Canada Pharmacy Information

Senate Approves Legislation That Would Allow The Reimportation Of Prescription Drugs From Canada

The Senate on Tuesday voted 68-32 to approve an amendment that would prohibit seizures by U.S. Customs and Border Protection of prescription drugs purchased from Canadian pharmacies by U.S. residents, the Los Angeles Times reports (Girion, Los Angeles Times, 7/12). Customs officials have seized thousands of packages of prescription drugs sent from Canadian pharmacies to U.S. residents since Nov. 17, 2005, when the agency began to increase enforcement of federal laws that restrict the purchase of prescription drugs from abroad. The purchase of medications from abroad is illegal, but customs and FDA officials generally have allowed the practice. Some Canadian pharmacy officials have said that they believe the increased seizures are related to the launch of the new Medicare prescription drug benefit. Customs officials in February acknowledged the increased enforcement against the purchase of medications from abroad but said the policy change was not related to the launch of the Medicare prescription drug benefit ( Kaiser Daily Health Policy Report , 3/14). Sen. David Vitter (R-La.) proposed the amendment as part of the fiscal year 2007 Homeland Security appropriations bill (Strohm, CongressDaily, 7/11). No Senate Democrats opposed the amendment (McCormack, The Hill , 7/12).

House Bills
The House has approved two FY 2007 appropriations bills -- Homeland Security and Agriculture -- that include provisions to allow the purchase of prescription drugs from abroad, according to Kirstin Brost, a spokesperson for House Appropriations Committee ranking member David Obey (D-Wis.) ( AP/San Francisco Chronicle , 7/12). The provision included in the House Homeland Security appropriations bill would allow the purchase of prescription drugs from any nation (Los Angeles Times, 7/12). According to the AP/Chronicle, the "Bush administration has opposed efforts to loosen the restrictions" on the purchase of prescription drugs from abroad, and FDA officials have said that the agency "cannot guarantee the safety of imported drugs" (AP/San Francisco Chronicle, 7/12).

Reaction
Vitter called the passage of the amendment a "breakthrough" on the issue of prescription drug reimportation and "the first clean vote on the issue in the Senate" (Crowley, CQ Today, 7/11). He added, "We should demand that (Customs and Border Protection) focus on the true priority that we face on the war on terror. Stripping small amounts of prescription drugs from the hands of seniors ... should not be a priority." Sen. Ben Nelson (D-Fla.) said, "This is going to ensure that Americans, especially the frail, elderly or those with debilitating conditions, are going to be able to at least have a chance of affording the medications that they need." However, Sen. Judd Gregg (R-N.H.) said that the amendment would lead to "a massive hole in our capacity to secure our borders and protect ourselves." He added, "If I were a creative terrorist, I would say to myself, 'Hey, listen, all I've got to do is produce a can here that says 'Lipitor' on it, make it look like the original Lipitor bottle, which isn't too hard to do, fill it with anthrax'" (AP/San Francisco Chronicle, 7/11). Sen. Rick Santorum (R-Pa.) said, "There's a profound risk ... with respect to these drugs that come in. This is a dangerous, dangerous piece of legislation" (CongressDaily, 7/11). Ken Johnson, a spokesperson for the Pharmaceutical Research and Manufacturers of America, said that the amendment "undermines the U.S. Customs and Border Protection from doing its job of protecting Americans as well as protecting our borders. It also undermines the government's ability to assure the American public that our drug supply is safe and secure" (Shields, Baton Rouge Advocate , 7/12). Customs officials did not respond to requests for comment on the amendment (Los Angeles Times, 7/12).

Counterfeit Rx Hearing
In related news, lawmakers and pharmacy industry experts on Tuesday at a House hearing said that FDA should implement federal standards to prevent the entry of counterfeit prescription drugs to the U.S. market, CQ HealthBeat reports. At a House Government Reform Subcommittee on Criminal Justice, Drug Policy and Human Resources hearing, Rep. Gil Gutknecht (R-Minn.), said, "Ultimately, we're going to end up with 50 different regulations. What we've encountered from the FDA so far is little more than foot dragging." However, Randall Lutter, acting associate commissioner for policy and planning at FDA, said the agency has taken action to address the issue of counterfeit prescription drugs. FDA in June announced plans to require prescription drug distributors to document the chain of custody, or pedigree, of medications that enter the U.S. market as of Dec. 1. Lutter said that the requirement will not include electronic tracking of prescriptions because the transition to the technology will take time. According to CQ HealthBeat, witnesses at the hearing "advocated the need for 'track' and 'trace' technologies and said accompanying resources and consistency would be necessary to make the system work." Carmen Catizone, executive director of the National Association of Boards of Pharmacy, said, "We're not happy that the states are embarking on this individually without a national standard" (Barrett, CQ HealthBeat, 7/11).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Pharmaceutical, Biotechnology Industry Lobbyists Seek Increased Funds For FDA

Pharmaceutical and biotechnology industry lobbyists hope to convince lawmakers to provide more funds to FDA to help reduce review times for new medications and ensure their safety, the Boston Globe reports. Part of the "motivation" for the effort involves a bill that Sens. Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.) plan to introduce this summer, the Globe reports. Among other provisions, the legislation likely would require pharmaceutical and biotech companies to pay higher user fees to cover the cost of increased oversight of prescription drug safety. According to the Globe, "persuading Congress" to increase funds for FDA "could be a hard sell, and, as more and more drugs come into the testing pipeline, debate is intensifying over who will foot the bill. Pharmaceutical and biotech companies maintain that they currently pay significant user fees to reduce review times for new medication and should not have to pay additional fees. Former Rep. James Greenwood (R-Pa.), president of the Biotechnology Industry Organization, said that, although user fees have doubled from 1998 to 2005, the FDA budget has remained about the same from 1986 to 2006. In fiscal year 2004, pharmaceutical and biotech companies paid $232 million in user fees, which accounted for 53% of the $436 million FDA budget for reviews of new medication, and companies will pay $320.6 million in user fees in FY 2007. Greenwood said, "Very simply, FDA is drowning under the weight of its added responsibilities and its budget woes, and it sees (user fees) as its life line." William Hubbard, a former associate commissioner of FDA, added, "The industry is really feeling like there is a steady progression toward them paying" the full cost of FDA reviews of new medications (Henderson, Boston Globe, 7/13).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at
http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

NEJM Perspective Examines Sales Of Physicians' Prescribing Data

"For Sale: Physicians' Prescribing Data," New England Journal of Medicine: In a perspective piece for NEJM, Robert Steinbrook, a doctor and NEJM correspondent, discusses how physicians' prescribing data are sold to pharmaceutical manufacturers and examines several issues surrounding the practice. According to Steinbrook, the American Medical Association's "best practice guidelines" include warnings that the pharmaceutical industry should keep prescribing data confidential and that sales representatives should not use a physicians' prescribing data to pressure them into prescribing a certain drug. However, the practice continues despite the warnings, and physicians increasingly are growing concerned, Steinbrook writes. He notes that AMA recently implemented a Prescribing Data Restriction Program that allows physicians to deny sales representative access to their prescribing data, and some states are considering enacting legislation banning the use and sale for most commercial purposes of prescribing data that identifies the prescriber. Steinbrook concludes that many physicians still are unaware they can restrict access to their prescribing data, and programs allowing physicians to compare their data to that of other physicians -- along with educational materials -- are not currently available, so the controversy "is likely to remain uncertain for at least several years" (Steinbrook, NEJM, 6/29).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Canadian Pharmacies Receive 30 Calls Daily for Nevada Prescription Rx Reimportation Program

The four Canadian online pharmacies licensed to sell prescription drugs to Nevada residents under a new state program each received an average of 30 telephone calls daily in the first month, and about one-third of the calls resulted in purchases, the Las Vegas Sun reports (Hansel, Las Vegas Sun, 6/6). Under the program, which was established under a state law enacted last year, Canadian pharmacists licensed by the Nevada State Board of Pharmacy can mail to state residents prescription drugs that appear in the Orange Book and HC-DPD, which list medications approved in the U.S. and Canada, respectively. Prescription drugs sold under the program must meet the manufacturing requirements of FDA and the Therapeutic Products Directorate of Health Canada; have a dosage that appears in the Orange Book and HC-DPD; and come from the onsite inventory systems of online Canadian pharmacies. In addition, Canadian pharmacists cannot mail prescription drugs in liquid, injectable or intravenous forms or medications that require refrigeration or other special handling during shipment. The state pharmacy board has inspected and approved four Canadian online pharmacies to participate in the program, and a Web site established by the state includes links to those pharmacies (Kaiser Daily Health Policy Report, 5/8). The Web site has received about 100,000 hits in the past month, the Sun reports.

Comments
David MacKay -- business director for Ultra Care Pharmacy, which participates in the program -- said that most of the telephone calls the pharmacy has received involved questions rather than purchases. MacKay said that some Nevada Medicare beneficiaries have used the program as an alternative to the prescription drug benefit. "We're seeing a return of patients who did join Medicare and are unhappy with the caveats and the devil in the details," he said. State Rep. Barbara Buckley (D) said that she expects a report on the program within the next few months. She added, "I've gotten calls and emails from a lot of people who say they are so glad this has finally gone through" (Las Vegas Sun, 6/6).

Editorial
"U.S. drug manufacturers have few, if any, reasons to control medication prices in this country," but the Nevada program that allows state residents to purchase prescription drugs from Canadian pharmacies might prompt such action, a Las Vegas Sun editorial states. "In the month since Nevadans could legally mail-order prescription drugs from Canadian pharmacies, hundreds of orders have been placed, and Canadian druggists are reaching out to not only seniors but also other groups that need medicines," the editorial states. According to the editorial, pharmaceutical companies might "find reasons" to reduce prescription drug prices "if enough Americans -- as individuals and business owners -- show they are sick of paying high prices for their medications and seek lower-cost alternatives elsewhere" (Las Vegas Sun, 6/8).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Massachusetts's Medicaid Program Overcharged CMS By $86.6 Million, HHS OIG Audit Says

Massachusetts's Medicaid program must repay the federal government $86.6 million for services related to targeted case management, according to an audit by the HHS Office of General, the Boston Globe reports. The HHS OIG conducted an audit of Massachusetts' Medicaid program's targeted case management division and found that the state charged CMS $171.2 million for unallowable services between 2001 and the first quarter of 2004. CMS paid about half that amount, or $86.6 million. Each of the reported violations involved state Medicaid officials billing CMS for case management provided by the state Department of Social Services that was not directly related to providing medical care. The audit documented "hundreds of thousands" of times when the state "overcharged Medicaid by amounts ranging from $209 to $295, the Globe reports. For example, the state billed CMS for a social worker who called a child's school, asking that he be allowed to return to class. HHS Inspector General Daniel Levinson in the report said, "We attribute these unallowable costs to the state agency's lack of procedures for ensuring compliance with Medicaid requirements." However, state Medicaid Director Beth Waldman said the state and federal government reached an agreement in 1994 that allows the billed services. Waldman said, "[I]f they want to change [the regulations], that's fine, but you can't do it retrospectively, and you can't do it through an audit." Waldman said she "would not be surprised" if the HHS OIG requires the state to pay the $86.6 million, at which point the state Legislature would consider ways to return the money. Levinson said the state also must work with the federal government to resolve another $27 million in disputed Medicaid charges, about half of which were paid by the federal government (Levenson, Boston Globe, 6/5).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Drug Ads Aimed At Cancer Patients Difficult To Read, Make More Appeals To Effectiveness Than Safety

Oncology drug advertisements that ran in patient-focused cancer magazines presented the drugs' benefits differently -- earlier in the advertisement text and in larger type size -- than their side effects or risks, according to an analysis by researchers at Dana-Farber Cancer Institute in Boston. The findings will be presented the American Society of Clinical Oncology's annual meeting in Atlanta.

"Direct-to-consumer advertising of oncology medications typically focuses on the drugs' benefits, as would be expected, but it does so in a manner that might lead some cancer patients to not appreciate equally the drugs' potential side effects and risks," says Gregory Abel, MD, MPH, the study's first author. "Oncology providers should be aware of these advertisement characteristics, as they may influence patients' perceptions of and requests for these medications."

Abel will present the data at a poster discussion session on Tuesday, June 6 at 8 a.m., Building A, Level 3, Room A 314.

The researchers reviewed all advertisements for oncology drugs that appeared in three cancer patient-focused magazines, CURE, Coping with Cancer and MAMM, in 2005. They analyzed the advertisement copy for readability using the Flesch Reading Ease measurement. They also assessed the type size and the placement of the benefits and side effects/risk information, as well as the advertisements' presentation of clinical trial data, apparent patient testimonials, images of patients, physicians and/or celebrities, and claims about effectiveness, social-psychological enhancements, ease of use, and/or safety.

A total of 75 medication-specific advertisements appeared in the magazines, but only 15 were unique, as some of the advertisements ran repeatedly during the year. The advertisements were found to be difficult to read overall, but the text outlining the benefits had the highest readability score. Information about the drugs' benefits, on average, appeared in the top third of the advertisement text, while descriptions of side effects and risks typically ran in the bottom third. Also, the largest type size of the text explaining the benefits was about twice as large as the largest text outlining side effects and risks. Interestingly, the amount of text devoted to benefits versus risks and side effects was roughly the same.

None of the advertisements included information about costs or contained celebrity or physician endorsements. About two-thirds (67 percent) referenced clinical data and 80 percent contained images of patients.

"We found that appeals to medication safety are infrequent in oncology print direct-to-consumer advertisements, while appeals to medication effectiveness are ubiquitous and often made through the presentation of clinical trial data," explains Abel, who is also an instructor in medicine at Harvard Medical School. "Such appeals to the scientific efficacy of cancer-related medicines, while suitable in the setting of clinical encounters, may not be appropriate when made directly to consumers via language that is difficult to read."

Bill Schaller
william_schaller@dfci.harvard.edu
Dana-Farber Cancer Institute
http://www.dfci.harvard.edu

Drug Companies More Often Sponsor Research; Many Such Studies Have Positive Findings For Their Products

Drug companies are increasingly funding medical studies, which often bring positive results for their own products, according to USA Today. Researchers on Wednesday at an American Psychiatric Association conference in Toronto reported that in 2002, 57% of drug studies published in medical journals were funded by drug companies, compared with 25% with 1992. Igor Galynker of Beth Israel Medical Center in New York City led the study, which examined studies on psychiatric drugs published in four medical journals: the American Journal of Psychiatry, the Archives of General Psychiatry, the Journal of Clinical Psychiatry and the Journal of Clinical Psychopharmacology. Reviewers were not told who paid for the studies. Galynker said the findings show a favored outcome for the drugs being studied in approximately:
Eight out of 10 studies that were paid for by the company that makes the drug;

Five of 10 studies that were conducted with no industry support; and

Three out of 10 studies funded by competitors manufacturing a competing product.

The findings do not prove that drug companies are conducting biased studies, according to study co-author Robert Kelly, also with Beth Israel. Nonetheless, some health experts are beginning to encourage publicly funded medical studies. Sidney Wolfe, director of the Health Research Group at Public Citizen, called for the government to fund more research (Elias, USA Today, 5/25).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Use Of Generic Rx Substitutes Grows To 54% Of Prescriptions, Medco Report Says

Pharmacy benefit manager Medco Health Solutions currently substitutes 54% of brand-name prescription drugs with generic medications, compared with 47% in 2005, according to a report released by the company on Friday, the Los Angeles Times reports. According to the report, increased use of generic medications has helped slow prescription drug spending growth in recent years (Yi, Los Angeles Times, 5/20). Prescription drug spending by health insurers and employers increased by 5.4% in 2005, compared with 8.5% in 2004, the report finds. In 2005, prescription drug spending growth in large part involved medications for high cholesterol, rheumatoid arthritis, asthma, diabetes and cancer, the report finds (Washington Post, 5/20). The use of brand-name prescription drugs began to decrease last year as a result of the market withdrawals of the COX-2 inhibitors Vioxx and Bextra -- as well as decreased sales of the COX-2 inhibitor Celebrex -- over safety concerns, the report finds. In addition, health care experts said that the use of generic medications has increased as employers have sought to reduce prescription drug spending. Chris Wright, a managing principal of pharmaceutical consulting company ZS Associates, added that many patents on brand-name prescription drugs have begun to expire (Los Angeles Times, 5/20).
Availability of Generic Versions of Statins Examined

In related news, the Chicago Tribune on Thursday examined the availability of generic versions of statins, a class of anticholesterol medications that in recent years "has been the most costly U.S. brand-name prescription group for U.S. consumers and employers." A generic version of Zocor, the second-most commonly prescribed statin, likely will become available by late June, and a generic version of Pravachol, the third-most commonly prescribed statin, became available earlier this month. According to the Tribune, the availability of generic versions of statins could reduce copayments by more than $200 annually for some consumers, with monthly copays reduced from between $20 and $40 to between $5 and $10 (Jaspen, Chicago Tribune, 5/21).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Industry-Sponsored Research Produces More Favorable Results For Experimental Treatments, Study Finds

Industry-sponsored medical research generated results favorable to experimental heart drugs or medical devices two-thirds of the time, according to a study published Wednesday in the Journal of the American Medical Association, Bloomberg/Arizona Daily Star reports. For the study, researchers from Harvard Medical School examined 324 comparison studies of cardiovascular treatments published between Jan. 1, 2000, and July 30, 2005, in JAMA, the New England Journal of Medicine and the Lancet. In trials funded by not-for-profit sources, 49% were favorable to new products, and studies that combined funding produced favorable results 57% of the time. Researchers found that tests of cardiovascular devices supported the experimental treatments 82% of the time when funded by for-profit companies, 50% when funded by not-for-profits and 69% of the time when funded jointly. For drugs, industry-funded research produced favorable results 66% of the time, 40% of the time in not-for-profit studies, and 54% when funded jointly. According to Bloomberg/Daily Star, the findings "are the latest to indicate funding bias in medical journal articles" (Bloomberg/Arizona Daily Star, 5/17). An abstract of the study is available online.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Grassley, Baucus Urge CMS To Resolve Questions About Medicare QIOs

Senate Finance Committee Chair Chuck Grassley (R-Iowa) and committee ranking member Max Baucus (D-Mont.) in a letter dated May 12 asked CMS Administrator Mark McClellan to address questions about the effectiveness of and "possible financial improprieties" involving Medicare Quality Improvement Organizations, CQ HealthBeat reports (Reichard, CQ HealthBeat, 5/16). CMS pays about $300 million annually to 53 private contractors to investigate beneficiary complaints, evaluate quality and work with physicians and hospitals to improve care (Kaiser Daily Health Policy Report, 3/10). The American Health Quality Association, which represents QIOs, in April recommended that CMS increase the contract lengths for QIOs and earmark additional funding to broaden the organizations' responsibilities. Grassley has raised several concerns about QIOs related to executives' salaries and perks for board members. A report from the Institute of Medicine in March also raised concerns and called for reforms, and the HHS Office of Inspector General, the Government Accountability Office and the finance committee are conducting ongoing investigations of QIOs.

Letter

In the letter to McClellan, Grassley and Baucus said CMS should delay actions to broaden the role of QIOs until their concerns can be addressed. They said that in addition to the "potential serious problems" related to possible financial wrongdoing, "there is still a need for more thorough evaluation of the QIOs' effectiveness in improving the quality of health care." Grassley and Baucus added, "We would like our staffs to discuss legislative and administrative changes necessary to ensure that QIOs improve the quality of health care for Medicare beneficiaries, use resources judiciously and adhere to ethical business practices." Todd Ketch, AHQA's vice president for governmental affairs, said QIOs already are responding to the calls for reform, and 50 of 53 QIOs have adopted industry standards on board structure, compensation and perks. He added that AHQA has proposed to CMS administrative and legislative changes to improve QIO accountability" (CQ HealthBeat, 5/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Drug Makers Pay Doctors To Write Studies Criticizing Generic Drugs, Opinion Piece Says

In a "move that may astonish even the most jaded critics of ethically challenged pharmaceutical marketing, makers of sleeping pills are now paying doctors to publish bad things about competing drugs," Daniel Carlat, a professor at the Tufts University School of Medicine, writes in a New York Times opinion piece. According to Carlat, widespread advertising for brand-name sleeping pills, such as Sepracor's Lunesta and Sanofi Aventis' Ambien, have made the medications "household names," but "most people have never heard of" trazodone, a widely prescribed generic hypnotic that psychiatrists frequently prescribe as a sleep aid. Trazodone carries no risk of addiction, is effective as a sleep aid, has a "long safety record" and costs as little as 10 cents per pill, Carlat writes. In recent years, several articles written by physicians have appeared in professional journals that criticize trazodone, using "rhetorical techniques" that "minimiz[e] [its] advantages" and "emphasi[ze] ... its negative qualities," he notes. Carlat says that the articles, which "purport to present balanced reviews of the scientific literature on sleeping pills," were sponsored by companies such as Sanofi-Aventis, Sepracor and Takeda Pharmaceuticals, the same firms "that stand to gain from trazodone's downfall." The "way to discourage [the] practice of negative marketing disguised as legitimate scientific commentary is to mandate fuller disclosure of links between drug companies and authors," Carlat writes, adding that the companies "should be required to disclose the exact nature of a doctor's involvement in preparing a sponsored article, as well as the dollar amount of his or her fee." He concludes, "I suspect it would be the rare doctor who would want such information to come to light" (Carlat, New York Times, 5/9).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

RE: Who Should Get Pandemic Vaccine First? The Strong, The Weak, The Young Or The Elderly?

"Public health experts are finding it hard to agree who should get the flu pandemic vaccine first? Should we protect the most vulnerable, such as the elderly and people who suffer from asthma, diabetes and weakened immune systems? Or should we focus on those who are most likely to recover? "

In my opinion, the most vulnerable and those that have been found to die from the diesese should be the obvious choice when it comes to the vaccination of the avian flu. My opinion is that the elderly and the young should be the first to get the vaccination, cause its seems that it will prevent early deaths, and early signs of getting the flu.

RE: Medicare Drug Information Hotline Full Of Mistakes

"The Government-Accountability-Office (GAO) had its people pose as senior citizens and placed 500 calls to 1-800-MEDICARE hotline and asked for information. Over 30% of the information they received was the wrong. The most important question Â‘Which drug plan costs the least for my specific needs' was answered incorrectly 59% of the time...... If energetic GAO employees have problems trying to sign up, one wonders what it must be like for senior citizens. How many of those who did manage to sign up got the best price for their needs?"

This is exactly my fear in the new Medicaree plan, the new plan states that all pharmaceuticals are going to be given at a cheaper rate to distract citizens from buying online with Canadian pharmacies. This goes to show that some of the seniors that will be effected by the new medicare may not even have the choice of getting the right plan for them.

Just some food for thought!