other health problems) and most likely in an emergency setting when you rely on hospitals and medical personnel having the medications necessary to keep you alive. <br />
<br />
And more important, as I pointed out in <a href="http://helpkeepasisteralive.blogspot.com/2011/08/real-death-panels.html">The Real Death Panels?</a>, the shortages are leading to rationing--by the drug manufacturers like Ben Venue who are using an allocation system of only providing Doxil to a limited subset of those who already were in treatment with it, and by the hospitals or infusion centers who are deciding who more critically needs the drug. (see my blog post <a href="http://helpkeepasisteralive.blogspot.com/2011/07/shortages-ethics-and-scramble-to-stay.html">Drug Shortages, Ethics and the Scramble to Stay Alive</a>) For example, as the <a href="http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs">10/3/11 NPR report</a> states, hospitals are taking from some patients to give to others.<br />
<blockquote>One reason that Kevin Zakhar [a fifteen year old boy] hasn't been able to get the calcium solution he needs is that hospitals have been reserving it for patients who need it even more desperately than he does. </blockquote><blockquote>Kathy Gura, a pharmacist at Children's Hospital in Boston, points to one of those patients, a tiny infant born only 23 weeks past conception, as premature as a baby can be and still survive. And he wouldn't have survived without the same kind of IV feeding that Kevin Zahkar gets.</blockquote><blockquote>Gura and caregivers at other hospitals say they have had to divert scarce electrolytes from other children and adults to save the lives of fragile preemies. Gura calls it "robbing Peter to pay Paul."</blockquote>See also <a href="http://www.usatoday.com/news/opinion/forum/story/2011-09-13/cancer-drug-shortage/50389896/1">here</a> for a discussion of one breast cancer fighter's experience with drug rationing.<br />
<br />
And as shortages of one drug occur, other substitute drugs have increased demand which then can lead to their shortages. No relief seems to be in sight. As <a href="http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs">NPR says,</a> drug shortages are "the new normal". My reaction continues to be: how can that be possible in the United States which is known for innovation in science and medication development? How can it be possible in any civilized society-- to leave your most vulnerable citizens without needed medications?Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-56676775529467421742011-10-03T09:54:00.000-07:002011-10-03T12:16:37.066-07:00Picture This!The other evening I got together with a dear friend of mine. While we were eating dinner, she pulled out a small album of photographs from her trip to <a href="http://www.sacredsites.com/americas/peru/machu_picchu.html">Machu Picchu</a> and surroundings areas. As I flipped through the album she gave me background information and vignettes about aspects of the trip which the photos captured. <br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-yJNoz0kmfsM/TonniNBsfYI/AAAAAAAAA-U/il6AyPahWio/s1600/5358440259.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="327" src="http://4.bp.blogspot.com/-yJNoz0kmfsM/TonniNBsfYI/AAAAAAAAA-U/il6AyPahWio/s400/5358440259.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Old School Photo Album</td></tr>
</tbody></table><br />
The last time I showed anyone my pictures from a trip in person, I did it on an iPad. The person looking at them went through the pictures quickly and did not pause enough for me to give too much background or too many vignettes. But then, vacation photos have always been something that either you love or hate/tolerate.<br />
<br />
Remember sitting through slide shows of pictures of someone's vacation while they narrated each event? Those slide shows are fodder for many comedians' routines. Anyone who has been through such a slide show will recall the dread of going to someone's house where the slide projector and a screen were set up in the living room. The last "slide show" I saw briefly was on a DVD of old family photos from my husband's family. My children found it fascinating. I found something else to do.<br />
<br />
These days I typically look at people's pictures online. I will peruse online photos of something within a day or so of it happening if the poster gets the photos up right away. In that way, we are on virtual holiday with the poster. I also see a lot more photos than if I had to meet the people in person and look at a physical photo album. And I get to choose what I want to see rather than having it foist upon me a la old school vacation slide show.<br />
<br />
The downside, of course, is the lack of information and context about the pictures I see online. Some people are good about explaining the pictures. Others do a photo dump and leave you to guess what you are looking at. And even with the written explanations, nuance and detail just tend to not be there in postings online. <br />
<br />
On balance, I think I prefer looking at photos online. I can take the amount of time I want to look without boring others if I linger or offending if I go fast. I can zoom in if I want on aspects of the photo that intrigue. But, as I realized the other day when looking at my friend's photo album, there is clearly something lost in the online experience--the real time human sharing of experiences rather than virtual sharing. What you get with online sharing is mostly quantity and less quality of experience. Some would mourn the loss of the quality of the in person photo sharing experience. Perhaps I do a little.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-50496088371865775762011-09-28T18:59:00.001-07:002011-09-28T18:59:56.625-07:00More Publicity But No ProgressA new friend of mine who also has ovarian cancer sent me a link to the following video of coverage earlier this week on CBS News of the drug shortage. In it, the woman featured in the CBS News spot I <a href="http://helpkeepasisteralive.blogspot.com/2011/09/cbs-news-report-on-doxil-misses-some-of.html">posted earlier </a>is revisited. This time she has somehow been able to get Doxil, but only one dose and she reportedly does not know from month to month whether she will get any more.<br />
<br />
<embed allowfullscreen="true" allowscriptaccess="always" background="#333333" flashvars="si=254&&contentValue=50112185&shareUrl=http://www.cbsnews.com/video/watch/?id=7382449n&tag=cbsnewsSectionsArea;cbsnewsSectionsArea.4" height="279" salign="lt" scale="noscale" src="http://cnettv.cnet.com/av/video/cbsnews/atlantis2/cbsnews_player_embed.swf" type="application/x-shockwave-flash" width="425"></embed><br />
<br />
Janssen <a href="http://www.doxil.com/sites/default/files/DHCP_september2011.pdf-">updated its notice</a> on September 23 about availability of Doxil, explaining that they expected to release limited amounts within the next six weeks but reading between the lines correctly this shortage will likely continue for several years. Janssen reiterates that the supplies will not be enough for those on the waiting list. The <a href="http://online.wsj.com/article/SB10001424052970204422404576595251529541230.html">Wall Street Journal</a> reported on September 26, 2011 that 2500 people are still on the Doxil waiting list. I am one of those 2500.<br />
<br />
The WSJ article also confirmed that Doxil is not a big seller for Johnson & Johnson (Janssen's parent), representing less than 1% of annual revenue. It was heartening to see the emphasis in the CBS News report on the issue of profit in the decision making creating these shortages. I understand from <a href="http://www.ovariancancer.org/2011/09/27/update-on-ovarian-cancer-drug-shortages/">Ovarian Cancer National Alliance</a> (OCNA) that GAO will issue a "definitive report" this fall about the causes. Somehow I do not think profit will be their explanation.<br />
<br />
Here are some other <a href="http://www.ovariancancer.org/2011/09/27/update-on-ovarian-cancer-drug-shortages/">interesting facts reported by OCNA</a>:<br />
<blockquote>FACTS FROM THE HEARINGS<br />
<ul><li>Of the 4 billion prescriptions filled in the United States in 2010, 3 billion were generic drugs</li>
</ul><ul><li>54 percent of shortages are due to quality control issues</li>
</ul><ul><li>21 percent of shortages are due to delays in manufacturing or capacity issues</li>
</ul><ul><li>The integrity or safety of drugs sold on the gray market cannot be assured</li>
</ul><ul><li>The average mark up of drugs on the gray market is 650 percent; one-quarter of drugs sold on the gray market are marked up 2000 percent</li>
</ul><ul><li>99 percent of hospitals report experiencing one or more drug shortage in the first six months of 2011</li>
</ul><ul><li>66 percent of hospitals report an oncology drug shortage</li>
</ul><ul><li>In an April 2011 survey, more than 90 percent of anesthesiologists reported at least one drug shortage at the time of the survey and 98 percent reported a shortage at some time during the past year</li>
</ul><ul><li>The shortages have cost hospitals $415 million in drug and labor costs</li>
</ul></blockquote><br />
By the way, do you think CBS News read my post <a href="http://helpkeepasisteralive.blogspot.com/2011/08/real-death-panels.html">The Real Death Panels?</a> I find it very suspicious that they chose to show Nexium in their report after I featured it in my blog post. ROFLMAO.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com1tag:blogger.com,1999:blog-6529774746474371944.post-35947654766815070842011-09-25T10:33:00.000-07:002011-09-25T10:33:48.898-07:00More about Drug Shortages- Get Out Those Scarves and Teal Arm Bands<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">What if the government and private donations pumped money into the development of drugs to treat a deadly cancer but suddenly when distribution of the drugs became unprofitable the companies making them stopped production. What happens to the war on cancer then? Should we just accept that in a capitalist economy, profits determine who lives and who dies? <br />
<br />
I have written in other <a href="http://helpkeepasisteralive.blogspot.com/2011/09/awareness-is-good-treatment-is_11.html">posts</a> that it appears to me that the current chemo shortages are disproportionately affecting ovarian cancer, which is primarily an older woman's disease. I was please to find this American Cancer Society <a href="http://www.cancer.org/Cancer/news/News/chemotherapy-drug-shortages-concern-doctors-and-patients">article</a> that confirms my position. Unfortunately the article skews the discussion a bit about what has caused the shortages by also quoting a large pharmaceutal distributor (McKesson) saying essentially it's all the FDA's fault. The spokesperson claims that FDA's increased scrutiny on manufacturing processes and quality control have made certain drugs too low in profits to sustain production of those drugs. The article further states,"McKesson’s Chief Medical Officer Dr. Roy Beveridge, MD, says there is no economic incentive for manufacturers to make or distribute low-priced generic drugs, and that unless the baseline system changes, shortages are going to continue." <br />
</span><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-dbW-5OYpLs4/Tn9d8dwupdI/AAAAAAAAABs/5k26lERcZm0/s1600/3648153831.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="328" src="http://4.bp.blogspot.com/-dbW-5OYpLs4/Tn9d8dwupdI/AAAAAAAAABs/5k26lERcZm0/s400/3648153831.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">J&J Headquarters designed by IM Pei</td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><span class="Apple-style-span" line-height: 19px;">Ben Venue Labs, the manufacturer of Doxil, </span></span><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">a critical treatment for recurrent ovarian cancer,</span><span class="Apple-style-span" font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 19px;"> for a subsidiary of Johnson & Johnson, claims that the problem is not one profit. An <a href="http://www.courier-journal.com/article/20110921/FEATURES03/309210120/Drug-shortages-curtailing-treatment-options-Louisville-area-patients?odyssey=tab|topnews|text|Features">9/22/11 article</a> in courier-journal.com by Laura Ungar states:</span><br />
<blockquote><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><span class="Apple-style-span" line-height: 19px;">Jason Kurtz, spokesman for the Ohio-based third-party maker, Ben Venue Laboratories, would only say “we’re facing capacity constraints” with a drug that is complex to make. He wouldn’t specify what type of constraints, but said examples of such problems include unplanned downtime because of machinery breakdowns and capital-improvement projects that limit manufacturing capacity.</span></span></blockquote><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><span class="Apple-style-span" style="background-color: white; line-height: 19px;"><br />
</span></span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><span class="Apple-style-span" line-height: 19px;">However, <a href="http://www.advfn.com/news_Ben-Venue-To-Exit-Drug-Contract-Manufacturing-Business_48897823.html">Ben Venue Labs wants out of the Doxil business</a> (and other contract manufacturing) to focus more on its business as Bedford Labs, a producer of generic injectables, and avoid all the problems that have caused bans from Canada and Europe of Ben Venue products. Like the <a href="http://online.wsj.com/article/SB10001424053111903554904576460290484704816.html">WSJ said</a>, it is all about manufacturing priorities. In the meantime, as Bedford Labs, the company has <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=57">discontinued cisplatin</a> and <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=659">carboplatin</a> and <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=790">has significant shortages in production of Taxol.</a> It <a href="http://www.bedfordlabs.com/BedfordLabsWeb/products/bprod.pdf">appears to focus on commonly needed </a>and presumably more profitable drugs such as those that treat migraine (generic Imitrix), indigestion (generic Zantac) and high blood pressure (generic Inderol).<br />
</span></span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">With Ben Venue moving on to greener pastures, who will J&J find to manufacture Doxil and how hard will they try? Doxil <a href="http://inthesetimes.com/article/11935/u.s._drug_shortage_big_pharma_big_phuck-up/">reportedly </a>represents less than 1% of Johnson & Johnson revenues. A few of my ovarian cancer sisters on inspire.com bulletin board noted that J&J makes a lot of money marketing to women, and in particular in women's products. </span><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">Here's one l<a href="http://drugs-about.com/firms/johnson-johnson.html">ist of products</a> that J& J sells.</span><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"> Perhaps J&J needs to be reminded that they need to focus on Doxil as well, and quickly. </span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><br />
</span><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">In addition, there are all the generic drug companies that have discontinued or have serious shortage in chemo drugs ovarian cancer patients need. For Taxol, they are <a href="http://www.apppharma.com/">APP</a>, Bedford, Hospira, <a href="http://www.sandoz.com/">Sandoz</a> and<a href="http://www.tevausa.com/"> Teva</a>. For carboplatin, they are APP, Bedford, Sandoz and Teva. For cisplatin, they are APP, Bedford and Teva. And with Bedford, now out of the ovarian chemo business for the most part, more of the market power will consolidate in the handful of generic companies left, who will continue to make "allocation decisions" of their manufacturing capacity based on profit. </span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">What can we do? <a href="http://inthesetimes.com/article/11935/u.s._drug_shortage_big_pharma_big_phuck-up/">Big Pharma would have us believe</a> that the causes are all very complicated--increased reliance on outsourced ingredients, Medicare price controls, increased demand from all those pesky cancer patients, complicated manufacturing processes and lack of inspection capacity from the FDA. But we all know that it boils down to making sure that Big Pharma makes maximum profit, even when lives are at stake. This is unacceptable in a civilized society.</span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;"><br />
</span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">In my previous posts, I have encouraged people to write to Congress. <a href="http://www.c-spanvideo.org/program/DrugSho">A hearing was held</a> on Friday September 23, 2011 in the <a href="http://energycommerce.house.gov/hearings/hearingdetail.aspx?NewsID=8926">House Energy and Commerce subcommittee on Health</a> but the human voice of the affected cancer patient was sorely missing. We can continue to try to get our government to take some action in this area which they have been loath to regulate thus far. Or we can take our message to the streets and protest at the offices of the companies who will not manufacture the drugs we need. </span><span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif; font-size: 15px; line-height: 18px;">We could show up at J&J corporate offices (and the generic companies too) wearing scarves and teal arm bands, with our message that we are still here, we are still fighting and they have an obligation to get us the drugs that will keep us alive. Who's up for a road trip to New Brunswick, New Jersey?</span><br />
<span class="Apple-style-span" style="font-family: arial, helvetica, verdana, sans-serif;"><span class="Apple-style-span" style="font-size: 15px; line-height: 18px;"><br />
</span></span>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-86631879513807457072011-09-24T19:07:00.000-07:002011-09-24T19:07:03.851-07:00You've Come a Long Way, Baby!<div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-el3qsdxhv0E/Tn6LzxtTTrI/AAAAAAAAA-Q/lHHZs5O7LUU/s1600/2074756554.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-el3qsdxhv0E/Tn6LzxtTTrI/AAAAAAAAA-Q/lHHZs5O7LUU/s320/2074756554.png" width="224" /></a></div>When I first read the <a href="http://www.latimes.com/news/opinion/commentary/la-oe-roth-women-20110826,0,3967925.story">LA Times August 26, 2011 op-ed piece</a> by Eve Weinbaum and Rachel Roth, "Beyond Suffrage: How far have women come since?", my reaction was "a long, long way" (<a href="http://www.time.com/time/magazine/article/0,9171,902353,00.html">even without our own cigarette now,baby)</a>. My first reading of the article was to pick apart all of the criticisms of what women have not accomplished and focus on how much has changed in the last 90 years. But, in watching the Gloria Steinem HBO documentary again this evening, I was struck by her quoting Susan B Anthony, "Our job is not to make young women grateful. It is make them ungrateful so they keep going."<br />
<br />
I needed to reconcile these two views. While I agree that making women "ungrateful" and ever aware of their second class status is motivating, I also believe that ignorance of where we have been and what we have accomplished can zap motivation for more change. Thus I found myself scrutinizing the Weinbaum/Roth article with both a look to what we have accomplished and what still needs to be done.<br />
<br />
The op-ed outlined a<a href="http://womenshistory.about.com/library/etext/bl_eastman_crystal_1920.htm"> four point plan by feminist Crystal Eastman</a> in 1920 for women's freedom now that they had won the vote. Weinbaum and Roth summarize the four points as follows (for the modern crowd):<br />
<blockquote>[E]conomic independence for women (including freedom to choose an occupation and equal pay), gender equality at home (raising "feminist sons" to share the responsibilities of family life), "voluntary motherhood" (reproductive freedom) and "motherhood endowment," or financial support for child-rearing and homemaking.</blockquote>Weinbaum and Roth then argue that women have not achieved these four things in the past 90+ years. For example, women on average still only make $0.77 for every dollar men make (and even less if you are a woman of color). But, I wanted to remind everyone, women did not make anything working 100 years ago and as recently as 40 years ago only made half of what men made, on average. Women are able to work in almost every occupation and have equal if not greater access to university educations, as a result of the feminist movements so far. But I know that women still are not well represented in the highest ranks of power either in government or in the boardroom.<br />
<br />
To me, the problem is that our society does not really accommodate the fact that women are the ones to give birth rather than men. All of the inequalities of today stem from that fact (and are magnified by inequalities of income). <a href="http://www.hrw.org/reports/2011/02/23/failing-its-families-0">Women in the United States, on the whole, do not have reasonable access to childcare either right after birth or as work continues.</a> They have reproductive freedom that was not available 90 years ago--contraception and abortion, but when a woman chooses to have a child, the support is quite limited. Two states (California and NJ) provide paid family leave insurance to workers covered by state disability insurance in the form of payment (at 55-65 percent (or less) of regular salary. A handful of other states, such as Rhode Island, New York, and Hawaii, offer temporary disability insurance to mothers to recover from the "disability" of childbirth based on a doctor's certification. For example, when I had my daughter in the late 80s, which was before California enacted its paid family leave insurance, I got this TDI for eight weeks, which was the maximum time any doctor would give unless there were unusual complications. Most states, however, do not have such TDI or insurance so that they are only bound by <a href="http://www.dol.gov/dol/topic/benefits-leave/fmla.htm">Family and Medical Leave Act,</a> which allows the employee to return after family leave to a job but does not pay for that leave and only applies in organizations with 50 or more employees. Only about half of United States employees are eligible for FMLA.<br />
<br />
Private sector generally does not voluntarily provide paid family leave. According to <a href="http://www.shrm.org/Research/SurveyFindings/Articles/Documents/Emp_Benefits_Tables.pdf">one 2011 survey</a> by the Society for Human Resource Management, only 16% of private sector companies in manufacturing and service sectors offer paid maternity or paternity leave. Private sector provision of child care is no better. <a href="http://www.bls.gov/opub/cwc/cm20071022ar01p1.htm">A </a><a href="http://www.bls.gov/opub/cwc/cm20071022ar01p1.htm">2007</a> <a href="http://www.bls.gov/opub/cwc/cm20071022ar01p1.htm">U.S Department of Labor study</a> reports that only 15 percent of private sector workers had access to employer-provided childcare assistance, including funds, on-site or off-site childcare, and resource and referral services. Even worse, however, is federal government employees who must use sick leave and other leave for childbirth and new infant care. A <a href="http://www.opm.gov/oca/leave/html/ParentalReport.htm">recent federal report </a>recommended against providing 6 weeks of paid leave, claiming the current system of cobbling other leaves together for childbirth and new infant care was <a href="http://www.opm.gov/oca/leave/html/ParentalReport.htm#IX.%20%20Conclusions%20and%20Recommendations">"generous"</a><br />
<br />
<a href="http://wiredworkplace.nextgov.com/2009/11/benefits_of_federal_paid_parental_leave.php?oref=search">Reportedly, Fortune 100 companies do better,</a> with about 75% of them offering paid maternity leave, which raises an interesting question of 25% of the 10 best companies for which to work do not offer paid maternity leave. However, <a href="http://money.cnn.com/magazines/fortune/bestcompanies/2011/full_list/">Fortune 100 companies in 2011</a>, the 100 <a href="http://money.cnn.com/magazines/fortune/bestcompanies/2011/">"Best Companies to Work For"</a>, with roughly 1.5 Million employees, only represent less than 1% of the <a href="http://www.bls.gov/news.release/empsit.nr0.htm">labor force</a>. And childcare in this rarefied stratosphere is not all that readily available or inexpensive. About 25% of the <a href="http://money.cnn.com/magazines/fortune/bestcompanies/2011/benefits/child_care.html">Fortune 100 companies offer onsite childcare</a> for which you still have to pay $400-$700 per month.<br />
<br />
Unfortunately, the lack of support for maternity leave and child care in this country is not just financial, although lower and middle income families keenly feel the lack of financial support . For those who can afford childcare, there is still the lingering sentiment that children need to be raised by their parents, not child care providers. The corollary to that belief is that women should do the brunt of raising of children because men make more money, or are not naturally good with children or some other rigamarole. If there are still those who think that the best child rearing environment involves a stay at home parent, let us free men from the stereotypes that they are not able to do it.<br />
<br />
As a matter of practicality in this economy, both men and women have to work for families to survive financially. Given that reality, our government needs to put behind its stereotypes of the past and take responsibility, <a href="http://www.hrw.org/sites/default/files/reports/us0211web_chart.pdf">like most countries,</a> to pay for a reasonable length maternity and new infant care leave. Until then, women in the United States will not experience critical equality.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-26960541202312463562011-09-19T14:51:00.000-07:002011-09-24T07:14:05.756-07:00CBS News Report on Doxil Misses Some of the Point<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-ziIK9M_LNOI/Tne3twELLvI/AAAAAAAAABo/5y6XbBC8c0U/s1600/5954130310.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="245" src="http://3.bp.blogspot.com/-ziIK9M_LNOI/Tne3twELLvI/AAAAAAAAABo/5y6XbBC8c0U/s320/5954130310.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gray Kitty wondering about Gray market drugs</td></tr>
</tbody></table>Finally, there is more nationwide focus by CBS News on the nationwide shortage of Doxil and the other shortages in over 200 drugs. Unfortunately, after starting out strong on the Doxil problem, this show shifts its focus to the gray market for drug shortages, which is likely a side effect of the shortages rather than a cause. The CBS piece also suggests that demand for these chemo drugs is up when we know from looking at the <a href="http://www.ashp.org/drugshortages/current/">ASHP schedules</a> that in fact supply is down. For example, the <a href="http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=659">ASHP report says</a> "Bedford discontinued carboplatin in May, 2011 to concentrate on the manufacturing of other products." The manufacturers have other drugs to make that are more profitable so cancer patients who need generics like carboplatin, cisplatin, Taxol, f<span class="Apple-style-span" style="color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;">luorouracil, 5-FU</span><span class="Apple-style-span" style="color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;"> and doxorubicin. While I deplore those in the gray market profiting from the shortages, let's not lose sight that they did not cause the shortages in the first instance. Let's keep our focus on the drug companies, who made manufacturing decisions to cut supplies, while demand for certain chemotherapies was going up. </span><br />
<span class="Apple-style-span" style="color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;"><br />
</span><br />
<span class="Apple-style-span" style="color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;"><br />
</span><br />
<embed allowfullscreen="true" allowscriptaccess="always" background="#333333" flashvars="si=254&&contentValue=50111550&shareUrl=http://www.cbsnews.com/video/watch/?id=7381127n" height="279" salign="lt" scale="noscale" src="http://cnettv.cnet.com/av/video/cbsnews/atlantis2/cbsnews_player_embed.swf" type="application/x-shockwave-flash" width="425"></embed>Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-74728082193465187952011-09-17T15:49:00.000-07:002011-09-17T15:49:17.867-07:00Bad News, Good News<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-DZA5o4wm01A/TnUFaHnYyfI/AAAAAAAAABY/qdW3ymkMFL4/s1600/5428771335.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="http://4.bp.blogspot.com/-DZA5o4wm01A/TnUFaHnYyfI/AAAAAAAAABY/qdW3ymkMFL4/s400/5428771335.png" width="247" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Even sweet doggies get IVs</td></tr>
</tbody></table>Yesterday my gyn/onc and I chatted a bit before I had my third infusion in this course of treatment for recurrent ovarian cancer. He confirmed what I expected--that Cedars Sinai had not received any Doxil and did not know when they would. He said that their pharmacist was dealing with multiple vendors now in an effort to secure some but no success. However, he thought some of the smaller treatment clinics may be getting some small amounts of Doxil. Oddly enough that made me feel good given that many times I have heard from sisters that they could not get either Taxol or platinum drugs at the smaller infusion centers.<br />
<br />
So it looks like I will continue my treatment with only carboplatin. The good news is that it is really knocking down my CA 125 numbers. After two infusions I have dropped from 100 to 15, which is almost in my baseline remission zone, which is 8-12. The doctor is optimistic that I will only need one more infusion after the one I got yesterday.<br />
<br />
My only nagging concern is that, as Dr. Li confirmed, <a href="http://annonc.oxfordjournals.org/content/18/2/263.full">studies</a> <a href="http://www.jcojournal.org/content/28/20/3323.short">show</a> that <a href="http://www.hindawi.com/journals/jo/2010/497429/">average time in remission</a> and overall survival is better with a combination of Doxil and carboplatin than with Doxil alone. And the longer you are in remission, the more likely you will respond to carboplatin in the future (i.e. be carboplatin sensitive). So there may be some problem in the future for me because I missed Doxil this time but only time will tell whether I am in the average group or as Dr. Li says at the good end of the bell curve with a lengthy remission ahead of me.<br />
<br />
Which leads me to a discussion of studies and numbers. While I was looking for studies about the effects of Doxil in combination with carboplatin on remisssion and survival, I came across a few studies that had not seen in the past. The<a href="http://www.cancer.org/Cancer/OvarianCancer/OverviewGuide/ovarian-cancer-overview-survival-rates"> first study </a>sent my heart soaring because it said the average five year survival rate for my type and stage (initially IIIa) of ovarian cancer is 45%. (Another <a href="http://emedicine.medscape.com/article/255771-overview#aw2aab6b2b5aa">report</a> said 41% which also made me feel ok). I had read in the past survival rates in the 25-30% for my type and stage of cancer. Hopefully these new stats mean treatments are getting better and hopefully the drug shortages will not cause the stats to decline again.<br />
<br />
On the other hand, contrary to what my doctor had told me, my recurrence may mean my survival rate has dropped. If I am reading these<a href="http://health.usnews.com/health-conditions/cancer/ovarian-cancer/treatment"> stage criteria correctly</a>, the fact that my cancer has spread to my lymph nodes should mean I am now IIIc. Staging is done during surgery but it would seem to me that now we know it has spread to the lymph nodes (which the doctor explained to my worried husband that it had nowhere else to go) should the stage not be IIIc? Another question for the doctor. If I am IIIc, my survival rate just dropped to either <a href="http://www.cancer.org/Cancer/OvarianCancer/OverviewGuide/ovarian-cancer-overview-survival-rates">35%</a> or <a href="http://emedicine.medscape.com/article/255771-overview#aw2aab6b2b5aa">23%</a>. Ooops!<br />
<br />
My doctor tells me not to look at the stats on the internet. They are old and they are averages for a population. They do not predict to the individual, i.e me. Someone has to be out at the good end of the bell curve. I know that the statistics do not tell me how long I will live. I once taught college statistics and have a PhD in psychology which fully covered study design (so don't get me going on some of the medical studies I have cited here). But it is hard not to feel like I have a five year expiration label on my forehead. No one knows for sure how much time one has. In the meantime, we need to keep going to make sure that ovarian cancer is recognized as the serious problem it is and that drug shortages are remedied.Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0tag:blogger.com,1999:blog-6529774746474371944.post-47799955440594121622011-09-16T11:42:00.000-07:002011-09-16T11:42:03.980-07:00I Have a New Blog Site for Cancer Posts!Please visit my new blog site where I will be posting only about cancer issues. http://helpkeepasisteralive.blogspot.com/<br />
<br />
So far I have only republished posts from this blog that concerned cancer. New posts will be forthcoming!Scoobydoobeachhttp://www.blogger.com/profile/02352889688477324959noreply@blogger.com0