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2. Acts pertaining to the profession of emergency care The following acts of emergency care personnel shall, for the purposes of the Act, be deemed to the acts that pertain especially to the profession of emergency care; . a ; The identification of the emergency care needs of a person in an emergency care situation; . b ; the evaluation of the emergency care needs of a person in an emergency care situation with due regard to his or her safety and the implementation of precautions to ensure his or her safety; . c ; the rescue of a person from an emergency care situation or from a potential emergency care situation; . d ; the provision of emergency care to a person in an emergency care situation; . e ; the prevention of further injury to, and the combating of possible complications of an illness or injury, a person in an emergency care situation; . f ; the transportation in an emer-gency care situation of an injured or seriously ill person to, at or between health estab 2. Handelinge wat by the nood-sorgberoep tuishoort Die volgende handelinge van noodsorgpersoneel word vir die toepassing van die Wet geag handelinge te wees wat veral by die noodsorgberoep tuishoort; . a ; Die identifisering van die noodsorgbehoeftes van `n per-soon in `n noodsorgsituasie; . b ; die evaluering van die noodsorgbehoeftes van `n persoon in `n noodsorgsituasie, met behoorlike inagneming van sy of haar veiligheid, en die implementering van maatrels om sy of haar veiligheid te verseker; . c ; die red van `n persoon uit `n noodsorgsituasie of uit `n potensile noodsorgsituasie; . d ; die verlening van noodsorg aan `n persoon in `n noodsorgsituasie; . e ; die voorkoming van die verdere besering van'n per-soon in `n noodsorgsituasie en die bekamping van moontlike komplikasies van `n siektetoestand of `n besering van so `n persoon; . f ; die vervoer van `n persoon wat in `n noodsorgsituasie beseer of ernstig siek is na, by of tussen gesondheidsinstellishment s ; by an approved ambulance service, 3. Repeal The regulations promulgated by Government Notice No. R. 670 of 15 April 1994 are hereby repealed. ling s ; deur `n goedgekeurde ambulansdiens. 3. Herroeping Die regulasies afgekondig by Goewermentskennisgewing No. R. 670 van 15 April 1994 word hierby. Nism, increased intracellular levels of cGMP can result in elevation of cAMP levels see section on PDE3 ; . The effects of PDE1C on SMC proliferation may therefore be due to hydrolysis of both cGMP and cAMP. Why Is PDE1C Induced in Proliferating Human SMCs but not in SMCs From Other Species? To date, detectable PDE1C activity has only been observed in proliferating human SMCs and, curiously, not in proliferating aortic SMCs from nonhuman primates pigtail monkey, Macaca nemestrina, and baboon ; , bovine SMCs, porcine SMCs, rat SMCs, or ovine SMCs.52, 63 On the other hand, all of these species express PDE1A and or PDE1B. As shown by Figure 6B, the PDE activity profile in proliferating aortic SMCs isolated from pigtail monkey is strikingly different from that of SMCs isolated from human aorta Figure 6A ; . Both human and monkey SMCs express PDE5 and PDE3 4, but whereas human SMCs express PDE1C, monkey SMCs express PDE1B Figure 6 ; . These findings show that there are marked differences in expression and activities of PDE1C in SMCs from different species. We can only speculate on the reason for induction of PDE1C in proliferating human SMC, as opposed to SMCs derived from other species. It is possible that human SMCs have the need for a more extensive and controlled cAMP and cGMP hydrolysis during cell cycle progression than SMC from many other species. Intracellular calcium levels are tightly regulated during cell cycle progression, 64 and induction of PDE1C may serve as a means to coordinate mitogenic calcium signaling with a concomitant decrease in levels of the growth-inhibiting actions of both cGMP and cAMP. Regardless of the reason for the induction of PDE1C in proliferating human SMCs, special care must be taken when extrapolating results obtained with selective PDE inhibitors in animal studies to clinical trials in humans. Given the key role apparently played by PDE1C in the regulation of human smooth muscle proliferation, it would not be surprising if therapeutic agents can be developed that target PDE1C activity. Such agents would be expected to minimize the excess smooth muscle proliferative response that occurs in response to injury and inflammation that is caused by balloon angioplasty or stenting and perhaps even hypertension. They likely also would be less toxic than many currently used agents, for example, fda. Substances studied was developed, and a scoring system to compare relative activity was presented. This quantitative scoring system to assess the oxidative stress protection capacity of an antioxidant could be the basis for an antioxidant ingredient performance rating system that consumers could easily understand. Similar in analogy to sun protection factor SPF ; or immune protection factor IPF ; , 14 the antioxidant protection factor or environmental protection factor EPF ; could be used to assess the relative strength of antioxidants in their ability to protect against oxidative stress. Reviewing the summation of all study results presented Table 3 ; , one compound, idebenone, appears as a powerful antioxidant most consistently throughout all experiments. Although this potent antioxidant is relatively unknown to dermatology today, idebenone may represent a promising new agent for topical skin care protection. Further research is currently being conducted to establish its in vivo ability to protect human skin from oxidative stress and assess its efficacy in the treatment of photodamaged skin. Garret fitzgerald, md, pharmd, of the center for experimental therapeutics, university of pennsylvania, philadelphia, discussed his findings relative to bextra at the american heart association scientific session 2004 on november 1 his studies showed that the risk for heart attack and stroke was more than twice as high among those patients taking bextra compared to the placebo group and cialis.

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By susan roberts in response to a number of inquiries from our clients, peacock keller is currently reviewing claims related to the use of vioxx® , bextra® , and celebrex®.

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It is advisable to rehydrate patients first and then start therapy with bextra and danazol.

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Many women prefer oral medications to intravaginal preparations for the treatment of vaginal infections. During treatment with this medication, patients should avoid exposure to uv radiation and exposure to excessive sunlight, if done so you should protect your skin appropriately and darvon. Alert Message: Serious skin reactions have been reported in patients receiving Brxtra valdecoxib ; . These skin reactions are most likely to occur in the first 2 weeks of treatment, but can occur any time during therapy. In a few cases, these reactions have resulted in death. Valdecoxib should be discontinued at the first appearance of a skin rash, mucosal lesions, or any sign of hypersensitivity. Valdecoxib contains sulfa, and patients with a history of allergic reactions to sulfa may be at a greater risk of skin reactions. Conflict Code: TA Therapeutic Appropriateness Severity: Major Boxed Warning Drugs: Util A Util B Util C Valdecoxib References: Bestra Product Information, Nov. 2004, Pfizer Inc. Medwatch: FDA Safety Information and Adverse Event Reporting Program, 2004. The new details about propulsid are timely in light of recent problems with the arthritis painkillers bextra, vioxx and celebrex that have re-ignited criticism that the fda is unable to properly monitor and regulate pharmaceuticals once they're on the market, the times said and deltasone.

Related article: vioxx too was aggressively marketed to consumers by merck ; fda directed that the label for bextra be changed to clearly show its adverse side effects. 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If this is not the case and you are only experiencing joint pain and stiffness there are alot of safer drugs on the market that can treat that these days, for example, stevens johnson syndrome. The drug compatibility physical and chemical ; , clinical efficacy and safety of accuneb solution, when mixed with other drugs in a nebulizer have not been established and famvir. But unlike vioxx, bextra was taken off the market because of its potential to cause a rare but serious skin reaction, which is already disclosed on its label, pfizer said. 02242705 01917056 02229837 AROMASIN - 25MG TAB ARTHROTEC 0.2 50 ARTHROTEC 0.2 75 BEXTRA - 10MG TAB BEXTRA - 20MG TAB BEXTRA - 40MG TAB CAMPTOSAR - 20MG ML CELEBREX - 100MG CAP CELEBREX - 200MG CAP CERICLAMINE - 100MG CAP CERICLAMINE - 150MG CAP CHRONOVERA - 180MG TAB CHRONOVERA - 240MG TAB COGNEX - 10MG CAP COGNEX - 20MG CAP COGNEX - 30MG CAP COGNEX - 40MG CAP COLESTID - 1000MG TAB COLESTID ORANGE - 7500MG DOSE CORTEF - 10MG TAB CORTEF - 20MG TAB DEPO-MEDROL - 20MG ML DEPO-MEDROL - 40MG ML DEPO-MEDROL - 40MG ML DEPO-MEDROL - 80MG ML DEPO-MEDROL - 80MG ML DEPO-MEDROL 40 10 DETROL - 1MG TAB DETROL - 2MG TAB DIFLUCAN - 2MG ML EMCYT - 140MG CAP ESTRING - 2MG RING GENOTROPIN - 1.5MG VIAL GENOTROPIN - 5.8MG VIAL GENOTROPIN - 5.8MG VIAL GENOTROPIN - 13.8MG VIAL GENOTROPIN - 13.8MG VIAL GLUCOTROL XL - 5MG TAB GLUCOTROL XL - 10MG TAB GLYSET - 25MG TAB GLYSET - 50MG TAB GLYSET - 100MG TAB IDAMYCIN - 5MG CAP IDAMYCIN - 10MG CAP IDAMYCIN - 25MG CAP IDAMYCIN - 5MG VIAL IDAMYCIN - 10MG VIAL LIPITOR - 10MG TAB LIPITOR - 20MG TAB LIPITOR - 40MG TAB exemestane misoprostol diclofenac sodium misoprostol diclofenac sodium valdecoxib valdecoxib valdecoxib irinotecan hydrochloride celecoxib celecoxib cericlamine cericlamine verapamil hydrochloride verapamil hydrochloride tacrine hydrochloride tacrine hydrochloride tacrine hydrochloride tacrine hydrochloride colestipol hydrochloride colestipol hydrochloride hydrocortisone hydrocortisone methylprednisolone acetate methylprednisolone acetate methylprednisolone acetate methylprednisolone acetate methylprednisolone acetate methylprednisolone acetate lidocaine hydrochloride tolterodine tartrate tolterodine tartrate fluconazole estramustine sodium phosphate estradiol somatropin somatropin somatropin somatropin somatropin glipizide glipizide miglitol miglitol miglitol idarubicin hydrochloride idarubicin hydrochloride idarubicin hydrochloride idarubicin hydrochloride idarubicin hydrochloride atorvastatin calcium atorvastatin calcium atorvastatin calcium L02BG M01AB M01AB M01AH M01AH M01AH L01XX M01AH M01AH N06AB N06AB C08DA C08DA N06DA N06DA N06DA N06DA C10AC C10AC H02AB H02AB H02AB H02AB H02AB H02AB H02AB H02BX G04BD G04BD J02AC L01XX G03CA H01AC H01AC H01AC H01AC H01AC A10BB A10BB A10BF A10BF A10BF L01DB L01DB L01DB L01DB L01DB C10AA C10AA C10AA tablet tablet tablet tablet tablet tablet injectable solution capsule capsule capsule capsule extended-release tablet extended-release tablet capsule capsule capsule capsule tablet oral granules tablet tablet injectable suspension injectable suspension injectable suspension injectable suspension injectable suspension injectable suspension tablet tablet injectable solution capsule vaginal ring powder for injectable solution powder for injectable solution powder for injectable solution powder for injectable solution powder for injectable solution extended-release tablet extended-release tablet tablet tablet tablet capsule capsule capsule powder for injectable solution powder for injectable solution tablet tablet tablet and imovane. Usefulness and economic benefits of oral linezolid as an alternative to outpatient parenteral antibiotic therapy OPAT ; in the treatment of primary cellulitis. Methods: Patients with moderately severe cellulitis referred to an infusion centre for antibiotic treatment were enrolled into an open, non-randomised, pilot study. After informed written consent, patients were treated with oral linezolid, 600 mg q12 h, in place of their prescribed parenteral antibiotic. Patients were followed with clinic visits and lab monitoring. Results: A total of 10 patients, five males and five females mean age, 49 years ; , were enrolled. Seven were obese mean weight, 146 kg; range, 101196 kg ; , six had lower extremity cellulitis, one had lymphedema, and two were smokers. The average length of linezolid therapy was 12 days range, 527 days ; . All were compliant with the treatment regimen and had a clinical cure of their infection. Mild side-effects nausea, loose stools, headache, metallic taste ; were reported by four patients. None developed thrombocytopenia or prematurely discontinued therapy. A 12-day course of linezolid therapy drug costs, clinic visits, and lab monitoring ; was found to be less expensive than 4 days of vancomycin treatment 1 g q12 h ; in the infusion centre. Conclusions: In this study, we found that oral linezolid was safe and effective in the treatment of moderately severe cellulitis and could be a suitable replacement for OPAT. Furthermore, oral linezolid has the potential to improve patient satisfaction as well as lower overall treatment costs when compared with OPAT. Patients who benefit most from the formulations of the present invention are those who are known to suffer from nausea upon oral administration using swallow tablets and lasix.

The US State of Wyoming 4. There are also several programmes, such as the Health InterNetwork Access to Research Initiative HINARI ; that provide access in developing countries. To find out whether your country is included in any of these programmes provisions, or to learn how to get access if you don't already have it, please visit: : thecochranelibrary . If you would like to see a full list of reviews published in the new issue of The Cochrane Library, or would like to request full access to the contents of the Library, please contact. Contact: Tel: Email: Polly Young + 44 0 ; 1243 770633.
After the vioxx side effects were discovered, just two other drugs in the same category remained on the market - celebrex and bextra and levitra and bextra. Would, therefore, be greater if events occurring in the first 1-2 years were excluded. Adverse effects Forty eight of the 164 trials of statins and LDL cholesterol reported the number of participants with one or more symptoms possibly caused by the drug 1063 14197 allocated to statins and 923 10568 allocated to placebo ; . Meta-analysis of these data showed no excess risk in people allocated to statins. On average 1% fewer treated patients than placebo patients reported symptoms 95% confidence interval 3% fewer to 1% more in treated patients ; . The prevalence of each of 12 specific symptoms, including muscle pain and various gastrointestinal symptoms, was similar in treated and placebo patients, even for the highest daily dose tested 80 mg for all six statins ; . The upper confidence limits excluded the possibility that statins caused any symptom in more than 2% of treated patients. The only known serious adverse effects of statins are rhabdomyolysis and liver failure from hepatitis. The absolute risks are low. In the trials of statins and adverse events, with about 35 000 people and 158 000 person years of observation in both treated and placebo groups see webextra table A ; , rhabdomyolosis was diagnosed variable criteria ; in eight treated and five placebo patients, none with serious illness or death. Raised serum creatine kinase activity 10 times the "upper limit of normal, " used to recognise rhabdomyolysis ; was reported in 55 treated patients 0.17% ; and 43 placebo patients 0.13% muscle symptoms were present in 13 and 4 respectively. From the first marketing of statins in 1987 to May 2001 the Food and Drug Administration recorded 42 deaths from rhabdomyolysis attributable to statins other than cerivastatin, which was not used in these trials ; in the United States, 19 a rate of one per 10 million prescriptions dispensed19 or as a prescription is typically for one month's supply20 ; about one per million person years of use. There were no cases of liver failure in the trials. Raised alanine aminotransferase activity 3 times the upper limit of normal, used to recognise hepatitis ; was reported in 449 treated 1.3% ; and 383 placebo patients 1.1% ; see webextra table A ; . From 1987 to May 2000 the Food and Drug Administration recorded 30 cases of liver failure attributable to statins, 21 again about one per million person years of use!


Advertising advice affiliate programs autos awards business careers cgi communication computers copywriting css dhtml direct mail domain names ebooks ecommerce education email entertainment environment family finance fitness food free gardening government health hobbies home business home repair html humor internet javascript law link popularity management marketing marriage metaphysical mlm motivational multimedia newsletters off-line promotion online promotion other pets politics psychology publishing religion sales scams science self help se optimization se positioning se tactics sexuality site security social issues spam sports technology traffic analysis travel web design web hosting webmasters weight loss viral marketing women's issues writing celebrex and betra proving to be popular altenratives to discontinued vioxx montreal, quebec affordabledrugs ; december 30, 2004 the prescription drugs celebrex and beextra have grown in popularity since the arthritis painkiller vioxx was pulled off the market earlier this year for safety concerns and lisinopril. SENATE, from Page 1 Grassley has been aggressively investigating the FDA's role in events leading up to Merck's September withdrawal of Vioxx after data revealed a link between Vioxx and an increased risk of heart attacks and strokes in patients taking the drug. FDA scientist David Graham contended the agency had suppressed his earlier findings that established the negative effects of Vioxx and other Cox-2 inhibitors See related story, Page 5 ; . "Expect a continued investigation by the chairman of the Finance Committee, " the aide said. "Whether that will mean a hearing or not hasn't been determined. There are a lot of ways to conduct oversight outside of hearings themselves, " she added. As part of this, Grassley sent a Dec. 9 letter to FDA acting Commissioner Lester Crawford to find out what the agency knew about the cardiovascular risks of Pfizer's arthritis drug Gextra valdecoxib ; , another drug in the Cox-2 class. HELP Committee Jurisdiction But some have questioned whether the probes into drug safety fall under Grassley's jurisdiction. At the November hearing, Sen. Orrin Hatch R-Utah ; acknowledged that Medicare and Medicaid make reimbursements for Vioxx and almost every other drug. "But my study of this issue leads me to believe that the questions you have raised -- and I emphasize that they are legitimate questions -- largely relate to the approval process of the FDA, which obviously is a HELP Committee issue, " Hatch told Grassley. The likely incoming chairman of the Senate HELP Committee said he plans to conduct "aggressive oversight" of federal departments and agencies under its jurisdiction, which includes the FDA. A committee priority will be to review the FDA's drug safety system to ensure the FDA has the structure and strategies in place to maintain its pre-eminence as the gold standard for protecting the public health, said Sen. Mike Enzi, RWyo. ; , who is in line for the chairmanship. The specifics of the FDA review, however, will not be determined until early January, when Enzi meets. The suit claims that pfizer has not acted responsibly and has failed to adequately and timely warn consumers about the life-threatening side effects associated with bextra, according to a statement by the two laws firms that filed the suit.

Reevaluation of studies mandated in addition, fda announced that it was requiring evaluation of all prevention studies that involve the cox-2 selective agents celebrex celecoxib ; and bextta valdecoxib ; to ensure that adequate precautions are implemented in the studies and that local institutional review boards reevaluate them in light of the new evidence that these drugs may increase the risk of heart attack and stroke.
CMAJ SEPT. 8, 1998; 159 ; 1998 Canadian Medical Association text and abstract rsum ; 451, because attorney bextra pennsylvania. Overview: Bexfra generic name: valdecoxib ; , a popular pain reliever used for the pain of arthritis and menstrual symptoms, has been associated with an increased risk of heart attack, ischemic blood clot ; strokes, and retinal vein occlusions, in addition to the previously-known risks of gastrointestinal toxicity and severe skin reactions such as Stevens Johnson syndrome. Approved in November 2001, Bextda is a Cox-2 inhibitor in the same drug class as Celebrex and Vioxx. In November 2004, Pfizer presented the FDA with data from a study showing a tripled risk of cardiovascular events heart attack, stroke, blood clots in legs and lungs ; among patients who took Bextra following coronary artery bypass graft CABG ; surgery. On April 7, 2005, the FDA stated that the risks posed by Bextra outweighed its benefits, and asked Pfizer to withdraw it from the market. Pfizer immediately halted its sales in the United States and Europe. News: Judge Breyer recently entered a Case Management Order concerning the procedure to be used to select trial cases in the MDL. This procedure involves a number of cases to be selected by the Plaintiffs, a number of cases to be selected by Pfizer, and a number of cases to be randomly selected. Discovery on these cases must be completed by May 11, 2007 so that the cases can be tried later in the year. Strongest Cases: Clients who suffered a heart attack or ischemic blood clot ; stroke within 72 hours of last ingestion have the best cases. We are also interested in any cases where clients have been diagnosed with Stevens Johnson Syndrome SJS ; or Toxic Epidermal Necrolysis TEN ; as a result of using Bextra and cialis. If we take this statement to encompass Thompson's cornucopia of drugs in addition to London's drink, it becomes clear why London would have recognized in Thompson, just as Thompson recognized in Hemingway, the sickness unto death of a soul brother. Fear and Loathing in Las Vegas, like John Barleycorn, is ultimately a celebration of its thinly fictionalized central character, a hypermasculine connoisseur of The White Logic, who attains through his duel with meaninglessness a dark triumph of the will. Mikal Gilmore suggests that besides its importance as a "landmark, defining work, " Fear and Loathing in Las Vegas is "also the story of the sort of life Hunter Thompson lived. The drugs and drink should have killed him, the anger should have worn him down, and maybe in the end, it all contributed to how he died that night in February" Gilmore 2005, 44 ; . There is no doubt, I believe, that for Thompson, as for London, Hemingway, Fitzgerald, and many others, the drugs and drink did kill him one day at a time. "`One toke over the line, Sweet Jesus, '" exults the lawyer. To which, Thompson sneers: "One toke? You poor fool: Wait till you see those goddamn bats" Thompson 1998, 4 ; . For Gilmore, Thompson is best understood as "The Last Outlaw." But since the very idea of "the outlaw" on which Thompson modeled his life derives from The White Logic, it makes better sense, I think, to regard him as "The Last Modernist, "--closing the book of The White Logic about a century after London had opened it. The idea of the drinking writer was gradually transformed in the course of the twentieth century. For one thing, increasing numbers of alcoholic writers got sober and stayed that way. Fewer came to the bad ends of their unregenerate elders: from The Lost Generation to Alcoholics Anonymous. The understanding of addiction, both scientific and humanistic, also shifted toward a model of pan-addictive personality that undercuts the special status accorded to the drunk by early modernists. In the future, writers will undoubtedly continue to drink and do drugs, but they are unlikely to embrace Thompson, as Thompson embraced Hemingway, as a role model.
If you or a member of your family has any of these conditions above and has taken bextra, then you may qualify for a legal claim. State medical for such into illicit have had tussionex produced. For painful menstrual cramping, the recommended dose of bextra is 20 mg twice daily, as needed.

It should me kept in mind that: drug research cannot be carried out in women who are or might be pregnant, or who are breast feeding, for example, bextra drug recall.

December 31, 2003 and 2002, respectively, while interest yields on marketable securities averaged 1.3% and 1.6%, respectively. Long-term debt at December 31, 2003, was denominated primarily in U.S. dollars but also included Japanese yen long-term debt of $293 million. Longterm debt increased to $8.5 billion at December 31, 2003 from $6.3 billion at December 31, 2002 primarily due to the $1.0 billion of fixed rate notes and $1.2 billion of floating rate convertible debentures issued in August 2003 and October 2003, respectively. The proceeds from these issuances were used to repay short-term borrowings and fund the cash needs of the U.S. operations. The convertible debentures mature in 2023, callable at par at any time on or after September 21, 2008 by the issuer, and are convertible into Company common stock at 24.2248 shares per $1, 000 debenture $41.28 per share ; , subject to increases up to a maximum of 38.7597 shares per $1, 000 debenture based on increases in the market price of the stock above $41.28 per share, plus anti-dilution and certain other adjustments. Interest is payable quarterly at an annual rate equal to 3-month LIBOR, reset quarterly, minus 0.50%. A majority of the Company's debt is fixed rate. The Company, however, has entered into fixed to floating interest rate swaps for $5.5 billion of its long-term debt. Interest expense in 2003, 2002 and 2001 was $488 million, $410 million, and $182 million, respectively. There was no U.S. commercial paper outstanding at December 31, 2003. U.S. commercial paper outstanding at December 31, 2002 was $1, 158 million with an average interest rate of 1.40%. The average interest rate for the year ended December 31, 2003 and 2002, on international shortterm borrowings were 8.04% and 9.58%, respectively, and on current installments of long-term debt were 1.33% and 2.56%, respectively. As of December 31, 2003, the Company had two revolving credit facilities, totaling $1.0 billion in aggregate, as support for its domestic commercial paper program. These facilities were established in September 2001 and August 2003, respectively, with a syndicate of lenders, and are extendable at each anniversary date with the consent of the lenders. One of the revolving credit facilities has certain financial covenants, of which the Company is in compliance with as of December 31, 2003. There were no borrowings outstanding under the revolving credit facilities at December 31, 2003 and 2002. The Company had unused short-term lines of credit with foreign banks of $363 million and $321 million at December 31, 2003 and 2002, respectively. In July 2003, Standard & Poor's lowered its long-term credit rating on the Company from AA to AA-. In addition, Standard & Poor's affirmed its A-1 + short-term rating. In April 2003, Moody's Investors Service lowered the Company's long-term credit rating from Aa2 to A1. In March 2003, Moody's affirmed the Prime-1 short-term credit rating for the Company. On March 10, 2004, Standard & Poor's placed both long-term and short-term ratings of the Company on watch with negative implications. Moody's long-term credit rating remains on negative outlook. Net cash provided by operating activities was approximately $3.5 billion in 2003, $0.9 billion in 2002 and $5.4 billion in 2001. The increase in 2003 is attributable to higher net earnings and income tax payments in 2002 primarily related to the gain arising from the sale of the Clairol business. Cash flow from operations also included pension contributions of $332 million, $554 million and $300 million in 2003, 2002 and 2001, respectively. Cash provided from operations and borrowings were primarily used over the past three years to pay dividends of $6.5 billion and to repurchase 32 million shares at a cost of $1.8 billion in 2002 and 2001. The Company has also invested $2.9 billion over the past three years in capital expansion to improve plant efficiency and maintain superior research facilities. During 2003, the Company did not purchase any of its common stock. The Company repurchased 5 million and 27 million shares of common stock at a cost of $164 million and $1, 589 million in 2002 and 2001, respectively, bringing the total shares acquired since the share repurchase program's inception to 372 million shares. The share repurchase program authorizes the Company to purchase common stock from time to time in the open market or through private transactions as market conditions permit. This program is intended to reduce the increase in shares outstanding from option exercises and to obtain shares for general corporate purposes. Employment levels of 44, 000 at December 31, 2003 remained constant compared to prior-year levels. Academic detailing has emerged as one strategy to provide balanced messages in the face of the perceived commercial influence of pharmaceutical company detailing on physicians' prescribing. Academic detailing programs aim to deliver independent, evidence-based information about best prescribing practices to physicians through oneon-one or small group visits. This strategy has been used in five Canadian provinces and in Australia, New Zealand, England, the Netherlands and the U.S. Programs operate at arm's length from government, and this independence is valued by physicians. At a time when drug costs are escalating and drug safety controversies are making the front pages, academic detailing represents a well-tested, effective strategy to promote both cost effectiveness and better patient health by providing evidence-based information to physicians on appropriate prescribing. In 2005, prescription drug expenditures in Canada continued their steady climb, increasing by 11.5% over the previous year to reach an estimated $20.6 billion CIHI 2006 ; . Drug safety issues go far beyond the high-profile withdrawals of VioxxTM, BextraTM and BaycolTM from the Canadian market. Important safety issues are raised for approximately 20 percent of new drugs after entry to the market Peterson 2006 ; . Clearly physicians need up-to-date, reliable information to enable them to deliver the safest and most cost-effective care to their patients.
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From Good Samaritan Regional Medical Center Drs Raschke, Leibowitz, and Peirce and Mss Gollihare and Susong ; , Samaritan Health System Messrs Wunderlich and Lemelson ; , and Desert Samaritan Medical Center Drs Guidry and Heisler ; , Phoenix, Ariz. Reprints: Robert A. Raschke, MD, MS, Good Samaritan Regional Medical Center, 1111 E McDowell Rd, Phoenix, AZ 85006 e-mail: robertr samaritan.

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