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HIV FAQ: What about the medical treatment, expenses, and prescriptions?/
This topic has received more questions than any other:
What is the extent of medical care involved in adopting a child with HIV?
Is affording the medication manageable?
Are you going broke on the cost of the meds?
How expensive are the medications? How often do you have to purchase them?
How often does your child have to go to the doctor?
How many medications is your child on?
Will they be on the same medications/amounts for their entire lives or will the types of medicine and amounts change as they grow and change?This question come up a lot in adoption, particularly special needs adoption: What about the costs? When a child is born to us, we can't foresee what medical expenses they'll have or when an ER trip will hit or how many times they'll have to see the doctor. We say yes to those uncertainties, not knowing if the expenses will run high or low or average.
We say yes because we deem our biological children to be worth it.
We say yes because they're "our flesh and blood."
We say yes because we'd never think of saying no.
It gets dicier once we're talking about adoption, especially in the early stages. Before you know a child who is waiting for a family, you can't see the humanity that comes before a diagnosis. Checklists on adoption agency forms ask which special needs you're open to. While my friend Amy Julia can write elegantly about using first-person language when speaking of Penny, her daughter with Down syndrome, it's a lot harder to put the child first and the diagnosis second when the adoption is still hypothetical, with the child feeling that way as well.
In adoption, we can say no.
And when we say yes, we have the opportunity to prepare more in advance, at least for the diagnoses known prior to the adoption.
It strikes me that these questions are actually coming from two different camps, so I will answer them in two ways. First, for those who are asking to know - out of curiosity or medical interest or adoption consideration - the bare bones details of the medication and treatment regimen, here's the answers:
- Doctor visits: We have a great pediatric infectious disease team at Duke. At first, we saw them once a month. Labs are looking so good now that it's every two months now. It will stretch longer as time goes on, first to every three months and then to every four months. In adulthood, it will likely be every six months.
- Lab tests: The main ones are CD4 counts (measures of how strong the immune system is: the higher, the better) and viral counts (measures of HIV in the blood: the lower, the better, with the goal to reach undetectable levels).
- Medications: Meds are given every 12 hours. In the morning, it's two half pills. In the evening, it's two half pills plus two capsules (which are the same med but two different quantities). So it's three medications given via four half pills and two capsules over a 24 hour period. At the orphanage, children either took their meds or received a beating, and no one taught our dear one how to swallow pills, so our child has the habit of chewing each pill. Dosages and medications will be adjusted as our child grows and develops.
- Costs: Over Thanksgiving, we had to pick up a refill. We talked with reps from our insurance company, with our pharmacist, and with a few other folks, making sure everything was in order. They all said it was. Come the day after Thanksgiving... nothing. The computerized insurance processing system at the pharmacy said our child wasn't insured. We had to pay out of pocket - though it was later determined that the insurance co. was at fault and we were reimbursed - a total of about $950 for a month's worth of medication. On a monthly basis, though, the costs are no different from any other prescription on our plan. In fact, insurance companies treat children who are adopted as if they were born biologically into the family: no conditions are considered pre-existing or exempt from coverage. It's as if our child was adopted in perfect health and only later contracted HIV. We are required by our insurance company to have the meds sent via a mail order specialty pharmacy, and they send three months worth at a time. Various state-led programs and pharmaceutical companies offer ways to reduce costs of HIV meds, but we haven't needed that help.
- Side effects: None, so far. One makes our precious one tired, but that one is given at nighttime, so it doesn't have any ill effects.
For those who are asking less about the logistics and more about the stress of all the medical stuff, it's not a big deal. Yes, medication is part of our routine. But it is now perfectly routine for us, not out of the ordinary or weird or anything like that.
Sure, managing HIV is part of our lives, but it's a small part.
And it's absolutely worth it.


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Target Debuts Sustainability Initiative
December 8, 2010,
MINNEAPOLIS-Target has established a number of company-wide sustainability commitments, which are designed to guide its ongoing efforts toward environmental sustainability.
The retailer has introduced a website, hereforgood.target.com, which outlines these commitments. Included will be efforts toward empowering consumers and Target employees to lead a more sustainable lifestyle, expanding Target's choices of sustainable products, leading retailers to develop buildings that use space more efficiently and that enhance local communities, using resources more responsibly, eliminating waste and minimizing its carbon footprint.
In a statement posted on the website, Gregg Steinhafel, chairman, president and chief executive officer, said Target's sustainability commitments are part of the "rigorous programs to reduce our environmental impact" and its goal of "strengthening the communities where we do business."
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Author and Page information
- This page: http://www.globalissues.org/article/588/global-health-overview.
- To print all information e.g. expanded side notes, shows alternative links, use the print version:
This article was originally written, on request, for Risk Group LLC, for their December 2005 edition on health care risks. It has been reposted here, reformatted for this web site, and as with most articles on this site, has and will be updated more as time allows.
This article looks at some global aspects of health issues, such as the impact of poverty and inequality, the nature of patent rules at the WTO, pharmaceutical company interests, as well as some global health initiatives and the changing nature of the global health problems being faced.
This web page has the following sub-sections:
- Millions die each year, needlessly
- Health, poverty and inequality
- Structural Adjustment—Cutting back on vital health and education services
- Large Pharmaceutical Companies—Profit at all costs?
- WTO—Patents, Intellectual Property, Emergency Drugs and Developing Countries
- Global Health Initiatives
- Increasing commodification and commercialization of healthcare
- Changing Dynamics in Global Health Issues and Priorities
- Summary
Millions die each year, needlessly
Despite incredible improvements in health since 1950, there are still a number of challenges, which should have been easy to solve. Consider the following:
- One billion people lack access to health care systems
- Over 7.5 million children under the age of 5 die from malnutrition and mostly preventable diseases, each year
These and other diseases kill more people each year than conflict alone.
Why has it got to such a level when the world has enough wealth to help address most of these problems, or at least alleviate more of the suffering?
This article looks at a number of global factors and issues around health problems.
Health, poverty and inequality
Although the statistics above make for grim reading, an important underlying cause of all these deaths is poverty. The World Health Organization (WHO) and others repeatedly point out that many of these diseases are "diseases of poverty."
However, some diseases are now not only the result of poverty, but have been contributing to poverty—a nasty feedback loop. In the case of malaria, for instance, the WHO notes that,
Malaria has significant measurable direct and indirect costs, and has recently been shown to be a major constraint to economic development.
… Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a "growth penalty" of up to 1.3% per year in some African countries.
… The indirect costs of malaria include lost productivity or income associated with illness or death.
… Malaria has a greater impact on Africa's human resources than simple lost earnings. Although difficult to express in dollar terms, another indirect cost of malaria is the human pain and suffering caused by the disease. Malaria also hampers children's schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.
The simple presence of malaria in a community or country also hampers individual and national prosperity due to its influence on social and economic decisions. The risk of contracting malaria in endemic areas can deter investment, both internal and external and affect individual and household decision making in many ways that have a negative impact on economic productivity and growth.
— Economic costs of malaria, World Health Organization, last accessed October 2, 2010
Structural Adjustment—Cutting back on vital health and education services
Economic policies, such as Structural Adjustment Programs (SAPs), enforced by the IMF and World Bank for decades on poor countries have had a disastrous effect on health. SAPs were designed as an economic measure to promote fiscal austerity for poor countries that were burdened with heavy debt repayments to the rich countries. With the economic and third world debt crisis in the 1970s and 1980s, developing countries were pressured to take on Structural Adjustment. Economies were restructured to ensure debt repayment to the rich countries, but this meant reducing the standards of living for most people. Side NoteThat much of third world debt has been considered odious debt, is another issue in its own right!
The typical prescription to this economic medicine included:
- Privatization at all costs;
- Capital market liberalization;
- Market-based pricing; and
- Free Trade.
Regardless of specific circumstances, almost all developing countries were handed the same medicine.
As former World Bank Chief Economist and Nobel Prize winner for economics, Joseph Stiglitz noted, the IMF typically handed out these policies with a blind allegiance to "market fundamentalism." This had a number of effects:
- Poor countries, typically without fully developed market economies, were driven into further poverty as state protection and nurturing of domestic industries were abandoned, leaving the country open to foreign takeover of key services and sectors;
- Cost of food, health services, education and other critical functions went up as important subsidies and other such programs were removed;
- Social unrest, or as Stiglitz called it, "IMF riots" occurred as the cost of living became unbearable
- Barriers to trade were removed, but in its place were the WTO rules, which favor the rich countries.
Side Note
See for example, Joseph Stiglitz, 'What I learned at the world economic crisis. The Insider', The New Republic, April 17, 2000; Gregory Palast, 'The Globalizer Who Came In From the Cold', The Observer, October 10, 2001; Stiglitz, The Roaring Nineties; Seeds of Destruction, (London: Allen Lane/Penguin Books, 2003); Stiglitz, Globalization and its Discontents, (London: Allen Lane/Penguin Books, 2002);
In terms of health, services were reduced or removed, and now health care is either unavailable for the poor in many parts of the world, or is too expensive. As noted above, 1 billion lack access to health care.
In Africa, for example,
The health care systems inherited by most African states after the colonial era were unevenly weighted toward privileged elites and urban centers. In the 1960s and 1970s, substantial progress was made…. Most African governments increased spending on the health sector during this period. They endeavored to extend primary health care and to emphasize the development of a public health system to redress the inequalities of the colonial era.
… With the economic crisis of the 1980s, much of Africa's economic and social progress over the previous two decades began to come undone. As African governments became clients of the World Bank and IMF, they forfeited control over their domestic spending priorities. The loan conditions of these institutions forced contraction in government spending on health and other social services.
… The economic austerity policies attached to World Bank and IMF loans led to intensified poverty in many African countries in the 1980s and 1990s. This increased the vulnerability of African populations to the spread of diseases and to other health problems.
... Declining living conditions and reduced access to basic services have led to decreased health status. In Africa today, almost half of the population lacks access to safe water and adequate sanitation services. As immune systems have become weakened, the susceptibility of Africa's people to infectious diseases has greatly increased.
… Even as government spending on health was cut back, the amounts being paid by African governments to foreign creditors continued to increase. By the 1990s, most African countries were spending more on repaying foreign debts than on health or education for their people. Health care services in African countries disintegrated, while desperately needed resources were siphoned off by foreign creditors…. Across Africa, debt repayments compete directly with spending on Africa's health care services.
— Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002
Despite these problems, the recommended solution by the IMF and others was privatization of the health system. For Africa, however, and many other poor countries, this was not appropriate.
Even in most developed countries, health is accepted as a fundamental human right, not a privilege, and is indeed enshrined in the UN Declaration of Human Rights (see Article 25, paragraph 1.) A solely market-based system for health services is even resisted, therefore, in some of the richest countries in the world. Canada, Australia, and many European nations, for example, boast rich public health systems, though some are under pressure to privatize at least partly, as well. Even in the US, where a privatized health system is generally in place, some 45 million people were without health insurance in 2003. If the rich countries are struggling on this issue, for poorer countries, it is even harder:
Throughout Africa, the privatization of health care has reduced access to necessary services. The introduction of market principles into health care delivery has transformed health care from a public service to a private commodity. The outcome has been the denial of access to the poor, who cannot afford to pay for private care.... For example … user fees have actually succeeded in driving the poor away from health care [while] the promotion of insurance schemes as a means to defray the costs of private health care … is inherently flawed in the African context. Less than 10% of Africa's labor force is employed in the formal job sector.
… Beyond the issue of affordability, private health care is also inappropriate in responding to Africa's particular health needs. When infectious diseases constitute the greatest challenge to health in Africa, public health services are essential. Private health care cannot make the necessary interventions at the community level … is less effective at prevention, and is less able to cope with epidemic situations. Successfully responding to the spread of HIV/AIDS and other diseases in Africa requires strong public health care services.
The privatization of health care in Africa has created a two-tier system which reinforces economic and social inequalities…. Despite these devastating consequences, the World Bank and IMF have continued to push for the privatization of public health services.
— Ann-Louise Colgan, Hazardous to Health: The World Bank and IMF in Africa, Africa Action, April 18, 2002
Furthermore, poverty has contributed to the phenomena of "brain drain" whereby the poor countries educate some of their population to key jobs such as in medical areas and other professions only to find that some rich countries try to attract them away. The prestigious journal, British Medical Journal (BMJ) sums this up in the title of an article: "Developed world is robbing African countries of health staff." (Rebecca Coombes, BMJ, Volume 230, p.923, April 23, 2005.)
Some countries are left with just 500 doctors each with large areas without any health workers of any kind. A shocking one third of practicing doctors in UK are from overseas, for example, as the BBC reports.
Structural Adjustment has therefore been a major cause of poverty, and as a result, a cause of many health issues around the world.
Side Note
This is a large topic. The following resources are useful starting points, perhaps:
- Structural Adjustment—A major cause of poverty from this web site
- Joseph Stiglitz, Globalization and its Discontents, (London: Allen/Penguin Books, 2002)
- Stiglitz, The Roaring Nineties; Seeds of Destruction, (London: Allen Lane/Penguin Books, 2003)
- Ann-Louise Colgan, 'Hazardous to Health: The World Bank and IMF in Africa', Africa Action, April 18, 2002
Large Pharmaceutical Companies—Profit at all costs?
Multinational pharmaceutical companies neglect the diseases of the tropics, not because the science is impossible but because there is, in the cold economics of the drugs companies, no market.
There is, of course, a market in the sense that there is a need: millions of people die from preventable or curable diseases every week. But there is no market in the sense that, unlike Viagra, medicines for leishmaniasis are needed by poor people in poor countries. Pharmaceutical companies judge that they would not get sufficient return on research investment, so why, they ask, should we bother? Their obligation to shareholders, they say, demands that they put the effort into trying to find cures for the diseases of affluence and longevity—heart disease, cancer, Alzheimer's. Of the thousands of new compounds drug companies have brought to the market in recent years, fewer than 1% are for tropical diseases.
In the corporate headquarters of major drug companies, the public relations posters display the image they like to present: of caring companies that bring benefit to humanity, relieving the suffering of the sick. What they don't say, is that, so far, their humanity has not extended beyond the limits of the pockets of the sick.
— Isabel Hilton, A Bitter Pill For The World's Poor, The Guardian, January 5, 2000
For many years, the large pharmaceutical companies and their lobby groups have come under sharp criticism for intensely lobbying rich country governments to protect their interests around the world through things like enforcement of strict patents laws on medicines, allowing companies to monopolize their products, charging high prices for medicines that people around the world depend on.
For the large companies, they feel their investment into research and development would suffer if other companies then simply copy what they produce. Yet, a lot of the base science and research that the large companies have benefited from has been publicly funded—through university programs, government subsidized research, and other health programs. Privatizing such profits may be acceptable to a certain degree. Certainly, the large pharmaceutical companies have created medicines that have saved millions of people's lives. However, Jamie Love, an AIDS activist,
denies that the pharmaceuticals even own the rights to the drugs in the first place. He points out that many of the anti-retroviral drugs used to treat HIV and AIDS today stem from the government-funded cancer drug research of the 1980s. The rights to government-created innovations were sold to pharmaceutical companies at low prices … guaranteeing companies like Bristol-Myers Squibb huge returns on investment. Given the public investment in these drugs, Love doesn't believe drug companies have the moral authority to determine who can or can't access them. And the fact that thousands of people in Africa continue to die because they can't afford the drugs adds urgency to his argument.
— Daryl Lindsey, The AIDS-drug warrior: Jamie Love, Salon.com magazine, June 1, 2001
Some of the plants patented for their medicinal purposes do not even belong to the rich countries where most of the big pharmaceutical companies are based; they come from the developing world, where they have been used for centuries, but patented without their knowledge. Economist and director of the Third World Network, Martin Khor writes,
Just as controversial [as patenting living organisms], or even more so, are patents and patent applications relating to plants that have traditionally been used for medicinal and other purposes (e.g., as an insecticide) by people in developing countries; or patents on medicines for serious ailments. Many medicines are derived from or based on biochemical compounds originating from plants and biodiversity in the tropical and sub-tropical countries. Much of the knowledge of the use of plants for medical purposes resides with indigenous peoples and local communities. Scientists and companies from developed countries have been charged with biopiracy when they appropriate the plants or their compounds from the forests as well as the traditional knowledge of the community healers, since patents are often applied for the materials and the knowledge.
— Martin Khor, Intellectual Property, Biodiversity and Sustainable Development; Resolving the Difficult Issues, (United Nations Environment Program, 2002), pp.27-28
From a purely economic perspective, the idea of patents is to spur innovation, but with pharmaceuticals, it is not just about economics. Dr. Drummond Rennie, from the Journal of the American Medical Association, noted in a television documentary that
Pharmaceuticals, they are a commodity. But they are not just a commodity. There is an ethical side to this because they're a commodity that you may be forced to take to save your life. And that gives them altogether a deeper significance. But they [big pharmaceutical companies] have to realize that they're not just pushing pills, they're pushing life or death. And I believe that they don't always remember that. Indeed, I believe that they often forget it completely.
— Dr. Drummond Rennie, transcribed from Dying for Drugs, Channel 4, UK, April 27, 2003
However, critics are pointing out that as well as saving lives, they are also taking lives from the poor, especially in the developing world, where, through rich country governments, they have lobbied for policies that will help ensure that their patents are recognized in most countries, thus extending those monopolies on their drugs. Writer and broadcaster, John Madeley, summarizes a number of concerns raised over the years:
[Non-governmental Organizations] allege that the corporations:
- sell products in developing countries that are withdrawn in the West;
- sell their products by persuasive and misleading advertising and promotion;
- cause the poor to divert money away from essential items, such as foodstuffs, to paying for expensive, patented medicines, thereby adding to problems of malnutrition;
- sell products such as appetite stimulants which are totally inappropriate;
- promote antibiotics for relatively trivial illnesses;
- charge more for products in developing countries than they do in the West;
- fail to give instructions on packets in local languages;
- resist measures that would help governments of developing countries to promote generic drugs at low cost;
- use their influence to try to prevent national drug policies;
- give donations of drugs in emergencies which benefit the company rather than the needy;
- use their home government to support their operation with threats if necessary, such as withdrawing aid, if a host government does anything to threaten their interests.
… The methods used by the corporations are highly controversial. Making use of advertising that is inexpensive in comparison to what they pay in industrialized countries, the drug TNCs [Transnational Corporations] use the most persuasive, not to say unethical, methods to persuade the poor to buy their wares. Extravagant claims are made that would be outlawed in the Western countries. A survey, in the Annals of Internal Medicine found that 62 per cent of the pharmaceutical advertisements in medical journals "were either grossly misleading or downright inaccurate."
— John Madeley, Big Business Poor Peoples; The Impact of Transnational Corporations on the World's Poor, (Zed Books, 1999) pp. 145-146, 147
The big pharmaceutical companies have caused enormous uproar in recent years when they have attempted to block poorer countries' attempts to deal with various health crises. A vivid case is that of South Africa and cheaper generic drugs. The huge pharmaceutical association, PhRMA (Pharmaceutical Research and Manufacturers of America), and other large companies had intensely lobbied the then US Vice President, Al Gore, in 1999, to threaten South Africa with trade sanctions for trying to develop cheaper, generic drugs to combat AIDS. They claimed that World Trade Organization (WTO) rules regarding patents and intellectual property were being violated.
In fact, there was no violation. As problematic as the WTO rules have been in this area, there was provision in the rules allowing generic drugs to be created for emergency situations and public, non-commercial use. While public outrage managed to get such a move backed down, the underlying concerns from the big pharmaceutical companies have remained, and in various ways since, they have pressured the United States and other rich, industrialized nations to prevent other countries from doing similar things.
You can understand why the big companies are in fear. When CIPLA, one of India's leading generics companies, offered a cocktail of anti-retroviral drugs for AIDS at $350 a year, compared to $10,000 from the multinational companies, this sent a shockwave in two ways. Poor countries realized they might have more affordable means to deal with a massive health crisis that afflicts them the most; and the large multinationals saw their monopoly prices severely threatened, and, exposed.
India's patent laws have allowed the production of cheap generics. CIPLA, for example, offered this low-cost price for their AIDS drug at a loss for itself, because it said it made profits from other drugs, and this was something that was more than about profit and loss. However, India's patent law has been under pressure from the rich countries for a long time now. Their patent laws were tightened up in early 2005, to come into line with WTO laws, thus making cheaper alternatives less easy to produce. This will not only impact India, but also a large majority of the world that looks to India's generics industry.
Brazil too has found itself under pressure from the United States for producing cheaper generics. When its currency devalued in 1999, the case of Brazil also highlighted another issue: the high cost of imported drugs from the big pharmaceutical companies become even more costly as exchange rates fluctuate. Even though the dollar may be relatively weak currently, other rich countries where pharmaceuticals may be purchased from have currently got currencies that are stronger than the dollar. Currencies of course fluctuate. The point is then, that the fluctuation makes it harder for poorer countries to forecast how much the drugs may cost. They, and any other country would be dependent upon price negotiations with the pharmaceutical companies, too.
On April 27, 2003, Britain's Channel 4 aired a documentary titled Dying for Drugs. Noting that drugs bring billions to big pharmaceutical companies, and hopes to people, they asked, "how far would drugs companies go to get their drugs approved and the prices they want?" As the documentary said in their introduction, the implications are alarming and if their "power remains unchecked, many more people will soon will be dying for drugs."
In Africa, the documentary showed how one of the world's biggest drug companies experimented on children without their parents' knowledge or consent. In Canada, it was revealed how a drug company attempted to silence a leading academic who had doubts about their drug. In South Korea, it followed the attempts of desperately ill patients to make a leading drug company sell them the drugs they need to save their lives at an affordable price. And, in Honduras they showed the brutal consequences of drug companies' pricing policies whereby to save a 12-year old child dying from AIDS, people had to smuggle drugs from across the border, in Guatemala, breaking the law in the process, just to get the drugs at affordable prices. The child died while the documentary crew filmed the desperate smuggling.
Experts interviewed in the documentary also made some important points of note:
On the controversial high pricing for drugs, the documentary noted, "Big pharma generally defends high prices for new drugs … to cover costs for researching and developing new drugs. But in fact, most new drugs launched are just slight variations of existing medicines. So called Me Toos." Nathan Ford, of Médicins Sans Frontiéres said, "At the moment we are getting more and more drugs of less and less use. Me Too drugs; the tenth headache pills; the 15th Viagra. There are currently eight drugs in development at the moment for erectile dysfunction. Do we need 8 more drugs for erectile dysfunction? I don't think we do. Meanwhile diseases like Malaria, TB that kill 6 million people every a year, are neglected—no new medicines are coming out and we are left treating people with old drugs that increasingly don't work."
Markets for pharmaceutical companies are not just about finding people to target, but people with money. Dr. Jonathan Quick of the World Health Organization (WHO) added that the majority of the market for some of the tropical diseases is in developing countries but, "it's a market in terms of numbers of people but the purchasing power is not there [and therefore] the normal dynamics of the research and development industry just don't address those problems."
In another example of how power was used, the documentary noted what happened in Thailand in 1990: the Thai government was making a number of generic drugs. They also wanted to make a generic AIDS drug. However, the U.S. Trade Representative threatened them with export tariffs on wood and jewelry exports, which made up some 30% of Thailand's total exports. The Thai trade representative was very frightened and they stopped making the generic drugs. The U.S Secretary of Commerce threatened the South Korean Minister of Health in a similar way, but despite those threats, he continued campaigning for cheaper drug prices. He was later sacked. How do companies have such power over entire countries? Jamie Love, also interviewed in this documentary, suggested an answer:
Its because they not only can threaten not to make medicines available, but they can credibly threaten that the U.S. and Europe will impose trade sanctions on those countries and the financial markets will punish them for overriding the patent protection and hurt the rest of the economy. They can actually make the credible threat that if they don't pay their price for their medicine you won't be able to sell your products. You won't be able to have jobs in the manufacturing sector. Your whole economy will suffer.
— Dying from Drugs, Channel 4, UK, April 27, 2003. Also has accompanying on-line material
These, and other examples presented in the documentary were not isolated cases. Hard-fought changes to WTO rules that would have allowed poorer nations easier access to generic drugs was agreed to by virtually every member country in the world, but was resisted by the U.S.—their veto killed the agreement. Side NoteFor more information on this aspect, see the Dying for Drugs link above. See also: Pharmaceutical Corporations and Medical Research from this web site; Larry Elliott and Charlotte Denny, US wrecks cheap drugs deal, The Guardian, December 21, 2002
These complex issues are alive today, as the latest Avian flu concerns confirm. The Third World Network raises the issue again of the role of patents in restricting access to badly needed medicines, in this case, Tamiflu, recommended by health officials to reduce the severity of this feared flu.
But as J.W. Smith from the Institute for Economic Democracy noted a long time ago, it is of course, a cruel world:
Few have challenged or even recognized the unfair tax upon the unfortunate created by vastly overpriced products and services. There is a consistent pattern; the greater the need, the greater the overcharge. Though the need of those with physical disabilities is great, they have limited power to defend themselves. The first efforts to develop mechanical aids for people with physical problems were undoubtedly undertaken with noble intentions. Typically no profit was involved and much labor and time was donated as generous people tried to help the unfortunate. However, those who knew the value of these aids when monopolized claimed patent rights, and those with disabilities now must pay those monopolists. Witness the hearing aids… Each is only a tiny amplifier, yet costs ten to twenty times as much as a radio, which is hundreds of times larger and much more complicated.
— J.W. Smith, The World's Wasted Wealth 2, (Institute for Economic Democracy, 1994), p. 78
WTO—Patents, Intellectual Property, Emergency Drugs and Developing Countries
Due to what many believe is reasons of bad publicity, many large pharmaceutical companies have given away AIDS and other drugs at cheaper prices and even donated large sums of money to global initiatives. However, less discussed are the many fundamental issues that affect poor countries: access to essential drugs, allowing cheaper alternatives to be more easily made available, patent issues, the rights for poorer countries to pursue these alternatives, and so on.
Many of these issues go to the heart of the World Trade Organization (WTO) and the global rules made at this organization to accommodate world trade. However, critics for many years have said that the WTO is overly influenced by the rich countries, who are far more able to wield their economic and political influences to get what is best for them, often at the expense of the developing world. Side NoteSee a collection of articles from this web site's free trade-related issues section for more information.
TRIPS (Trade-Related Aspects of Intellectual Property) is one of the main areas of the WTO agreements. Created in 1994, medicines were included in its patent rules. Some of its rules had come under severe criticism from activists and developing countries. Concerns included that TRIPS allowed monopolization of life-saving drugs for 20 years, risking price increases, and even stifling innovation. Poor countries cannot afford to wait 20 years to enjoy the benefits of important drugs.
Developing countries had to enforce the TRIPS rules by 2005, but the Least Developed Countries (LDCs)—32 of them in the WTO—had until 2006. (In the 2005 WTO meetings in Hong Kong, LDCs requested a 15-year extension for administrative, economic, and financial reasons. This was reduced to a 7½–year extension with conditions attached (for example, any changes in the meanwhile must not be less consistent with the provisions of the TRIPS agreement.)
During the WTO meeting in Doha, Qatar, 2001, the overall outcome was not seen as favorable for the poor. However, one area where there was some success was in health issues. Slightly strengthened WTO TRIPS rules meant governments that could not afford branded drugs would be able to take measures to protect health a bit more easily by creating cheaper generics themselves, through "compulsory licensing."
WTO patent rules still allow 20 years of exclusive rights to make the drugs. Hence, the price is set by the company, leaving governments and patients little room to negotiate—unless a government threatens to overturn the patent with a "compulsory license." Such a mechanism authorizes a producer other than the patent holder to produce the product though the patent-holder does get some royalty to recognize their contribution.
Parallel importing is another potentially powerful mechanism available to poor countries. Effectively, it allows a nation to shop around for the best price for the same drug, which may be sold in many countries at different prices.
Compulsory licensing and parallel importing (in particular, parallel importing of generic drugs) are very effective tools to get prices down for developing countries. For example, the above-mentioned documentary noted that a drug in question had been offered in Brazil at dramatically reduced cost by Novartis themselves because of the threat that generic versions would have posed. (In the Europe Union (EU), parallel importing has been practiced for a while, though it is only on brand drugs and only amongst EU member states, so the benefits to patients of reduced prices appear more questionable. Side NoteFor more information on this, see for example: EU pharmaceutical parallel trade—benefits to patients? from the London School of Economics, January 27, 2004; European Union should liberalize drug market, EU judge says, from Bloomberg, April 18, 2005.)
However, compulsory licensing laws in TRIPS imply that generics are only to be used for domestic purposes, not for export, and so parallel importing—which has been strongly resisted by the US and the pharmaceutical multinationals—was not part of the 2001 agreement. In reality, this means that given most poor countries do not have a sophisticated domestic pharmaceutical industry and thus would not have the ability to make their own generics, they would likely have to purchase the more expensive branded drugs.
At the next major WTO meeting, in Cancun, Mexico in September 2003, the developing countries managed to get another small win. But parallel importing may still prove difficult:
Developing countries successfully stopped the US and the pharmaceutical lobby from excluding many important diseases of the third world from the deal, which is an important achievement. However no matter how desperate the health need, a poor country without the capacity to produce a needed drug—which is virtually all of them—will have to ask another government to suspend the relevant patent and license a local company to produce and export it.
Few countries, if any, will be prepared to help other countries in this way, as it would provoke retaliation by the US, which fiercely defends the commercial interests of the drug companies. What is more the agreement is wrapped in so much red tape and uncertainty that in practice it will be very difficult to use.
The bottom line is that many poor countries will still have to pay the high price for patented medicines or most probably, doing without. The World Trade Organization has failed to live up to the Doha pledge to put people's health before profits.
This "waiver" as it was in 2003, will now become a permanent amendment to the TRIPS agreement. While praised by some richer countries as meeting poorer countries concerns, poorer countries and NGOs criticized it codifying a difficult-to-work waiver, which no one has used yet and thus is unproven.
In addition, as noted further above however, the US has sought to undermine the agreement made at Doha. Oxfam, a prominent NGO, has been highly critical of the practices of big pharmaceutical companies, arguing that, "The U.S. Trade Representative is pursuing standards of patent protection which go far beyond WTO patent rules, and it is doing so regardless of the devastating impact that this could have on … developing countries." Oxfam also believes the US is "pursuing this pro-patent agenda on behalf of its powerful pharmaceutical lobby, PhRMA. The industry has an interest in strong patent protections, which limit generic competition and therefore protect its market share and profits." Furthermore,
The cheapest generic versions of new patented drugs are being blocked from developing-country markets by U.S. trade policies on intellectual property, at the urging of the drug companies that benefit from the monopoly position that patents confer.
During the two years since Doha, the U.S. has contravened the goal of the Declaration—'access to medicines for all'—by pressuring developing countries to implement 'TRIPS-plus measures': patent laws which go beyond TRIPS obligations and do not take advantage of its public-health safeguards. The USA does this in a number of ways. It provides biased technical assistance in countries such as Uganda and Nigeria, which benefits its own industry by increasing drug prices and limiting the availability of generics, but reducing access. It uses bilateral and regional free trade agreements to ratchet up patent protection in developing countries. It has recently concluded free trade agreements with Chile and Singapore and is using the high intellectual property standards in the latter as a model for negotiations on the FTAA (Free Trade Area of the Americas … and with Central American, Southern African, and other countries. And lastly, the U.S. bullies countries into increasing patent protection by threatening them with trade sanctions under section 301 of the Trade Act of 1974; nearly all those targeted are developing countries, including countries in compliance with their WTO obligations. The Costa Rican Pharmaceutical Industry estimates that the implementation of such TRIPS-plus patent rules would mean an increase in the cost of medicines of up to 800 per cent, because these rules would seriously restrict competition from generics.
— Robbing the Poor to Pay the Rich? How the United States keeps medicines from the world's poorest, Oxfam, December 2003
Martin Khor reported for the Third World Network on a global AIDS conference in Bangkok, July, 2004 and also commented on the negative impacts of the growing number of bilateral agreements signed with the US that Oxfam alluded to. These agreements, Khor wrote, "are creating new barriers to access to medicines, as they forbid the developing countries from policies (which the WTO allows) that promote generic medicines." To add to the sour French-US political relations, "There was a diplomatic uproar when the French President Jacques Chirac accused the US of blackmailing developing countries to give up measures to obtain life-saving drugs through these bilateral trade deals."
Global Health Initiatives
Since around 2000, a number of global initiatives have been set up to deal with various global health crises. To their credit, the big pharmaceutical companies have been actively involved in them, too.
Mega-rich individuals, such as Bill Gates, have also shown incredible charity by donating hundreds of millions of dollars to these initiatives. Some of the donations from people like Bill Gates are not without their criticisms for other motives, however. Side NoteSee for example, Gates gives $100m to fight HIV, $421m to fight Linux, by Thomas C. Greene, The Register (UK), November 11, 2002; Bill Gates: Killing Africans for Profit and PR, by Greg Palast July 14, 2003. But more fundamentally, as the magazine Himal South Asia notes,
"Private charity is an act of privilege, it can never be a viable alternative to State obligations," said Dr James Obrinski, of the organization Médicins Sans Frontiéres, in Dhaka recently at the People's Health Assembly…. In a nutshell, industry and private donations are feel-good, short-term interventions and no substitute for the vastly larger, and essentially political, task of bringing health care to more than a billion poor people.
— Rajshri Dasgupta, Patents, Private Charity and Public Health, Himal South Asian, March 2001
The Global Fund to Fight AIDS, TB and Malaria was created at the urging of UN Secretary General, Kofi Annan, in 2001. It was supposed to be the largest fund set up to tackle these global health issues. However, it has suffered from poor funding, slow distribution, and other political obstacles from some of the richest countries such as the US that would prefer to have their own initiatives so they have more control over where the money goes (the Global Fund is supposed to be a fund where countries donate without any strings attached. The US, as the international HIV and AIDS charity AVERT criticizes, prefers to go via its own PEPFAR (the President's Emergency Plan For AIDS Relief). This allows the US to avoid supporting countries perceived to be hostile, or those who may support programs it currently does not like—such as abortion and condom use, or use of generic drugs. For a good overview about the challenges and obstacles for the Global Fund, see The Global Fund to Fight AIDS, Tuberculosis and Malaria by AVERT, September, 2005).
As Oxfam and other organizations have charged, the large pharmaceutical companies are using corporate philanthropy to push their products at prices that would still be higher than generics, which poorer countries would be able to afford:
Several major pharmaceutical corporations are supporting international initiatives either by donating drugs or by subsidizing drugs provision, often receiving generous tax benefits in return. There are longstanding initiatives in place for controlling malaria, tuberculosis, and river blindness.
Pharmaceutical companies cite such agreements as evidence that strict patent protection under the WTO is compatible with socially responsible marketing. Reality is more prosaic. The main problem with these initiatives is that drugs are often made available in limited quantities, and at prices which compare unfavorably with those for generic-equivalent products.
During 2000, these initiatives were supplemented by an agreement between UNAIDS and five pharmaceutical companies … to improve access to treatment for HIV-positive people in developing countries [and] provide anti-retroviral products at significant discounts as part of a national AIDS plan.
Nevertheless, it has been slow to implement … and many African governments continue to argue that the waiving of patent rights on life-saving drugs would be a far more effective way of bringing down prices.
In effect … Commercial self-interest and corporate philanthropy are pulling in different directions. [Emphasis is original]
— Patent Injustice: How World Trade Rules Threaten the Health of Poor People , Cut the Cost campaign, Oxfam, September 2003
Poverty exacerbates health issues. Under conditions of poverty, entities such as large pharmaceutical companies can wield even more power and influence over poorer countries. Some major reasons for unnecessary deaths around the world are therefore due to human decisions and politics, not just natural outcomes. Well-intentioned companies, organizations and global action show that humanity and compassion still exists, but tackling systemic problems is paramount for effective, universal health care that all are entitled to.
Addressing health problems goes beyond just medical treatments and policies; it goes to the heart of social, economic and political policies that not only provide for healthier lives, but a more productive and meaningful one that can benefit other areas of society.
(Image credit: health shield courtesy of DevCom)
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Oh, Patti! When I read your essay, "Give and Take," in the February/March 2011 issue, I thought I was reading about myself. I have an 11-year head start on you with my multiple sclerosis (MS), so these days I don't run in high heels—even in my dreams. I do, however, dream I'm walking unaided, which I can't do in real life anymore. Like you, I'm still driving: I just passed a road test with flying colors this past summer. And like you, I have a wonderful husband who, in addition to doing the laundry and the groceries and the errands and countless other things, has made it possible for me to be only semi-retired from my profession.
Except for a gradual worsening of the problem with my left leg, there's been no progression of my MS beyond what I had at diagnosis. Hope you have similar good fortune.
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Glover Stadium
Glover Stadium is park at La Palma Park located at N Harbor Blvd & W La Palma Ave in Anaheim, CA 92801.
Glover Stadium
N Harbor Blvd & W La Palma Ave
"Home of Loara High School football"
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The Elders, along with the Pastor, are the Spiritual Leaders of the Church and meet every month for vision casting, spiritual growth and prayer, learning together, making decisions about the mission and ministry of the church and just having fun together. Click on a name to find out more about our leaders or click on a team to find out more about our ministries!
- Phil Ruxton, Clerk of Session, Session Liaison to the Faith Formation Team
- Harry Redd, Session Liaison to the Worship Team
- Amy Harrington, Session Liaison to the Fellowship and Outreach Team
- Aimee Ranaivoarijaona, Session Co-Liaison to the Fellowship and Outreach Team
- Judith Taylor
- Rusty Wilbur


text:
Research Topics
Affiliation: Oregon Health and Science University
Country: USA
Research Grants
Detail Information
- The stem cell fitness landscape and pathways of molecular leukemogenesisGrover C Bagby
Department of Medicine, Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon 97239, USA
Front Biosci (Schol Ed) 3:487-500. 2011....
- Global rank-invariant set normalization (GRSN) to reduce systematic distortions in microarray dataCarl R Pelz
Department of Molecular and Medical Genetics, Oregon Health and Sciences University, Portland, OR 97239 3098, USA
BMC Bioinformatics 9:520. 2008..Therefore, methods to correct this kind of technical variation are critical. Here we consider a method to reduce this type of variation applied after three common procedures for processing microarray data: MAS 5.0, RMA, and dChip...
- Genetic basis of Fanconi anemiaGrover C Bagby
Oregon Health and Science University Cancer Institute, Department of Medicine, Oregon Health and Science University, Portland 97201, USA
Curr Opin Hematol 10:68-76. 2003....
- Myelodysplasia and acute leukemia as late complications of marrow failure: future prospects for leukemia preventionGrover C Bagby
Department of Molecular and Medical Genetics, Oregon Health and Sciences University, Portland, OR, USA
Hematol Oncol Clin North Am 23:361-76. 2009..This article reviews the evidence supporting a model of clonal selection, a paradigm that provides a reasonable expectation that these often fatal complications might be prevented in the future...
- Fanconi anemiaGrover C Bagby
OHSU Cancer Institute, Department of Medicine and Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR 97239, USA
Semin Hematol 43:147-56. 2006....
- Discovering early molecular determinants of leukemogenesisGrover C Bagby
Department of Medicine and Molecular and Medical Genetics, Oregon Health and Sciences University, Oregon, USA
J Clin Invest 118:847-50. 2008....
- Human FANCC is hypomorphic in murine Fancc-deficient cellsLaura E Hays
Portland Veterans Administration Medical Center, Portland, OR 97239, USA
Blood 116:2057-60. 2010....
- TLR8-dependent TNF-(alpha) overexpression in Fanconi anemia group C cellsScott M Vanderwerf
Department of Biochemistry and Molecular Biology, Oregon Health and Science University, Portland, OR 97239, USA
Blood 114:5290-8. 2009..In conclusion, FANCC suppresses TNF-alpha production in mononuclear phagocytes by suppressing TLR8 activity and this particular function of FANCC is independent of its function in protecting the genome from cross-linking agents...
- Cytogenetic instability in ovarian epithelial cells from women at risk of ovarian cancerTanja Pejovic
Department of Obstetrics and Gynecology, Center for Women s Health, Oregon Health and Science University Cancer Institute, Portland, OR 97239, USA
Cancer Res 66:9017-25. 2006..Inherited mutations that result in tissue-specific FANCD2 gene suppression may represent a cause of familial ovarian cancer...
- Impaired type I IFN-induced Jak/STAT signaling in FA-C cells and abnormal CD4+ Th cell subsets in Fancc-/- miceSara R Fagerlie
Oregon Health and Science University Cancer Institute, Portland, OR, USA
J Immunol 173:3863-70. 2004..We suggest that Fancc mutations result in a subtle immunological defect owing to the failure of FANCC to normally support Jak/STAT signaling...
- Fancd2-/- mice have hematopoietic defects that can be partially corrected by resveratrolQing Shuo Zhang
Oregon Stem Cell Center, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
Blood 116:5140-8. 2010..We conclude that Fancd2(-/-) mice have readily quantifiable hematopoietic defects, and that this model is well suited for pharmacologic screening studies...
- The anti-apoptotic function of Hsp70 in the interferon-inducible double-stranded RNA-dependent protein kinase-mediated death signaling pathway requires the Fanconi anemia protein, FANCCQishen Pang
OHSU Cancer Institute, Department of Medicine and Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR 97201, USA
J Biol Chem 277:49638-43. 2002..We conclude that Hsp70 requires the cooperation of FANCC to suppress PKR activity and support survival of hematopoietic cells and that FANCC does not require the multimeric FA complex to exert this function...
- Constitutional marrow failure: IntroductionGrover C Bagby
OHSU Cancer Institute, Oregon Health and Science University, Portland, OR, USA
Semin Hematol 43:145-6. 2006
- Acquired FANCA dysfunction and cytogenetic instability in adult acute myelogenous leukemiaM William Lensch
OHSU Cancer Institute, CR145, Hatfield Research Center, 3181 SW Sam Jackson Park Rd, Portland, OR 97201, USA
Blood 102:7-16. 2003....
- Evaluation and lead optimization of anti-malarial acridonesRolf W Winter
Medical Research Service, RD 33, VA Medical Center, 3710 SW U S Veterans Hospital Road, Portland, OR 97239, USA
Exp Parasitol 114:47-56. 2006..Haloalkoxyacridones represent an extraordinarily potent novel class of chemical compounds with the potential for development as therapeutic agents to treat or prevent malaria in humans...
- Nucleophosmin interacts with and inhibits the catalytic function of eukaryotic initiation factor 2 kinase PKRQishen Pang
OHSU Cancer Institute, Schools of Medicine and Dentistry, Oregon Health Sciences University, Portland, OR 97201, USA
J Biol Chem 278:41709-17. 2003..Inhibition of PKR by NPM may be one mechanism by which neoplastic clones evolve in sporadic malignancies and in neoplastic cells arising in the context of the cancer predisposition syndrome, Fanconi anemia...
Research Grants3
- HIV INDUCED BONE MARROW DYSFUNCTIONGrover Bagby; Fiscal Year: 2003..Results of these studies should clarify the molecular pathogenesis of regenerative granulopoietic failure in HIV-1 seropositive patients and may also reveal determinants of lymphoma progression in this clinical context. ..
- Microarray Program for NHLBI InvestigatorsGrover Bagby; Fiscal Year: 2005..abstract_text> ..
- Eighteenth Annual Fanconi Anemia Research SymposiumGrover Bagby; Fiscal Year: 2006..This application seeks partial support for this meeting, scheduled to be held in Bethesda in October 2006. [unreadable] [unreadable] [unreadable]..


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A guide to the new euro crisis
The eurozone crisis is back – although some argue it never really went away.
The failure of Italy's elections to produce a clear winner, with Pier Luigi Bersani's centre-left coalition narrowly winning the lower house but no overall control of the upper chamber of Parliament, has re-injected tensions into markets, affecting instruments as far-flung as the Japanese yen and the CBOE Volatility Index. What should investors watch to judge the depth of market fears?
Italian bond yields will be front and center. Yields surged higher early Tuesday and remained there. Ten-year yields rose to 4.89%, their highest since late November, with the yield gap to Germany widening by well over 0.5 percentage point. Italy had to pay up to issue six-month T-bills on Tuesday, accepting an average yield of 1.237%, compared with 0.731% in late January. Wednesday brings another test, as Italy auctions a new 10-year bond for €3bn-€4bn.
Investors should keep a particularly close eye on two-year Italian yields for signs the market is worried that political paralysis has voided the protection offered by the European Central Bank's bond-buying pledge.
Spain will suffer, too; but if Italian yields close the gap with or rise above Spanish yields, that would be a significant reversal. Concerns about credit-ratings downgrades could rise again.
In currencies, the euro-Swiss franc rate is a key crisis barometer: If the euro falls to 1.20 francs, then the Swiss National Bank will have to intervene again. Strong appetite for francs would signal a real desire for safety among investors, since Swiss banks have introduced charges on deposits and short-dated Swiss government-bond yields are still negative. From close to Sfr1.25 in January, the euro has now fallen to Sfr1.217.
Another key measure will be how far corporate-bond spreads widen for Italian and Spanish banks and companies. That might signal renewed fragmentation in eurozone markets, something the ECB has been keen to reverse.
Finally, watch German bunds, where 10-year yields are back below 1.50% and two-year yields are closing in on zero. New 10-year-yield lows remain a ways off - some 0.3 percentage point lower - but would be a signal the crisis is back with a vengeance.
--write to Richard Barley at email@example.com
To read more from Heard on the Street, click here http://online.wsj.com/public/page/news-wall-street-heard.html


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Lacoste unveils their new collection "Flag", carrying sporting values, the spirit of international competition, inspired by the flags of each country.
With major international sporting events such as The London Olympics 2012 and Euros 2012, Lacoste has decided to hoist the flags and make its emblematic crocodile the standard bearer of 16 nations.
The Croco Flag polo shirt sees Lacoste's signature little green mascot swapping his scaly shirt for the colours of a country over a classic white cotton pique.


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The sad tale of turkeys goes way back with me. You see, I am not a rock star when it comes to making the bird. First, I hate to touch it. This has left me with the unfortunate disaster of cooking "the parts" all in their handy pouch inside the bird. Second, it is heavy. I have been known to cook it upside down. However it falls on the cooking sheet, I basically leave it where it falls. But then I heard that if you cook it breast side down, it makes for a juicier bird. I rejoiced that I wasn't an idiot and it helped with my next issue which is, I do not cook a moist bird. Despite the breast side down technique, I just can not master the art of having a juicy bird. In fact my son said to me just recently, "mom, can you just make a turkey that isn't so dry?" I have since banished him to the basement and took away all electronic devices for this
So alas, what is a girl to do? I of course had to see what my friend The Pioneer Woman had up her sleeve. You see, she is a rock star of cooking and of many other things. I turn to her when I am stumped with something to feed my hungry troops. She has never let me down as she is only a mouse click away. Guess what? She had a turkey recipe that I thought I should try. Make a brine......I always wanted to do that. Sounds fancy, but isn't. The promise of a moist bird.....I love it! Buy a fresh bird, nor frozen.....better yet as I hate thawing that bird out in my fridge for a
The Pioneer Woman's Turkey Brine
3 cups Apple Juice Or Apple Cider
2 gallons Cold Water
4 Tablespoons Fresh Rosemary Leaves
5 cloves Garlic, Minced
1-½ cup Kosher Salt
2 cups Brown Sugar
3 Tablespoons Peppercorns
5 whole Bay Leaves
Peel Of Three Large Oranges
Preparation Instructions
Combine all ingredients in a large pot. Stir until salt and sugar dissolve. Bring to a boil, then turn off heat and cover.
Allow to cool completely, then pour into a large brining bag or pot. Place uncooked turkey in brine solution, then refrigerate for 16 to 24 hours.
When ready to roast turkey, remove turkey from brine. Submerge turkey in a pot or sink of fresh, cold water. Allow to sit in clean water for 15 minutes to remove excess salt from the outside.
Discard brine. Remove turkey from clean water, pat dry, and cook according to your normal roasting method.


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When we drop our kids off at the school's front gates or wave good-bye to them at the bus stop, we hope that the main event is the three Rs, but we know that reading, writing, and arithmetic are not the only kinds of education kids get at school. As Ralph Waldo Emerson observed long ago, "I pay the schoolmaster, but 'tis the schoolboys that educate my son." Teachers, like parents, are caught in the middle of the maelstrom—pre-adolescents just coming into their own sexuality may practice kissing on the playground, hold hands in the halls, and play "games" to experiment with different kinds of intimate expression. How do we make sure our kids are managing invitation to various peer games, such as "Playing house," and later "Truth or Dare" or "Seven Minutes in Heaven?"
One teacher's clear-sighted way of handling the situation can offer insights to us as parents. In response to rumors about kids kissing, this teacher took the time to hold an "open circle session." In an environment where they felt safe, the kids were able to honestly share their concerns and discuss the ways they were trying to explore their sexuality. The teacher's basic messages were: "Listen to your conscience—and don't engage in dares that make you go against that voice," "Boys and girls can be friends," "Kids should not be kissing anybody but family members," and "Talk to an adult if you ever feel scared, nervous, or uncomfortable."
We can learn a lot from the way the teacher handled this situation. We have to recognize that our kids face challenges and pressures at school that we may find difficult to imagine. But our response can still be comforting: although we cannot be present on the playground or in the hallways to guide our children along, we can provide them with a set of pointers, similar to the ones offered by this teacher, to remember when they're in a situation of pressure. The more we stay aware of the pressures our children face from their peers, the more we can equip them with the tools to explore their sexuality in a healthy and values-rich way.
In primary grades, kids learn to follow rules and develop discipline, especially through sports. Their growing bodies allow them for the first time to demonstrate strength and grace. They are already developing physical models of masculinity and femininity, and you will notice that they identify with particular styles as they develop their personalities.
Physical: Though somewhat uncommon, it is not unheard of for 7- or 8-year-olds to develop secondary sexual characteristics (such as budding breasts and pubic hair), so it is important that you begin talking earlier rather than later about the changes that happen to our bodies as we grow up. Kids at this age also start to take more responsibility for their own hygiene, so you'll need to initiate conversations that keep up with their physical development so they are prepared to take more care of themselves as their bodies change.
During primary school, children are often introduced to rudimentary sex education or science classes that give specific information about differences between male and female anatomy and the stages of human reproduction. It's important to be aware of the content of material covered regarding sexuality so that you can integrate your conversations to blend what your kids learn at school with your family's values. For example, in later primary school, kids will start to put together, either from what they've heard in classroom instruction or on the playground that sexual intercourse occurs when a man inserts his penis into a woman's vagina. You want to make a link between this information and your own talks about sexuality—particularly because kids may take sexual information as secretive if it is not also addressed at home. You want to show that you understand sexuality as natural and support them so they feel comfortable with it.
Emotional: Children at this age begin to develop stronger friendships and often develop best friends. These friendships become more and more important as they get older. With their friends, children in primary grades may partake in games in which they "play house," taking on identities as "mommies" or "daddies." These games often recreate perceived gender stereotypes—the man goes to work while the woman stays home with the children or cooks the dinner. You may want to observe this play and use it as an opportunity to point out that many women also go to work, and men also take care of children, cook, and clean.
In primary school, children begin to be aware of sexual activity, and their reaction tends to be mild aversion: things like kissing are considered "gross" (with the exception of parents—we hope). Jokes begin to develop around sexual humor, and kids will laugh (and sing songs) about who likes whom. As kids express a full range of emotions and develop the capacity to think for themselves, parents have an obligation to pay attention to their growing child's feelings, whether of joy or sorrow, pleasure or embarrassment.
Relational: School, friends, and activities take children out of the home more and more. At this age they learn that there are different kinds of love (for family, friends, and parents, also the idea of being "in love"). As they expand their definitions of love, you will notice that they begin to initiate caring gestures—from bonding gestures in sports events (such as patting a teammate on the back) to embracing a friend after a long summer vacation.
Though kids at this age primarily gravitate toward friends of the same sex, the opposite sex is beginning to be increasingly noticeable. Conversation about girlfriends and boyfriends stirs at school, and boys start to catch up with girls and include the opposite sex in their network of awareness—though admittedly they're usually well behind girls in social consciousness.
Social: Primary school children begin to understand different circumstances that lead to marriage or divorce. They observe that relationships often evolve from friendship to courting, then dating, then falling in love, and finally, marriage, and they also may learn that having kids does not mean that people are necessarily married.
Primary school kids begin to learn how to manage conflicts and develop long-term relationships with others, identifying qualities that they admire and desire in friends. At this time, children become aware of differences in communication and interaction styles between homes and individuals. This is an appropriate time to help your child deal with and understand why he or she is valued or not by peers. By taking the time to discuss friendships and qualities that nurture healthy relationships (such as kindness, fair play, generosity, and understanding), you help your child to develop practices that will serve him or her throughout life.
Spiritual: Through exposure to religious traditions other than their own, primary school kids learn how different religions or belief systems can have different values. This age is a ripe time for discussing the values that are important in your family as they relate to lifestyle choices and current events. Part of understanding values is accepting that individuals' choices may have broad consequences. Value systems are important in helping kids later understand why sex is appropriate at some ages while not at others. As they come to understand and accept these values, they can see how values determine whether sexuality is seen as positive or negative, that it may be abused or used improperly, and that it is something to be handled with care.
If you make the effort to engage in an open dialogue with your children about your values and your perception of God, they will be equipped to develop a spiritual life, providing them with yet another resource (besides parents!) for seeking counsel in trying times, as their spiritual connection becomes personal.
John T. Chirban, Ph.D., Th.D., is a clinical instructor in psychology at Harvard Medical School and author of How to Talk With Your Kids About Sex that explains what kids need from parents at each stage of their sexual development and how parents can effectively communicate. For more information please visit www.dr.chirban.com, https://www.facebook.com/drchirban and https://twitter.com/drjohnchirban.


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Rainbows in Lynn Camp
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Jim Casada
Senior Member
Join Date: Jun 2009
Location: Rock Hill, SC
Posts: 992
Grannyknot--Interestingly, over the years, I have gotten different explanations as Park officials attempted to justify allowing extensive use of trails by horses. I've heard the explanation you offer, one to the effect that locals had traditionally used horses (only marginally valid but there's some truth to it), and even suggestions they did no more damage than humans (which is unmitigated hogwash).
One explanation which was never offered, but there's appreciable truth in it, is that no one in a position of authority has had the intestinal fortitude to stand up to a pretty powerful lobby which includes some political bigwigs (same sort of situation which left "summer retreats" for the rich and influential intact, let politically powerful folks stay at the Calhoun House on Hazel Creek, and the like). Another thing which frosts my grits is the tremendous amount of noise pollution from motorcycles. There are places you can be five or six miles from a roadway and hear them.
In truth, it's a balancing act for bureaucrats, but they have long turned a blind eye to the deleterious impact of horses.
Jim Casada
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City needs land for 7th, Pike work
The City of Marietta hopes to reach an agreement soon with Marietta College over land the city needs to acquire to add a turn lane at the Seventh, Pike and Greene Street intersection.
The city engineering department recently requested $227,700 for right-of-way acquisition for the more-than $2 million project to improve traffic and pedestrian safety, slated to be done next year. There are six pieces of property ranging from a couple hundredths of an acre in size to more than a tenth of an acre that the city must obtain to make room for the widened road.
"Offers have already been made to every one of these property owners with the exception of Marietta College and Captain D's," said city engineer Joe Tucker. "Those are two of the more complicated ones."
The college's soccer field sits on the property of which the city wants a piece. The portion the city is to acquire would go about three-and-a-half feet past the fence, which would have to be removed and replaced. A temporary fence will be erected while the work is being done. Those additional costs will be included in the city's offer to the college.
Tucker said city and college representatives have met multiple times to discuss the acquisition and the size of the property the city is seeking has been scaled back.
If an agreement cannot be reached, the city could invoke its power of eminent domain to acquire the land. A jury trial could be held to determine how much the city should pay for the land, city law director Paul Bertram III said.
But both sides say they aren't looking to go down that road.
"We're trying to do a mutually agreeable process," Tucker said.
A statement issued this week by Tom Perry, Marietta College's executive director of strategic communications and marketing, said the college has been working with the mayor's office and city council for more than a year on the issue.
"We are pleased with the progress that has been made up to this point, and college officials are optimistic that an acceptable resolution will be reached," Perry said. "We are focusing on collaborative solutions and have not discussed, nor have we considered, legal action."
Once the offers are presented to the property owners, they have 30 days to review them and respond. The project is being funded mostly with state money and is expected to be put out for bid in March. Tucker said the project is running close to its original timetable, and the plan is to have everything completed next year.
Another entity that will feel the impact of the project is the Marietta Morning Rotary, which maintains the garden at the intersection that includes greenery spelling out the city's name. The garden will have to be shifted, something that is expected to cost about $30,000, included in the overall project price.
Morning Rotary member David Haas isn't a fan of the project itself, believing adjustments to the traffic lights could cut down on congestion, but he's not overly concerned about the impact on the garden, he said.
"What we decided to do is move everything back," he said. "I'm pretty well satisfied that they're going to get us back to something we can live with."


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The Lafayette Parish Sheriff's Department has shown a great deal of initiative and foresight in establishing the Juvenile Assessment Center at its Poydras Street office. If this new method of processing juvenile offenders lives up to expectations, it could help salvage young lives, lower the crime rate in the parish and ultimately save taxpayer dollars.
The idea is to target young people who have committed less serious crimes and give them the help and guidance they need to avoid the pitfalls that could lead them to become career criminals.
That seems a more enlightened approach than simple incarceration.
Before the center opened, all juvenile offenders, whether they were arrested for truancy or attempted murder, were treated the same. They were charged with a crime, then sent to the juvenile detention center or released to their parents, said Capt. Kip Judice of the Lafayette Parish Sheriff's Office. He added there was no centralized way of keeping track of young offenders in the parish — they all entered the system in the municipality where they were arrested.
Now, all juvenile offenders, regardless of what law enforcement agency arrested them, are sent to the Juvenile Assessment Center. There, their problems and needs are assessed by a juvenile deputy specialist, a mental health professional and a representative of the school system. All this is made possible through partnerships the sheriff's office has forged with agencies and organizations in the parish.
Those who have committed more serious crimes will be booked, just as they were before.
But those who have committed lesser crimes may be eligible for individualized intervention outside the criminal justice system.
In those cases, the team of professionals will recommend appropriate "avenues" tailored to the child's needs, Judice said.
Some may need counseling. Some may need extra help with school work or workforce training. Some may be disruptive in school and may be referred to an "alternative school," such as N.P. Moss.
In other cases, Judice said, the problem is not so much with the child as it is with the parents. In those cases, the adults receive counseling to improve their parenting skills.
Sometimes, all that is needed is a behavior contract negotiated by a professional between parent and child. If the contract is violated, the young offender is then booked and enters the criminal justice system.
It's good that the program has consequences built in for kids.
The center and its program is modeled after similar programs in Calcasieu and Jefferson parishes, Judice said.
In Calcasieu Parish, he said, citizens passed a millage to support their program. In Lafayette Parish, the participating partners have each put up some of the money to run the center.
There is the hope that in time the program will be self-sustaining, using money that was saved by not having to house and feed as many juvenile offenders.
That would be the best of all worlds.
Since the center opened in August, Judice said 274 juveniles have been arrested. Of those, 70 percent have completed the program and continue to honor it; 10 percent have been re-arrested and 19 percent did not go through the Juvenile Assessment Center.
Unfortunately, there's a gap in the program. The JAC is open from 6 a.m. to 6 p.m., so kids who are arrested outside those times must be booked into the juvenile justice system the traditional way.
Having the center stay open 24 hours a day would be ideal, but Judice said funding is not adequate at this time to do that.
It will take at least five years of records-keeping to get a real sense of the program's effectiveness. Laws that protect juveniles' privacy also present an impediment to comparing results.
It may be true that this approach is as yet unproven, but the preliminary numbers look promising.
We hope the program has a chance to prove itself and that funding will somehow be made available to keep the center open 24 hours a day.
There are young people in the criminal justice system who need to be there. But there are others who just need another chance.
The Juvenile Assessment Center just may be the tool that will give them that second chance.


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As you read this there are dozens of men and women and hundreds of dogs crossing a very cold Alaska: more than a thousand miles of it. It's called the Iditarod by everyone who doesn't drive a team in it. For those who have, it's the Idiot Road.
There are deadly serious mushers in that race who are after that prize money, and a few of them will get it. But there are also the taildraggers. They know they won't win. What they want to do, really, is finish this most difficult of all races. And more than that ... to find out exactly what's inside them.
Thirty-nine years ago this week, that was me.
I had seven dogs. The minimum that year. And I had to borrow two to make the minimum. Most teams were in the 12 to 16 dog range. This translates to putting a VW bug in the Indy 500. Forget any prize money.
The front runners have snow machines half a day ahead of them, packing trail. With packed trail, those teams can average something like 80 miles a day. Without packed trail, you're lucky to get five miles, on snowshoes. And all it takes to turn a packed trail into snowshoe time is half an hour of wind.
There have always been "recreational mushers," like I was back then. I lived 12 miles from a road in those days, and for six months each year, the dogs got us back and forth to the village. They were basic transportation and basic family.
But this race, this monumental journey from Anchorage to Nome, makes a person want to hook up the dogs and head out.
I wasn't able to finish the race that year, 1973, because of an injury, and while I was on the trail, everyone passed me. And I guess it's because of that that each March I say a little prayer for all the mushers and all the dogs, but especially for the recreational mushers, for the tail-draggers. They'll be out in the cold and the lonely longer than the winners, looking to find that certain personal something.
Packed trail and fresh dogs, people. It's a very long way to Nome.
To buy Slim's books, go to www.slimrandles.com


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Moose Jaw Fire Department
At 1:30 p.m. on Friday, Moose Jaw Fire Department responded to a service call in the 300 block of Main Street North.
At 4:43 p.m. on Friday, firefighters responded to a grass fire one kilometre west on the Trans Canada Highway.
At 5:18 a.m. on Saturday, fire crews responded to the 1200 block of 11th Avenue Southwest for what turned out to be a false alarm.


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The Style Gallery is a great new way for you to view, love, and share outfit photos. It's meant to showcase
all the expressive, creative, and inspirational personalities of our community!
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Step up your style game by embracing accessories with character like this cute cappuccino headband by Wooden Ships! Made from a super fuzzy, knit yarn and knotted with a little loop, this pretty piece will take your unique looks to a whole new level. Try it on with a macrame vest, simple V-neck, high-waisted pants, and 1970s-inspired platforms for an on-point outfit you'll adore!
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Starting Monday, dozens of Texoma women will have a new place to call home.
Following a year of construction, Faith Refuge for Women is finished.
Last week, the public toured the $4.4 million dollar shelter, which can house more than 120 women.
And now that the grand opening celebration has come and gone shelter officials say it's on to the next big step.
"Everyone moves in. People who are already at Faith Mission and people who are on the waiting list to get into this new facility. Move in day is Monday, May 7th," says Faith Refuge Task Force Co-Chair Carol Wagner.
About 40 women are expected to move into the shelter Monday, including two women who are ordered there by the courts.
Copyright 2016 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


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21 CFR 312.50 - General responsibilities of sponsors.
|Updated to:
|April 2013
Title 21: Food and DrugsCHAPTER I: FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) SUBCHAPTER D: DRUGS FOR HUMAN USE PART 312: INVESTIGATIONAL NEW DRUG APPLICATION Subpart D: Responsibilities of Sponsors and Investigators 312.50 - General responsibilities of sponsors. Sponsors are responsible for selecting qualified investigators, providing them with the information they need to conduct an investigation properly, ensuring proper monitoring of the investigation(s), ensuring that the investigation(s) is conducted in accordance with the general investigational plan and protocols contained in the IND, maintaining an effective IND with respect to the investigations, and ensuring that FDA and all participating investigators are promptly informed of significant new adverse effects or risks with respect to the drug. Additional specific responsibilities of sponsors are described elsewhere in this part.


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/ News - NRCS California Accepting Applications for Tribal EQIP Initiative
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David Sanden (530) 527-2657, ex. 107
Alan Forkey (530) 792-5653
DAVIS, Calif., January 24, 2013—The USDA Natural Resources Conservation Service (NRCS) is accepting applications for the California Tribal Initiative, a partnership effort with Tribal Nations in California to help tribal farmers and ranchers put additional conservation on the ground.
This initiative is funded through the Environmental Quality Incentives Program (EQIP) and is being made in two statewide and three landscape tribal resource priority areas. The funding provides financial and technical assistance to Tribes and tribal producers who voluntarily agree to NRCS guidelines to install approved conservation practices that address program priorities related to soil, water, air quality, domestic livestock, wildlife habitat, surface and groundwater conservation, energy conservation, and related natural resource concerns. Applications will be accepted through February 15, 2013.
The three landscape resource priorities are aimed at improving water quality, rangeland health, forest health, and reducing the threat of wildfire. The three priority areas are:
The two statewide resource priorities are aimed at reducing soil erosion, improving irrigation water efficiency, water quality, and restoring and managing native plants for traditional Native American food and fiber production. The two statewide priorities are:
NRCS staff is available to help producers create conservation plans on a first-come, first-served basis. Applications can be submitted throughout the year. Applications received by Feb. 15 will be evaluated for funding priority for the pending 2013 funding. Applications received after Feb. 15 may be considered for future funding.
For additional information, eligible producers are encouraged to contact their local NRCS Service Center. Service center locations and more information on the programs can be found at www.ca.nrcs.usda.gov.
The Natural Resources Conservation Service provides leadership in a partnership effort to help people
conserve, maintain, and improve our natural resources and environment.
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FLOWERY BRANCH, Ga. — Tony Gonzalez has accomplished much during his 16 years in the NFL.
But one of the best tight ends in football history has never won a game on the biggest stage. Not even one playoff win.
The gaping hole on his playoff résumé eats at Gonzalez.
"I'm not going to lie to you," he said. "I really, really, really want to win this game."
If the 36-year-old Gonzalez is to be believed, he's down to his final chance. The Atlanta Falcons tight end has maintained all year that retirement is 95 percent certain after the final game, and he has not backed down despite an age-defying season in one of the NFL's most potent offenses.
So if Gonzalez doesn't get it done today when the top-seeded Falcons (13-3) play host to the surging Seattle Seahawks (12-5) in an NFC divisional game, there likely won't be a chance for a do-over.
"For me, obviously, this could be it," Gonzalez said. "There is no tomorrow. There is no saying, 'We'll get 'em next year.' It's about going out there and trying to finish on the right note."
He already has done more than enough to start writing his Pro Football Hall of Fame induction speech. No tight end in NFL history has more receptions (1,242), receiving yards (14,268), touchdown catches (103), 100-yard games (30), Pro Bowl appearances (12) and 1,000-yard seasons (four).
Even more remarkable, Gonzalez shows no signs of slowing down. This season, he led the Falcons with 93 receptions, no small feat on a team that also includes Roddy White and Julio Jones. He has 930 yards receiving, his best output since acquired from Kansas Cityfour years ago and eclipsed only by his 1,000-yard seasons with the Chiefs.
Gonzalez is fanatical about his workout program and always on the lookout for any new trend or discovery that might help him stay in peak physical condition. He is so in tune with his body that quarterback Matt Ryan looks for No. 88 when everyone else is covered.
"I tell him he's old all the time, so I guess his age does cross my mind every now and then," the 27-year-old Ryan said with a smile. "But he certainly doesn't play that way. He keeps himself in perfect shape, takes care of himself as well as anybody. That's why I keep telling him he could play a couple of more years."
The Falcons would love for Gonzalez to put off retirement for at least one more season, and he has left a slight crack open to a possible return.
He won't be making any definite plans before his final game; in fact, there's unlikely to be any sort of announcement right after the season, either.
"It will probably be well into the offseason," Gonzalez said, about as definitive as he has been on how this will all play out. "I want to make sure that I make the right decision."
He paused and considered his next words carefully.
"I'm not going to play that game with the media, and I'm really not going to play that game with my team," Gonzalez said. "So, we'll see."
This is the fourth time Gonzalez has been on a 13-win team heading into the playoffs. Two years ago, the Falcons were in the same position, needing two wins at home to reach the Super Bowl. Instead, they were blown out by Green Bay, 48-21.
A first-round loss to the New York Giants last year left Gonzalez 0-5 in the postseason.
He believes this is his best chance yet to finally end the drought, playing on a tight-knit team with loads of talent.


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WASHINGTON A senior adviser to Sen. Joseph Biden, D-Del., told a contingent of restaurateurs Wednesday that the frequent ally of organized labor would likely support employer accommodations in the card-check bill, a measure feared by the industry as a boon to unionization. "At the end of the day, there may well be accommodations made for small businesses," said James B. Greene, senior policy adviser for Biden, a longtime senator and current vice presidential candidate. "Though the ...
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A warm Shropshire welcome to The Clairmont Guest House
54, Haygate Road, Wellington, Telford, TF1 1QN ~ 01952 414214
Clairmont Guest House offers bed and breakfast in a Victorian property located in the small town of Wellington on the outskirts of Telford, Shropshire. We are an ideal B&B for both business and leisure visitors:
Telford International Centre and the town's commercial area are within a short drive. The World Heritage Site of Ironbridge and the 10 Victorian museums are just 4 miles away. The beautiful Shropshire countryside and a wide range of visitor attractions are all within easy reach.
For those travelling by train we are within walking distance of Wellington railway station. There is also easy access to the motorway, with Junction 7 of the M54 just 1 mile away. Wellington has a variety of pubs and good local amenities including an excellent Leisure Centre with recently refurbished gym & swimming pool - all just a short stroll away.
We offer bed and breakast in our beautifully furnished bedrooms, all en-suite with colour TV and tea/coffee-making facilities. Ground floor accommodation available.
Double room from £70.00 | Single occupancy from £45.00. Click here for more information about our Rates.
Check in times are between 3pm-7pm to check in outside these hours please contact the hotel directly.


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Roasted Sugar Snap Peas
Total Time
Prep 13 mins
Cook 2 mins
This recipe was adapted from Bon Appetit Magazine...very easy and delicious side dish.
Ingredients Nutrition
- 1 lb sugar snap pea (also called sugar peas, these peas are not shelled, as the entire pod is eaten)
- 1 tablespoon extra virgin olive oil
- coarse salt
- 2 tablespoons chopped fresh chives
- Preheat broiler.
- Line a large baking sheet with aluminum foil.
- Toss peas with olive oil on prepared baking sheet.
- Spread peas in a single layer.
- Broil approximately 2 minutes, or just until crisp-tender and they are beginning to brown in spots, stirring once.
- Remove from oven and transfer to a serving bowl.
- Sprinkle with coarse salt and chives.
- Serve immediately.
Most Helpful
Great recipe: only change was I used 1/2 tablespoon olive oil and it was still a little too oily; will try maybe 1 tsp next time. The chives were a nice touch. Great way to eat that big bag of Costco sugar snaps!
Soo yummy and easy. Our garden produces tons of sugar snap peas for a short amount of time. We eat more of them in one sitting with this recipe than any other. Seriously, two of us can eat that whole pound of peas.
I combined this recipe with another on this site. Roasted the peas per this recipe and then proceeded to follow the tangy sugar snap recipe. What a great combination although I think the roasted peas would've been great on their own.


text: ART3209 From Modern to Postmodern: Art Since 1940 Focusing on art from 1940 to the present, this course covers the transition from Modernism to Postmodernism. After examining the rise and fall of painting, this course will pay close attention to new media used by artists, including performance art, video art, and installation art. The course will investigate the shifting definition of art in the late 20th century and the artist's role as cultural critic. As required. 4 credits Junior or senior standing only