VOL. 2 ISSUE 12 May 21, 2002

PSORIATIC ARTHRITIS MEDICAL NEWS

It has become almost impossible to sort out the important articles,
editorials, and news bulletins that could be published in our newsletter. For
this issue alone, I have over 40 articles to choose from, including news
about the medical profession, attitudes of doctors, medical editorials from
web sites, new drug information, pharmaceutical marketing, patient attitudes,
FDA activity, etc. For the benefit of all, I will issue two newsletters.

THE DEATH OF MEDICINE - NO CURE, NO VACCINE, NO TREATMENT
by Nicholas Regush, RedFlagsWeekly.com
There is no way to be nice about this. There is no point in raising false
hopes. There is no treatment or vaccine in sight. There is no miracle
breakthrough on the horizon.

Medicine, as we know it, is dying. It is entering a terminal phase.

What began as an acute illness reached the chronic stage about a decade ago
and progression towards death has been remarkably swift and well beyond
anything one could have predicted.

The disease is caused by conflict of interest, tainted research, greed for
big bucks, pretentious doctors and scientists, lying, cheating, invasion by
the morally bankrupt marketing automatons of the drug industry, derelict
politicians and federal and state regulators - all seasoned with huge doses
of self-importance and foul odor.

As a journalist, it has become very plain to see how little anything the
medical Establishment does these days can be trusted or taken at face value.
Press conferences, journal articles, symposia - all are geared to spike and
obfuscate the truth, to hide red flags from the public and to bulk up the
shares of investors in the companies that are promoting the science and the
researchers.

Like a disease that festers to the point of no return, medicine has reached
that line and stepped over it.

Item: A well-known expert in prescription drugs tells me that it is no longer
possible for him to fight the system. His wife has made it clear to him that
she is losing out on the good times and wealth that "all the other wives" are
enjoying.

So he has thrown in the towel and now expects to get the perks that all the
other guys are getting: free trips to conferences, invitations to give
speeches at luncheons, research funding without having to beg for it, and so
on. He is sad about this - but hey what can you do?

Item: Dr. David Healy, a well-known Welsh expert in psychiatric drugs is
approached by an agency representing an antidepressant manufacturer. He is
invited to speak at a symposium. The deal is that he will write a paper for a
supplement based on his talk.

The agency tells him that their ghostwriters will actually produce the paper,
based on his previous work. He says no. He writes his own paper but the
agency also wants the ghostwritten paper to appear in the supplement because
it had some "commercially important points." The agency finds another
"expert" who will lend his name to its "paper."

Item: There is more noise being made these days about who pays for research
published in journals. But what about research published in books? And who
actually reviews these "books?"

Do we have any idea of how many medical books are actually financed by
industry? No, we don't because most people don't tell who their backers are.
This has been a non-issue.

Item: Whose agendas are fueling medical research? A case in point: Should
Cancer researcher John Mendelsohn, who is president of the University of
Texas MD Anderson Center in Houston, sit on the corporate board of ImClone?

This is a biotech company that has been developing a new anticancer drug.
Forget for a moment that ImClone is being investigated by the U.S. Securities
and Exchange Commission (Did the company mislead investors about the cancer
drug?) Does it make make any sense for John Mendelsohn to have ties to
ImClone? Can we trust that MD Anderson is looking out for its patients first?

Item: A scientist with ties to research at the National Cancer Institute
managed to convince an editor of an obscure cancer journal to publish a paper
that had been previously rejected. The journal's editor, a buddy, had also
been involved in the research that was featured in the paper.

You're right. This is all very depressing. It goes on and on. Any
enterprising reporter could put a list together of thousands of examples like
these of how both the giants and the pipsqueaks of modern medicine have sold
out and can no longer be trusted.

I feel bad for the physicians who do care about their patients- and yes,
there are still many of those around. Day in and day out, they turn up at
their community or hospital offices and meet with people who need help. And
they mend wounds and take the time to do careful histories. They usually are
not the type who go to big conferences and give speeches.

The problem, unfortunately, is that the foot soldiers rely on the information
from the monster pack that has ripped away the heart of medicine and now they
will also watch it die, as they have known it. RedFlagsWeekly.com - Nick
Regush was the most clued in health reporter in the entire traditional media
industry when he was working for ABC News. ABC's policies started shifting
and prevented him from doing the reporting that he knew needed to be done, so
he ventured out on his own and now has his own web site. The mission of
redflagsweekly.com is to probe medical, scientific, environmental, artistic
and political issues in a manner that one rarely encounters in mainstream
news reports.

********************************

TOO MUCH MEDICINE? By Ray Moynihan - British Medical Journal
Most doctors believe medicine to be a force for good. Why else would they
have become doctors? Yet while all know medicine's power to harm individual
patients and whole populations, presumably few would agree with Ivan Illich
that "The medical establishment has become a major threat to health."
Many might, however, accept the concept of the health economist Alain
Enthoven that increasing medical inputs will at some point become
counterproductive and produce more harm than good.
So where is that point, and might we have reached it already?
Any consideration of the limits of medicine has to begin a quarter of a
century ago with Illich, who has so far produced the most radical critique of
modern or industrialized medicine.
His argument is in some ways simple. Death, pain, and sickness are part of
being human. All cultures have developed means to help people cope with all
three. Indeed, health can even be defined as being successful in coping with
these realities.
Modern medicine has unfortunately destroyed these cultural and individual
capacities, launching instead an inhuman attempt to defeat death, pain, and
sickness. It has sapped the will of the people to suffer reality. "People are
conditioned to get things rather than to do them... They want to be taught,
moved, treated, or guided rather than to learn, to heal, and to find their
own way."
The analysis is supported by Amartya Sen's data showing that the more a
society spends on health care the more likely are its inhabitants to regard
themselves as sick.
Illich's critique may seem laughable, even offensive, to the doctor standing
at the end of the bed of a seriously ill person. Should the patient be thrown
out and told to cope? It is of course much easier to offer a critique of
cultures than to create new ones and Illich (like doctors, ironically) is
much stronger on diagnosis than cure. But he does write about recovering the
ability for mutual self-care and then learning to combine this with the use
of modern technology.
Though his polemic was published long before the Internet, this most
contemporary of technologies combined with the move to patient partnership is
shifting power from doctors back to people.
People may increasingly take charge, more consciously weighing the costs and
benefits of the "medicalization" of their lives. Armed with better
information about the natural course of common conditions, they may more
judiciously assess the real value of medicine's never ending regimen of tests
and treatments.
Global pharmaceutical companies have a clear interest in medicalizing life's
problems, and there is now an ill for every pill. Likewise companies
manufacturing mammography equipment or tests for prostate specific antigen
can grow rich on the medicalization of risk.
Ivan Illich did not want the wholesale dismantling of medicine. He favored
"sanitation, inoculation, and vector control, well-distributed health
education, healthy architecture, and safe machinery, general competence in
first aid, equally distributed access to dental and primary medical care, as
well as judiciously selected complex services."
These should be embedded within "a truly modern culture that fostered
self-care and autonomy." This is a package that many doctors would find
acceptable, particularly if available to everybody everywhere.
Doctors and their organizations understandably argue for increased spending
because they are otherwise left paying a personal price, trying to cope with
increasing demand with inadequate resources. Indeed this is one of the
sources of worldwide unhappiness among doctors. Although seen by many as the
perpetrators of medicalization, doctors may actually be some of its most
prominent victims.
Perhaps some doctors will now become the pioneers of de-medicalization. They
can hand back power to patients, encourage self care and autonomy, call for
better worldwide distribution of simple effective health care, resist the
categorization of life's problem as medical, promote the
de-professionalization of primary care, and help decide which complex
services should be available. This is no longer a radical agenda. British
Medical Journal April 13, 2002

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HOW PHARMACEUTICAL COMPANIES USE ENTICEMENTS TO "EDUCATE" PHYSICIANS by Brian
Ross and David W. Scott - ABC News.com
It was doctors' night out last June at the world-renowned Museum of Modern
Art in New York City, and the Saturday night party, put on by Pfizer Inc.,
was lavish. The event was strictly private, closed to reporters, as the
pharmaceutical company entertained a very select list of doctors and their
guests.

But Primetime's undercover cameras saw the kind of big-money splurge that
some say drives up the cost of prescription drugs and corrupts the practice
of medicine. Further investigation into the $6 billion spent by drug
companies for what they say is a way to educate doctors showed that tactics
like lavish gifts and trips are surprisingly common.

"It's embarrassing, it's extravagant and it's unethical," said Dr. Arnold
Relman, a Harvard Medical School professor and the former editor of the New
England Journal of Medicine. "It makes the doctor feel beholden . it suborns
the judgment of the doctor."
But doctors seemed thrilled to have been invited for a weekend in New York
City with some seminars along the way, with all expenses paid by Pfizer on
behalf of one of its drugs, Viagra.

One Small-Town Doctor: $10,000 in Goodies - Few doctors were willing to talk
publicly about their relationships with pharmaceutical companies, but one
upstate New York doctor was willing to come forward. "It's very tempting and
they just keep anteing it up. And it's getting harder to say no," said Dr.
Rudy Mueller. "I feel in some ways it's kind of like bribery."

Disgusted by how the free gifts and trips add to the high price of medicine,
and moved by the plight of patients forced to skip needed medication, Mueller
agreed to provide Primetime with a rare glimpse of the astounding number of
drug company freebies he was offered by various drug companies in a
four-month period.

He was presented with an estimated $10,000 worth, including an
all-expenses-paid trip to a resort in Florida, dinner cruises, hockey game
tickets, a ski trip for the family, Omaha steaks, a day at a spa and free
computer equipment.

"It changes your prescribing behavior. You just sort of get caught up in it,"
said Mueller, who said he was offered a cash payment of $2,000 for putting
four patients on the latest drug for high cholesterol. The company called
this a clinical study; Mueller called it a bounty.

"I've never been offered money before," he said. "I don't remember that 10,
15 years ago."

Though Mueller normally declines the offers, he agreed to attend a dinner,
which Primetime secretly taped. Not only were the doctors wined and dined,
but each was also offered a payment of $150 for just showing up to listen to
a pitch for a new asthma treatment for children.

The company called it "an honorarium," but Mueller saw it differently.
"Again, it's bribery," he said. "This is very effective marketing."

There's a wide range in value of the free gifts offered to doctors - from
lavish trips to free Mother's Day flower bouquets for doctors willing to hear
a pitch about a new osteoporosis medicine.

In the latter example, when asked whether a floral shop was the most
effective place for a discussion on pharmaceuticals, one of the
representatives said, "I'm sorry, we're not allowed to comment on anything."

Detail Men - The goodies are dispensed by an army of drug company
representatives known as detail men and women, of whom there are 82,000
nationwide.

It's the job of the detail people to quietly befriend doctors, keeping close
track of which doctors take the free gifts and then determining which drugs
the doctors later prescribe.

"I think it's sleaze," said Relman. "Anybody who's been in that position
knows that yes, those gifts, $60, $100, $40, again and again, do influence
your attitude about that company and will influence the prescriptions that
you write."

And the multibillion-dollar drug company blitz extends throughout the
profession, even at the yearly gathering of one of the most prestigious
medical groups, the American College of Physicians. It was like a carnival:
Doctors could be seen taking free massages, free food, free portraits, free
Walkman players, free basketballs, and from one company pushing a new antacid
drug, free fire extinguishers.

Many doctors say it's no different than any other business or convention, and
that it doesn't affect their medical judgment. But that's not the view of the
new president of the American College of Physicians, Dr. William Hall, who
says anything beyond a pen or a mug could have an impact.

"Whether we like it or not, it can cloud our clinical judgment," he said.
"Unequivocally, I would say that."

So why are some of the very practices Hall publicly criticizes permitted at
his group's supposedly scholarly convention? "I think there it's a situation
where every physician is going to have to balance what's right or wrong,"
said Hall.

"We are concerned about it," he added, saying that at some point the system
may be changed.

But right now, Hall's group receives $2 million a year from the drug
companies to have their exhibition booths at the convention, yet another
example of how the big drug companies spend billions to influence doctors in
this country.

"The basic mistake we're making with our health-care system now is that we
regard it as just another business. And it's clearly not just another
business. Patients, sick patients and worried patients, are not like ordinary
consumers," said Relman. "Doctors ought to be incorruptible . That's the
doctor's sacred obligation. They're being corrupted and undermined by this
kind of salesmanship."
ABC News.com

***************************

ILLEGAL METHODS USED FOR MARKETING ARTHRITIS DRUG
By Melody Petersen - New York Times

Centocor a subsidiary of Johnson & Johnson has been providing doctors with
marketing materials that describe how they can make extra money by
prescribing a new drug, a practice that health care fraud experts say may be
illegal.

Some doctors have recently raised concerns about Centocor's marketing of the
new drug, Remicade, an expensive treatment for rheumatoid arthritis.

A document available to doctors on Centocor's Web site until last week, when
a reporter asked about it, stated that one "benefit" of prescribing Remicade
was the "financial impact" on the physician's practice. The document included
a worksheet where physicians could calculate their "estimated revenue per
patient" from prescribing the drug.

The "revenue," according to the worksheet, was primarily the difference
between what Medicare pays doctors for Remicade, which is given intravenously
in their offices, and the lower amount that Centocor charged doctors for the
drug. The drug is one of the few rheumatoid arthritis treatments that
Medicare covers.

Legal experts say the document described a marketing practice similar to ones
found to be illegal when used by other companies and that remain a focus of
federal health care fraud investigators.

In one of those cases, federal prosecutors said that Tap Pharmaceutical
Products had illegally promoted Lupron, a drug often prescribed for prostate
cancer, by telling doctors they could make money through Medicare and
Medicaid reimbursements for the drug. Tap agreed to pay $875 million last
year to settle criminal and civil charges in that case, the largest sum ever
paid for health care fraud.

Dr. Paul April, a rheumatologist in Tulsa, Okla., said that other doctors
have told him that Centocor representatives had invited them to meetings
where they could learn about how they could profit from Remicade. He said
that the rheumatology field is now abuzz with discussion of the money to be
made.

Dr. April said he believed that some doctors were prescribing Remicade, which
can cost more than $20,000 a year, before they tried a low-cost generic drug
called methotrexate, a standard treatment for rheumatoid arthritis. He said
some doctors were also choosing Remicade over Enbrel, a similar new medicine
that is also expensive, because of the extra money they could make.

Doctors are also motivated to prescribe Remicade, Dr. April said, to help
their elderly patients afford an effective medicine since it is covered by
Medicare and similar drugs are not.

American College of Rheumatology guidelines suggest that doctors prescribe
Remicade or Enbrel only after patients have not responded to methotrexate, or
have shown they cannot tolerate it.

Both Remicade and Enbrel, are made by Immunex in a marketing partnership with
Wyeth. But both drugs have side effects, including an increased risk of
serious, life-threatening infections.

Remicade is being overused because there is money to be made by using it.

Medicare pays only for drugs that must be administered by a physician. Of
drugs for rheumatoid arthritis, Remicade is one of very few covered by
Medicare because it must be given intravenously. Enbrel, also a biologically
engineered medicine, can be injected by patients themselves and is not
covered. Most of the other drugs for rheumatoid arthritis are taken orally.

Remicade and Enbrel, which were approved in 1998, are in a heated marketing
battle. Sales of both drugs have risen rapidly since they were approved in
1998, but Enbrel has been outselling Remicade. Now Remicade is gaining
ground.

Sales of Remicade were $658 million last year, more than double the $256
million in sales in 2000, according to NDCHealth, a health care information
company. Sales of Enbrel were $907 million last year, up almost 18 percent
from $770 million in 2000.

Medicare is supposed to receive a discount on the prices that pharmaceutical
companies charge other customers. Medicare, therefore, reimburses doctors for
drugs at 95 percent of what is called the average wholesale price. But
investigators have found that some companies have inflated the average prices
reported to the government so that Medicare reimbursements are higher than
what the companies most often charge.

According to the federal government, Medicare's payments for Remicade
skyrocketed last year. Medicare paid at least $141 million for Remicade last
year - almost three times the $48 million the government paid for the drug in
2000. New York Times, 2002

******************************

ARE PRESCRIPTION DRUGS HELPING TO KEEP HEALTH-CARE
COSTS DOWN? - By Harold J. DeMonaco, M.S. Massachusetts General Hospital
Anyone who has visited a pharmacy recently recognizes that prescription-drug
costs have increased dramatically in the past several years. Over the next
year, prescription-drug costs are expected to increase by another 15 percent
to 17 percent, making them the fastest-growing segment of expense for health
care. The drug makers would have us believe that theses cost increases are
justified, suggesting that medications reduce other costs of care. Consumer
groups contend that prescription-drug costs are out of control and do little
to improve health or lower overall health-care costs. The reality is that
both are correct, at least in part.

Drugs Can Reduce Costs - The potential of drug therapy to reduce the costs of
disease management is well illustrated by the treatment of people with
depression.

The management of moderate to severe depression is a challenging clinical
problem. Inpatient admissions are quite expensive, and many patients have
relapses requiring multiple hospital stays. There are a large number of
antidepressant drugs available to treat patients. The most expensive are a
class of antidepressants known as the selective serotonin reuptake inhibitors
(SSRIs). The SSRIs include Prozac, Celexa, Zoloft and others. Older
antidepressant drugs like Elavil (amitriptyline) and Sinequan (doxepin) and
others are as effective as the newer SSRIs, but the older drugs have a number
of side effects that can be quite troublesome for patients. The SSRIs,
although they have a different set of troublesome side effects, such as
sexual dysfunction, appear to be better tolerated than the older drugs. That
means that people can take them longer and with greater reliability. Many
studies have suggested that the SSRIs, while more expensive than older drugs,
improve care and do in fact reduce the costs for people with depression. So,
although drug costs for this category have risen dramatically, overall costs
are down.

The Role Of Advertising - Unfortunately, not all new drugs have such a
positive impact. For example, some expensive drugs used to treat hypertension
appear to increase risk of diseases like congestive heart failure and kidney
disease. Physicians have a large number of drugs in different categories to
use in the treatment of people with high blood pressure, a number of which
are relatively new and expensive. But lowering blood pressure is really not
the ultimate goal of treatment. Reducing the risk of heart disease, stroke,
and kidney failure are really the reasons for treating people with high blood
pressure. We know from clinical studies that treatment of people with high
blood pressure with diuretics (like hydrochlorothiazide) and beta adrenergic
blockers (like atenolol and propranolol) not only reduces blood pressure but
also reduce the likelihood of stroke and heart attack. The National Heart
Lung and Blood Institute (NHLBI) of the National Institutes of Health has
published a set of guidelines for the treatment of people with high blood
pressure no fewer than six times in the past several decades. The guidelines
were developed with input from experts across the country and are based on
the results of clinical studies. The NHLBI recommendations have stated
consistently that people with hypertension should be treated first with a
diuretic or beta adrenergic blocker. That is because these kinds of drugs
have been shown to reduce a person's risk of heart attack and stroke.

So why would more expensive drugs with less proven track records be
prescribed over the older, time-tested medications? A major reason is
advertising.

Drug companies have learned that advertising prescription drugs directly to
consumers on television and in magazines promotes sales of their drugs. Ads
for drugs used to treat hypertension, allergy, erectile dysfunction, elevated
cholesterol and herpes infections, to name a few, grace the pages of almost
every magazine. As a result of the loosening of restrictions on this kind of
advertising, physicians now report patients asking for specific brand-name
products on a frequent basis. Some have argued that these advertisements are
educational and promote health awareness. But by definition, advertisements
are intended to bring attention to some product or service. Education is not
the primary intent.

The Bottom Line - Prescription drugs represent an efficient and inexpensive
way to treat people with a variety of illnesses when used judiciously and
selectively. Unfortunately, prescription drugs also can represent an
unnecessary expense if not used wisely.

Harold J. DeMonaco, M.S., is the director of Drug Therapy Management and the
chair of the Human Research Committee at Massachusetts General Hospital. He
is an author of over 20 publications in the pharmacy and medical literature
and routinely reviews manuscript submissions for eight medical journals.

*******************************

LARGEST U.S. DOCTOR GROUP ATTACKS MEDICARE CUTS
WASHINGTON (Reuters) - The American Medical Association, which represents
about a third of the nation's doctors, said Wednesday it was launching an
advertising campaign to denounce recent cuts in how much they get paid for
seeing Medicare patients.

The doctors' advocacy group said it was launching ads starting on Thursday
decrying a 5.4 percent cut in Medicare reimbursements that took effect Jan.
1.

It said doctors would simply stop seeing Medicare patients if they could not
be paid properly for the visits.

"If Congress doesn't act, Medicare patients lose. A dumb Washington, D.C.,
rule is suddenly taking medical resources away from Medicare patients just
when more of them need the best care possible," the ad reads.

The AMA, which represents more than 290,000 doctors, supports a bill that it
says has strong support in the House and Senate called the Medicare Physician
Payment Fairness Act of 2001.

The AMA has long campaigned to reform Medicare, suggesting that incentives
such as competition be used to make it more cost-effective. It also supports
tax credits to help people to buy their own health insurance. Copyright 2002
Reuters Limited. All rights reserved.

*************************************

PAYING TWICE FOR THE SAME DRUGS
By Peter Arno and Michael Davis - The Washington Post

So now Congress has launched a bidding war to see who can propose the largest
subsidies to help elderly Americans afford prescription drugs under Medicare.
If only our elected officials would take a look at existing laws on the
books, they might notice that one already holds the potential to make
pharmaceuticals significantly more affordable for all Americans and to reduce
the inflated costs for these proposed subsidies.

It is called the Bayh-Dole Act. Unfortunately, no one is enforcing it.

Bayh-Dole is a provision of U.S. patent law that states that practically any
new drug invented wholly or in part with federal funds will be made available
to the public at a reasonable price. If it is not, then the government can
insist that the drug be licensed to more reasonable manufacturers, and, if
refused, license it to third parties that will make the drug available at a
reasonable cost.

The idea behind Bayh-Dole is to protect taxpayers' investment in drug
research and development. After all, the American public pumps more than $20
billion a year in taxpayers funds into health-related research and
development, making it the single largest investor in the pharmaceutical
industry. These dollars have led to the development of numerous new drugs.

Consider cancer research, for example. As of 1997, 54 of 84 anti-cancer drugs
approved by the Food and Drug Administration were the products of federal
funding. The percentage is even higher with respect to AIDS drugs developed
with federal funds. The pharmaceutical giants make profits averaging three
times the rate of any major industry -- spending twice as much or more on
advertising and marketing as they claim they spend on research.

Meanwhile, prescription drug costs continue to soar at a rate of 19 percent
per year. We've already paid for the cost of research. Why, then, aren't we
seeing lower drug prices?

The federal government is supposed to manage the public's investment in the
pharmaceutical industry, but it doesn't. Although Bayh-Dole has been in place
for 20 years, the government has never enforced it -- not even once. That,
despite the AIDS crisis at home and abroad, despite the millions of elderly
and chronically ill Americans in need of affordable prescription drugs and
the 40 million others who have no health insurance coverage whatever -- and
despite the general hand-wringing over the skyrocketing costs of
pharmaceuticals.

Why is the federal government such an irresponsible investor of public funds?
First, the government agencies responsible for implementing Bayh-Dole either
do not understand the law or are reluctant to exercise their
responsibilities. In particular, the National Institutes of Health prefers to
avoid pricing issues and to remain within the loftier realms of research.
Some of NIH's repeated public statements over the years indicate an
astonishing and continuing ignorance of the Bayh-Dole provisions.

Second, there has been no leadership on this issue. Since its enactment,
Bayh-Dole has never been publicly discussed by any administration. Small
wonder that the law has been so grossly misunderstood by government
bureaucrats. The recent stem-cell patents came from government research.
Government labs should have the right to use those patents for free, but the
government has not even insisted that they be subject to the law. Instead,
the Bush administration used its Bayh-Dole leverage behind the scenes for
short-term political goals, getting the patent owners to agree to
antiabortion restrictions on stem cells in exchange for dropping the rights
to intervene. As a result, we may end up paying again for use of these
patents.

Third, the drug companies have successfully cast Bayh-Dole as an
anticompetitive price-control measure that they claim will strangle new R &
D. But Bayh-Dole is not about price control. It is about ensuring that
pharmaceutical manufacturers live up to their bargain with the public when
they accept the public's money. The pharmaceutical manufacturers say federal
funding is critical to the development of new drugs. This may be true. But
they can't have it both ways. If the drug companies want the public to invest
in their research, they must provide the agreed-upon return on investment in
the form of reasonable prices.

All Americans deserve relief from the high costs of prescription drugs. The
federal government has the means to help them without spending another dime
of taxpayer money. Bayh-Dole should be enforced.

Peter Arno is a professor of epidemiology and social medicine at the
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y.
Michael Davis is a professor of law at Cleveland State University in Ohio. ©
2002 The Washington Post Company

Good Health to All

Jack Nicholas
Newsletter Editor
Cornishpro@aol.com

Issue 2002 5/21/2002 - 12