"The Protests of Allegiance"

From an LA Times Op Ed: The Protests of Allegiance by Gustavo Arellano

Even if the proposed bill passes, you won't see these immigrants take the decision lightly. These people who long searched for a voice will now scream with it. They will continue to press for recognition and will not rest until Congress gives it. Not handouts, but recognition. A chance. They will no longer accept exploitation. Illegal immigrants no longer want to hide from the federal government; they welcome scrutiny, confident in their potential as Americans.

By protesting, the marchers pledged allegiance to their future and ours, not the past. The U.S. will benefit from these newly conscious illegals, just as it has when it put other minority groups through the fires of nativism and bigotry. The undocumented yearning to be legal should not worry us. Most will turn out like my father: He still loves his Mexico, but he realizes that the best future for him and his family is in los Estados Unidos.

What a Great Idea

From the Los Angeles Times

Posted on Mon, Mar. 27, 2006
`ALIENS'
Reality show for members of Congress
BY ROSA BROOKS
reb2d@virginia.edu

Here's an idea for a reality TV show. Call it Aliens. The contestants will be drawn from the U.S. Congress.

To start, they'll have their credit cards, cellphones, computers and cars confiscated. Next, they'll be sent -- with their families -- to live in rural villages and urban shantytowns in poor countries. Each will be assigned a menial job in his new home, for which he will receive $1 a day.

Most members of Congress won't last more than a few episodes, of course. Their kids will quickly lose the baby fat that comes from a hearty American diet and instead gain the bloated tummies that characterize children with nutritional deficiencies. This development will frighten off the faint of heart.

Hardships along the route

The remaining contestants will be given the opportunity to compete in an even tougher game. They'll be instructed to make their way to a distant country, but they won't be provided with money, a passport or transportation. Hardships along the route will include fording flood-prone rivers, crossing dangerous deserts on foot and evading the armed gangs of smugglers and traffickers who will attempt to rob, rape and kidnap them.

Contestants will then have to covertly cross a border into a country guarded by armed agents.

Those who make it will then have to find food, shelter and employment in a place where they don't know the language and are in constant danger of being detected, detained and deported by the authorities. The only jobs available to them will be low-paying and often backbreaking labor.

What's the prize, you ask? Any contestants who manage to survive a full season will be offered the opportunity to draft a new immigration-reform bill for the United States.

Aliens would have an enormous natural audience among the two-thirds of Americans polled who disapprove of Congress' job performance. And one thing's for sure: The resulting immigration-reform bill would look nothing like the reform bill under consideration in Congress.

Both House and Senate versions of the bill share the same punitive spirit. At the moment, being in the United States unlawfully is a civil violation, not a crime. But current versions of the bill would make it a felony, resulting in possible prison time as well as deportation. Both versions of the bill would criminalize many forms of humanitarian assistance to illegal immigrants. The House version, for instance, makes it a felony for anyone to ''assist'' an unlawful immigrant to ''reside or remain'' in the United States. This means that a church volunteer who serves hot meals to illegal immigrants could end up in prison.

Such punitive provisions are mean-spirited and foolish.

Border security

Here's a radical idea: Instead of spending the $206 billion that the Center for American Progress estimates it would take to implement a five-year policy designed to detect, prosecute, imprison and deport people found here unlawfully, what if the United States stopped trying to punish all illegal immigrants?

We need border security, and we should take action against any person whose behavior poses a serious threat to public safety. But there's no need to be so punitive toward the ordinary economic migrants who find their way into our country.

Although most people assume that any slackening in efforts to enforce immigration laws would lead to a rapid influx of illegal immigrants and damage the U.S. economy, there's little reason to believe that this would happen.

Look at the European Union's recent experience. After poorer Eastern European states were admitted to the EU in 2004, many Western Europeans feared an influx of cheap labor that would push local workers out of jobs. But the evidence suggests that the xenophobes got it backward.

Desperate, courageous

In February, the European Commission released a study concluding that far fewer Eastern Europeans than expected had sought jobs in the three EU member states -- Britain, Ireland and Sweden -- that have completely opened their labor markets. These three states mainly saw ''positive effects'' of increased immigration from Eastern Europe, including ``high economic growth, a drop of unemployment and a rise of employment.''
Even when it means facing hardship, most people prefer to remain in their home countries, surrounded by family and compatriots who share their language and culture. Those desperate and courageous enough to leave in search of a better life far away are the exception, not the rule.
And our economy benefits from their presence. As the U.S. Chamber of Commerce has pointed out, illegal immigrants are ``working hard and performing tasks that most Americans take for granted but won't do themselves.''
As far as I'm concerned, anyone brave and determined enough to walk here from Guatemala deserves admiration, not hostility.
Rosa Brooks is an associate professor at the University of Virginia School of Law.
©2006 The Los Angeles Times

¡Si Se Puede!

Between 3,000 and 7,000 people (depending on if you ask the news papers or the parks department) converged on the Statehouse in Ohio yesterday to protest the ugliness of anti-immigrant sentiment that is sweeping Ohio and the nation, and in particular, to protest HB 4437, which would make it a felony to 1: be a person in this country illegally, or 2: to aid in any way shape or form someone who is in this country illegally (that could include giving someone a ride home from church without asking for their papers first!) I've written about this in past posts and am so glad to see backlash against this kind of hatred be so strong.

The Catholic Church has come out strongly against this bill, and has even preached from the pulpit that people of faith should give aid and comfort to all, even if it means breaking the federal law. Roger Mahoney, the cardinal Archbishop of Los Angeles said in a recent New York Times Op-Ed, "Called by God to Help":

This situation affects the dignity of millions of our fellow human beings and makes immigration, ultimately, a moral and ethical issue. That is why the church is compelled to take a stand against harmful legislation and to work toward positive change.

It is my hope that our elected officials will understand this and enact immigration reform that respects our common humanity and reflects the values — fairness, compassion and opportunity — upon which our nation, a nation of immigrants, was built.

Elenamary has a good post with an awesome picture of her mom at the rally.Though it wasn't the same as LA, New York, Phoenix, Atlanta, where hundreds of thousands walked out of school and work, and took to the streets in protest, for Ohio, even 3,000 people is pretty amazing, and 7,000 almost unheard of. We tend to be a state of folks who sit in front of the t.v. and don't get off of our butts to stand up for anything.

Here is the Columbus Dispatch article on the rally

Fighting to live the American dream
Monday, March 27, 2006
Misti Crane
THE COLUMBUS DISPATCH

Photo by Tom Dodge
Noelia Ontiveros, with her face painted the colors of Mexico, takes part in a rally on the Statehouse lawn protesting proposals aimed at putting tighter controls on illegal immigrants, including making it harder for them to live and work in the United States


Two boys no taller than their mothers’ waists jousted on the Statehouse lawn yesterday afternoon. One brandished an American flag; the other, the flag of Mexico. Their play battle went unnoticed by the sea of cheering, chanting, praying, poster-board-waving grownups around them. Signs floated atop a crowd that grew into the thousands: "This country was built on immigration." "Human beings are not illegal." "Jesus would be a felon." Spanish-speaking voices united in booming chants: "United people will never be defeated! " "Bush! Listen! We are in a fight! " And again and again, from the workers, from those still learning their ABCs and from those too old to work any longer, the farm workers’ motto: "Si se puede!" (Yes we can!)
The crowd, drawn from across the state, joined nationwide protests against a proposal to build fences between Mexico and the United States; make it more difficult for undocumented immigrants to live and work here; and punish those who hire or otherwise help them.

In Columbus, speakers reminded the largely immigrant gathering of its contribution to the economy — to restaurants, construction crews and farms and into a social security system from which they can’t collect.

They encouraged them to fight against anti-immigration efforts and for labor rights.

"Don’t let ’em give you this garbage that you need to go back where you came from, because we are home," said Baldemar Velasquez, president of the Toledo-based Farm Labor Organizing Committee.

"We are not strangers. We are not immigrants. We were born on this continent and this continent belongs to us."

Wilberto Pacheco, a Cincinnati janitor, said he has been disrespected and exploited by employers but learned that working together can make a difference.

"Our job is to go to our communities and convince people that this is a moment of hope and not of sadness, of pride and not fear," he said in Spanish.

Mayor Michael B. Coleman praised diversity and slammed the federal legislation, which passed the U.S. House of Representatives and will be debated in the Senate this week.

"They are dividing us under an umbrella called reform," he said.

"I call this a sledgehammer against all Americans."

The protesters roared in waves as an interpreter translated Coleman’s words, delivered in English, into Spanish.

"Hispanics aren’t like terrorists," said 12-year-old Steven Escobedo, attending his first rally.

"We get treated bad sometimes. My parents get treated bad," the Columbus boy said.

Lucy and Nacho Serna left the rally happy to have shown their American-born daughters the power of joining thousands of voices. The Delaware couple moved to the United States 15 years ago. He works in construction, she at McDonald’s.

Never before had the girls seen so many Latinos gathered in one place.

Janie, 9, and Kimberly, 4, dragged signs beside them: "We are not criminals" and "My parents taxes are criminals too."

Cindy, 2, held her mother’s hand.

"It’s important that they know when people get together they are strong. That’s what we do in Mexico when nobody listens to us," Mr. Serna said.

Behind them, a man thrust a crutch high over his head. Tied to it, the green, white and red flag of Mexico flew.

mcrane@dispatch.com

For Example

My post from a couple of days ago on my fear of religious zealots, is easily pointed out by this story by Emily Wax in the Washington Post on child soldiers, returning from war.

Uganda- The afternoon bell rang at the Children of War Rehabilitation Center, and a column of former child fighters filed stoically across a dusty yard, past blooming bougainvillea vines.

In silence, the children entered a thatch-roofed hut and sat on straw mats. Colorful murals on the walls depicted scenes from their lives in Africa's longest-running war: being captured by rebel fighters, training for warfare, escaping and finally reuniting with parents and beginning therapy.

The children are victims of a 20-year insurgency waged by the Lord's Resistance Army, a shadowy rebel group that wants to overthrow the government and install the Ten Commandments as law. Since it was founded in the 1980s, the group has kidnapped an estimated 20,000 children to serve as fighters, porters and sex slaves.

A group that wants the Ten Commandments to rule has forced these horrible acts upon children. Innocents. In the name of God? What God is this?

H2O... The Medicine We Need

From an article in Orion by Mike Davis entitled Slum Ecology

"...clean water is the cheapest and single most important medicine in the world."

Wha Wha Wha Whaaaaaaaat?

This is just too crazy. And leave it up to Michael Crichton to once again, warn us of possible dangers we face. Sheesh.

New York Times Op-Ed Contributor

This Essay Breaks the Law

By MICHAEL CRICHTON
Published: March 19, 2006

• The Earth revolves around the Sun.

• The speed of light is a constant.

• Apples fall to earth because of gravity.

• Elevated blood sugar is linked to diabetes.

• Elevated uric acid is linked to gout.

• Elevated homocysteine is linked to heart disease.

• Elevated homocysteine is linked to B-12 deficiency, so doctors should test homocysteine levels to see whether the patient needs vitamins.

ACTUALLY, I can't make that last statement. A corporation has patented that fact, and demands a royalty for its use. Anyone who makes the fact public and encourages doctors to test for the condition and treat it can be sued for royalty fees. Any doctor who reads a patient's test results and even thinks of vitamin deficiency infringes the patent. A federal circuit court held that mere thinking violates the patent.

All this may sound absurd, but it is the heart of a case that will be argued before the Supreme Court on Tuesday. In 1986 researchers filed a patent application for a method of testing the levels of homocysteine, an amino acid, in the blood. They went one step further and asked for a patent on the basic biological relationship between homocysteine and vitamin deficiency. A patent was granted that covered both the test and the scientific fact. Eventually, a company called Metabolite took over the license for the patent.

Although Metabolite does not have a monopoly on test methods — other companies make homocysteine tests, too — they assert licensing rights on the correlation of elevated homocysteine with vitamin deficiency. A company called LabCorp used a different test but published an article mentioning the patented fact. Metabolite sued on a number of grounds, and has won in court so far.

But what the Supreme Court will focus on is the nature of the claimed correlation. On the one hand, courts have repeatedly held that basic bodily processes and "products of nature" are not patentable. That's why no one owns gravity, or the speed of light. But at the same time, courts have granted so-called correlation patents for many years. Powerful forces are arrayed on both sides of the issue.

In addition, there is the rather bizarre question of whether simply thinking about a patented fact infringes the patent. The idea smacks of thought control, to say nothing of unenforceability. It seems like something out of a novel by Philip K. Dick — or Kafka. But it highlights the uncomfortable truth that the Patent Office and the courts have in recent decades ruled themselves into a corner from which they must somehow extricate themselves.

For example, the human genome exists in every one of us, and is therefore our shared heritage and an undoubted fact of nature. Nevertheless 20 percent of the genome is now privately owned. The gene for diabetes is owned, and its owner has something to say about any research you do, and what it will cost you. The entire genome of the hepatitis C virus is owned by a biotech company. Royalty costs now influence the direction of research in basic diseases, and often even the testing for diseases. Such barriers to medical testing and research are not in the public interest. Do you want to be told by your doctor, "Oh, nobody studies your disease any more because the owner of the gene/enzyme/correlation has made it too expensive to do research?"

The question of whether basic truths of nature can be owned ought not to be confused with concerns about how we pay for biotech development, whether we will have drugs in the future, and so on. If you invent a new test, you may patent it and sell it for as much as you can, if that's your goal. Companies can certainly own a test they have invented. But they should not own the disease itself, or the gene that causes the disease, or essential underlying facts about the disease. The distinction is not difficult, even though patent lawyers attempt to blur it. And even if correlation patents have been granted, the overwhelming majority of medical correlations, including those listed above, are not owned. And shouldn't be.

Unfortunately for the public, the Metabolite case is only one example of a much broader patent problem in this country. We grant patents at a level of abstraction that is unwise, and it's gotten us into trouble in the past. Some years back, doctors were allowed to patent surgical procedures and sue other doctors who used their methods without paying a fee. A blizzard of lawsuits followed. This unhealthy circumstance was halted in 1996 by the American Medical Association and Congress, which decided that doctors couldn't sue other doctors for using patented surgical procedures. But the beat goes on.

Companies have patented their method of hiring, and real estate agents have patented the way they sell houses. Lawyers now advise athletes to patent their sports moves, and screenwriters to patent their movie plots. (My screenplay for "Jurassic Park" was cited as a good candidate.)

Where does all this lead? It means that if a real estate agent lists a house for sale, he can be sued because an existing patent for selling houses includes item No. 7, "List the house." It means that Kobe Bryant may serve as an inspiration but not a model, because nobody can imitate him without fines. It means nobody can write a dinosaur story because my patent includes 257 items covering all aspects of behavior, like item No. 13, "Dinosaurs attack humans and other dinosaurs."

Such a situation is idiotic, of course. Yet elements of it already exist. And unless we begin to turn this around, there will be worse to come.

I wanted to end this essay by telling a story about how current rulings hurt us, but the patent for "ending an essay with an anecdote" is owned. So I thought to end with a quotation from a famous person, but that strategy is patented, too. I then decided to end abruptly, but "abrupt ending for dramatic effect" is also patented. Finally, I decided to pay the "end with summary" patent fee, since it was the least expensive.

The Supreme Court should rule against Metabolite, and the Patent Office should begin to reverse its strategy of patenting strategies. Basic truths of nature can't be owned.

Oh, and by the way: I own the patent for "essay or letter criticizing a previous publication." So anyone who criticizes what I have said here had better pay a royalty first, or I'll see you in court.


Michael Crichton is the author, most recently, of "State of Fear."

You Said It

New York Times Op-Ed Contributor

The Doctor Will See You for Exactly Seven Minutes

By PETER SALGO
Published: March 22, 2006

WHEN politicians speak of America's health care needs, they often miss an important point: the doctor-patient relationship has become frayed. Patients aren't unhappy just because health care costs too much (though they would certainly like it to be more affordable). Rather, people sense a malaise within the system that has eroded the respect they feel patients deserve.

There has been a shift in attitude within the profession. I see examples of it every day. I was making rounds in my intensive care unit recently when one of the interns presented a case. "This is the first admission for this 55-year-old male," he said.

"Stop," I said. "He is a man."

"That's what I said," the intern replied.

"Not exactly," I answered. Clearly, the intern didn't get it. Neither do a lot of other health care professionals anymore.

The problem has been sneaking up on us for almost two decades. As health-care dollars became scarce in the 1980's and 90's, hospitals asked their business people to attend clinical meetings. The object was to see what doctors were doing that cost a lot of money, then to try and do things more efficiently. Almost immediately, I noticed that business jargon was becoming commonplace. "Patients" began to disappear. They were replaced by "consumers." They eventually became "customers."

This may seem a trivial matter, but it is not. You treat "patients" as if they were members of your family. You talk to them. You comfort them. You take time to explain to them what the future may hold in store. Sometimes, that future will be bleak. But you assure them you will be there to help them face it.

You treat "customers" quite differently. Customers are in your place of business to purchase health care. You complete the transaction such a relationship suggests: health care for money. And then they aren't your customers any more. Taken a step further, you can make the case that the less time you spend with your customers, the better your bottom line will be. This gets everyone's attention.

"Length of stay" became a buzz phrase in hospitals in the 1990's. So did "throughput," an awful neologism for the number of patients per hospital bed per week. One of my colleagues joked that a hospital stay was a lot like a taxi ride. The institution collected a big fee when a patient got admitted, just as a cab driver saw most of his fare when he first turned the meter on.

The additional money collected over time wasn't nearly as impressive as that initial charge. The economics of the situation favored short trips, or lengths of stay, and lots of new riders, or throughput. The arithmetic worked, but I didn't notice a lot of people laughing.

Doctors in hospitals all over the country began hearing the same business language and facing the same pressures to "keep things moving." I used to be asked how well my patients were doing. Suddenly administrators were asking how long I was planning on keeping sick people in the intensive care unit. Each day a patient spent in my unit was a day some other paying patient would have to wait for a bed. Eventually, I was warned, some of those patients "in orbit" would go elsewhere, and we would not only "lose their business," but we risked losing future referrals from other centers.

It wasn't just hospitalized patients who were taking up space other "customers" could use. Outpatients "consumed" health care "resources," too. Publicly traded H.M.O.'s, for example, began restricting doctors to an average seven-minute "encounter" with each customer. This apparently kept shareholders happy. But it reduced the doctor-patient relationship to a financial concept in a business school term paper.

Doctors know you cannot provide compassion in seven-minute aliquots. But we have felt powerless to change things. The medical establishment has, many of us feel, simply rolled over and gone along to get along. It has sacrificed patients' best interests on the altar of financial return.

This leaves the solution to the problem in the hands of our patients. You, the patient, are the system's best hope. In the age of seven-minute health care, you need to realize that you employ doctors. That is, your doctor works for you. Although doctors shouldn't think of patients as customers, you can, and should, adopt a business mind-set when shopping for health care.

Evaluate what it is you expect from your doctor, then ask for it. If you are unhappy with your doctor, fire him. If you cannot get more than a seven-minute face-to-face encounter with your doctor, he needs fewer patients. The true power in the health care economy rests not with the doctors and certainly not with the backroom business staff. It rests with you. If you insist on being treated with care and respect, you will be. And the system will improve as a result.

A pediatrician I know put it quite succinctly. "There are a lot of doctors in town," she said. "There's no need to settle for one that doesn't treat you well."

In one respect the business people are right. Restoring the doctor-patient relationship will not save anyone any money. But I submit that it doesn't have to. There are other ways to curtail health care costs. Some involve high technology; others do not. None of them requires patients to sacrifice their self-respect.

We can and must reduce health care expenses. But we cannot do it at the expense of patients' well-being. The doctor-patient relationship is critical to the integrity of the health care system. It is not disposable. Turning doctors into shopkeepers who regard patients as customers is unacceptable.

How will the M.B.A.'s and the politicians respond to what can only be termed a "patient-driven revolution"? They will have to cope. I suspect doctors will be thrilled.

Peter Salgo, a professor at the Columbia University College of Physicians and Surgeons, is an internist and anesthesiologist, as well as the host of the PBS series "Second Opinion."

I Want To Be Here.....NOW

Hmmmmm.....

An Op-Ed from Slavoj Zizek in the New York Times Sunday discusses the value of atheism in a world full of increasingly violent religious zealots. I'm a very spiritual person, but this is a very interesting article that kind of pinpoints the growing sickening feeling that I have inside about people who shroud themselves in religious "morality". He speaks about the warning of Dostoyevsky that without God, we have a society of anything goes. He says:

This argument couldn't have been more wrong: the lesson of today's terrorism is that if God exists, then everything, including blowing up thousands of innocent bystanders, is permitted — at least to those who claim to act directly on behalf of God, since, clearly, a direct link to God justifies the violation of any merely human constraints and considerations.

I would urge you to read the full article. This is just one of the many points that the author made that made me go: hmmmm.

What is Your Life Worth? We'll Charge You That Amount

This is so disgusting, I hardly know what to do with myself. This, amongst arguments made that the out of control health care costs increases are because we consumers just use too damn much health care, and try to sue our doctor's too often. Yeah, right! When are we going to open our eyes and see the truth? Health care is NOT something that can be treated like any other consumable. The open market is NOT the place to let these things play out. GREED IS NOT MORE IMPORTANT THAN THE HEALTH AND LIVES OF HUMAN BEINGS. AND THAT IS WHAT THIS IS. Let's not kid ourselves here. Pharmaceutical CEO's getting yearly bonuses of tens of millions of dollars is NOT the most important thing that we need to assure as a society. Where is our sense of responsibility? There is all of this talk about "personal responsibility" these days. What about our personal responsibility TO EACH OTHER? Our societal responsibility? Did it get blown away with Katrina? Where have our values gone?

A Cancer Drug's Big Price Rise Is Cause for Concern

By ALEX BERENSON
Published: March 12, 2006

On Feb. 3, Joyce Elkins filled a prescription for a two-week supply of nitrogen mustard, a decades-old cancer drug used to treat a rare form of lymphoma. The cost was $77.50.

On Feb. 17, Ms. Elkins, a 64-year-old retiree who lives in Georgetown, Tex., returned to her pharmacy for a refill. This time, following a huge increase in the wholesale price of the drug, the cost was $548.01.

Ms. Elkins's insurance does not cover nitrogen mustard, which she must take for at least the next six months at a cost that will now total nearly $7,000. She and her husband, who works for the Texas Department of Transportation, are paying for the medicine by spending less on utilities and food, she said.

The medicine, also known as Mustargen, was developed more than 60 years ago and is among the oldest chemotherapy drugs. For decades, it has been blended into an ointment by pharmacists and used as a topical treatment for a cancer called cutaneous T-cell lymphoma, a form of cancer that mainly affects the skin.

Last August, Merck, which makes Mustargen, sold the rights to manufacture and market it and Cosmegen, another cancer drug, to Ovation Pharmaceuticals, a six-year-old company in Deerfield, Ill., that buys slow-selling medicines from big pharmaceutical companies.

The two drugs are used by fewer than 5,000 patients a year and had combined sales of about $1 million in 2004.

Now Ovation has raised the wholesale price of Mustargen roughly tenfold and that of Cosmegen even more, according to several pharmacists and patients.

Sean Nolan, vice president of commercial development for Ovation, said that the price increases were needed to invest in manufacturing facilities for the drugs. He said the company was petitioning insurers to obtain coverage for patients.

The increase has stunned doctors, who say it starkly illustrates two trends in the pharmaceutical industry: the soaring price of cancer medicines and the tendency for those prices to have little relation to the cost of developing or making the drugs.

Genentech, for example, has indicated it will effectively double the price of its colon cancer drug Avastin, to about $100,000, when Avastin's use is expanded to breast and lung cancer patients. As with Avastin, nothing about nitrogen mustard is changing but the price.

The increases have caused doctors to question Ovation's motive — and left lymphoma patients wondering how they will afford Mustargen, which is sometimes not covered by insurance, because the drug's label does not indicate that it can be used as an ointment. When given intravenously to treat Hodgkin's disease, its other primary use, the drug is generally covered by insurance.

"Nitrogen mustard has been around forever," said Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society. "There's nothing that I am aware of in the treatment environment that would explain an increase in the cost of the drug."

Dr. David H. Johnson, a Vanderbilt University oncologist who is a former president of the American Society of Clinical Oncology, said he had contacted Ovation to ask its reasons for raising Mustargen's price.

"I'd like to have some evidence from them that it actually costs them X amount, so that the pricing makes sense," Dr. Johnson said.

"It's unfortunate that a price adjustment had to occur," Mr. Nolan said. "Investment had not been made in these products for years."

Ovation, a privately held company, also needs the money to conduct research on several new drugs for rare diseases, Mr. Nolan said.

He acknowledged that Merck still made Mustargen and Cosmegen, an antibiotic that is used to treat a rare childhood kidney cancer, for Ovation. He said he was not sure when Ovation would begin producing the drugs, and a Merck spokesman said that Merck would continue to provide the drugs to Ovation as long as necessary.

But people who analyze drug pricing say they see the Mustargen situation as emblematic of an industry trend of basing drug prices on something other than the underlying costs. After years of defending high prices as necessary to cover the cost of research or production, industry executives increasingly point to the intrinsic value of their medicines as justification for prices.

Last year, in his book "A Call to Action," Henry A. McKinnell, the chairman of Pfizer, the world's largest drug company, wrote that drug prices were not driven by research spending or production costs.

"A number of factors go into the mix" of pricing, he wrote. "Those factors consider cost of business, competition, patent status, anticipated volume, and, most important, our estimation of the income generated by sales of the product."

In some drug categories, such as cholesterol-lowering treatments, many drugs compete, keeping prices relatively low. But when a medicine does not have a good substitute, its maker can charge almost any price. In 2003, Abbott Laboratories raised the price of Norvir, an AIDS drug introduced in 1996, from $54 to $265 a month. AIDS groups protested, but Abbott refused to rescind the increase.

And once a company sets a price, government agencies, private insurers and patients have little choice but to pay it. The Food & Drug Administration does not regulate prices, and Medicare is banned from considering price in deciding whether to cover treatments.

While private insurers can negotiate prices, they have limited leeway to exclude drugs from coverage based on price, said C. Lee Blansett, a partner at DaVinci Healthcare Partners, which works with drug makers on pricing and marketing.

"Price is simply not included in whether or not to cover a drug," Mr. Blansett said.

The result has been soaring prices for some drug classes, notably cancer treatments. In 1992, Bristol-Myers Squibb faced protests for its plans to charge $4,000 a year for Taxol, a breast cancer treatment.

Now, most new cancer treatments are priced at $25,000 to $50,000 annually. In some cases, companies are pushing through substantial price increases on already-expensive drugs.

Last year, Genentech raised the price of Tarceva, a lung-cancer drug, by about 30 percent, to $32,000 for a year's treatment.

In an interview last month, Dr. Susan Desmond-Hellmann, the president of product development for Genentech, said that the company had raised Tarceva's price because the drug works better than Genentech had anticipated.

"Tarceva was a more powerful and more active agent than what we understood at the time of launch, and so more valuable," she said. In an environment of soaring cancer drug costs, Mustargen's previous price was a comparative bargain, giving Ovation the opportunity to raise it substantially, said Dr. Richard Hoppe, a professor of radiation oncology at Stanford University and an expert in treating cutaneous lymphoma.

Mustargen's patent protection expired many years ago, so any company can make it. But because its sales are tiny, no drug maker has invested in a generic version.

"There's only one company that makes the drug, and they can decide what it's worth," Dr. Hoppe said.

Nitrogen mustard was initially tested as a chemical weapon. Its properties as an anti-cancer agent were discovered more than 60 years ago; today, it has been superseded by newer, less toxic medicines, and it is a niche product, with sales of only $546,000 in 2004, according to IMS Health, a market research firm.

Still, Dr. Hoppe and other oncologists call nitrogen mustard an effective treatment for cutaneous lymphoma, which initially appears as a rash but can turn deadly if it spreads inside the body. Some patients need only tiny amounts of the ointment, but others must apply it every day across large areas of their bodies.

For instance, Ms. Elkins has a severe case of lymphoma and must cover much of her body with Mustargen each day, a process that requires her to refill her prescription every two weeks. She said that the ointment was working, so she and her husband would find a way to pay for it.

Mr. Nolan of Ovation said that his company intended to work to improve access to insurance coverage for Mustargen. But Ovation has just begun to petition insurers to cover the drug. Meanwhile, patients are paying Mustargen's new, higher price out of pocket.

This is not the first time that Ovation has sharply raised the price of a drug it owns. In 2003, the company bought Panhematin, a treatment for a rare enzymatic disease called porphyria, from Abbott Laboratories. While Abbott still produces Panhematin, Ovation raised Panhematin's price, which had been $230 a dose, to $1,900, according to Desiree Lyon, executive director of the American Porphyria Foundation.

"It was a major increase," Ms. Lyon said. But she said that Ovation had worked to improve insurance coverage for Panhematin and to find ways for patients to get the drug even if they could not afford it.

Ovation also financially supports the porphyria foundation in its efforts to increase awareness of the disease and of Panhematin as a treatment, she said.

But many patients who rely on expensive drugs are stuck in a bind. Don Schare of Saratoga, Calif., said he paid $1,260 last month for 200 grams of nitrogen mustard cream, about 10 times what he paid for his prior prescription.

Mr. Schare, 69, said he was covered by the new Medicare Part D drug program and by supplemental insurance from AARP, but that neither of his plans covered Mustargen.

Jeffrey Malavasic, 58, a retired railroad worker in Florence, Ore., said he had decided to fill only half of his Mustargen prescription when he learned of the price increase. He used the drug sparingly in the past and will be even more frugal, he said.

And We Thought We Had it Bad in Ohio...

From the Kansas City Star

House OKs birth control funding ban

By KIT WAGAR The Star’s Jefferson City correspondent
JEFFERSON CITY — The Missouri House voted Wednesday to ban state funding of contraceptives for low-income women and to prohibit state-funded programs from referring those women to other programs.
Critics jumped on the proposal, saying it would lead to more abortions and more unwanted children on welfare.
But the proposal’s sponsor, Republican Rep. Susan Phillips of Kansas City, said contraceptive services were an inappropriate use of tax dollars. “If doctors want to give contraception privately or personally, they can,” Phillips said. “But we don’t need to pay for contraception with taxpayer funds.”
The change was the most controversial amendment adopted during the second day of debate on next year’s state budget. The Republican majority also turned back several efforts to boost funding for health-care programs by trimming farm and agribusiness subsidies.
Phillips’ amendment did not save the state money. Instead, it imposed restrictions on how state agencies could spend $9.23 million earmarked for public-health programs, mainly for people who are poor but make too much money to qualify for Medicaid.
The Budget Committee had approved expenditures on screenings for breast and cervical cancer, sexually transmitted diseases, infertility treatments and contraception.
Phillips’ amendment eliminated infertility treatments and contraception, and substituted alternatives to abortion and prenatal care for the purpose of giving birth. It also prohibited spending on any treatment and referrals for any treatment not spelled out in the budget.
Rep. Bob Johnson, a Lee’s Summit Republican, offered an amendment that deleted infertility treatments, but reinstated contraceptives. Most of the money, he said, would go to county health departments serving women with no alternatives to obtain health care. “If we don’t allow for contraception for low-income women, we will have more unplanned pregnancies and more pregnancies ended by abortion,” Johnson said. “No one here wants more abortions.”
He drew support from Rep. Rob Schaaf, a St. Joseph Republican and a family doctor. Schaaf said contraceptives were a basic part of medical care and should be covered.
Johnson’s proposal was defeated 100-53, with nearly all Republicans and a handful of Democrats voting against the change.
The House then took up Phillips’ amendment. Rep. Melba Curls, a Kansas City Democrat, asked how Republicans could vote to block access to contraceptives after last year’s dramatic cuts in Medicaid and other social services. “Not all the low-income women who will get pregnant will have abortions,” Curls said. “If you have the baby, you’re still low-income. And if you’re poor and you have a baby, who takes care of the baby? The state of Missouri. You’re setting up poor women once more not to have services.”
Rep. Kate Meiners, a Kansas City Democrat and an abortion opponent, said Phillips intended her amendment to be a statement against abortion. But Meiners said she feared it would have the opposite effect by creating more unplanned pregnancies.
But Phillips said she was comfortable with the change because the group Missouri Right to Life and the Missouri Catholic Conference supported it.
The House held a voice vote and the amendment appeared to fail. But supporters quickly called for a roll call to put each lawmaker on record supporting or opposing Missouri Right to Life. The amendment was approved 96-59.
The contraceptive services banned were an effort to jump-start a family-planning program that had been cut in 2003 because of the state’s severe budget crunch.
Rep. Rachel Storch, a St. Louis Democrat, pointed to a study that found the teenage birth rate in Missouri dropped 32 percent from 1991 to 2002. The drop was attributed to wider availability of contraceptives.

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To reach Kit Wagar , call (816) 234-4440 or send e-mail to kwagar@kcstar.com.