Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Wall Street Journal Article] The Biggest Mistake Doctors Make

From the 17 December 2013 Wall Street Journal article

A patient with abdominal pain dies from a ruptured appendix after a doctor fails to do a complete physical exam. A biopsy comes back positive for prostate cancer, but no one follows up when the lab result gets misplaced. A child’s fever and rash are diagnosed as a viral illness, but they turn out to be a much more serious case of bacterial meningitis.

Such devastating errors lead to permanent damage or death for as many as 160,000 patients each year, according to researchers at Johns Hopkins University. Not only are diagnostic problems more common than other medical mistakes—and more likely to harm patients—but they’re also the leading cause of malpractice claims, accounting for 35% of nearly $39 billion in payouts in the U.S. from 1986 to 2010, measured in 2011 dollars, according to Johns Hopkins.

The good news is that diagnostic errors are more likely to be preventable than other medical mistakes. And now health-care providers are turning to a number of innovative strategies to fix the complex web of errors, biases and oversights that stymie the quest for the right diagnosis.

Part of the solution is automation—using computers to sift through medical records to look for potential bad calls, or to prompt doctors to follow up on red-flag test results. Another component is devices and tests that help doctors identify diseases and conditions more accurately, and online services that give doctors suggestions when they aren’t sure what they’re dealing with.

Finally, there’s a push to change the very culture of medicine. Doctors are being trained not to latch onto one diagnosis and stick with it no matter what. Instead, they’re being taught to keep an open mind when confronted with conflicting evidence and opinion.

“Diagnostic error is probably the biggest patient-safety issue we face in health care, and it is finally getting on the radar of the patient quality and safety movement,” says Mark Graber, a longtime Veterans Administration physician and a fellow at the nonprofit research group RTI International.

Big Efforts Under Way

The effort will get a big boost under the new health-care law, which requires multiple providers to coordinate care—and help prevent key information like test results from slipping through the cracks and make sure that patients follow through with referrals to specialists.

There are other large-scale efforts in the works. The Institute of Medicine, a federal advisory body, has agreed to undertake a $1 million study of the impact of diagnostic errors on health care in the U.S.

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Some researchers suggest the best solution isn’t to flood doctors with information but to provide a second set of eyes to find things they may have missed.

The focus now is preventing dangerous delays in follow-ups of abnormal test results. In a pilot program, researchers at the Houston VA developed “trigger” queries—a set of rules—to electronically identify medical records of patients with potential delays in prostate and colorectal cancer evaluation and diagnosis.

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More health-care systems are also turning to electronic decision-support programs that help doctors rank possible diagnoses by likelihood based on symptoms and notes in the medical record. In a study of one such system, called Isabel, researchers led by Dr. Graber found that it provided the correct diagnosis 96% of the time when key clinical features from 50 challenging cases reported in the New England Journal of Medicine were entered into the system. The American Board of Internal Medicine is studying how Isabel could be linked to assessments of physician skill and knowledge.

Journal Report

More in Unleashing Innovation: Health Care

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But such devices will never replace a thorough physical exam with a trained eye and careful follow-up, says Dr. Alexiades-Armenakas: “These diagnostic tools are aids to increase our accuracy and adjuncts to good physical diagnosis, not a substitute.”

Some efforts to cut down on errors take a different route altogether—and try to improve diagnoses by improving communication.

For instance, there’s a push to get patients more engaged in the diagnostic process, by encouraging them to speak up about their symptoms and ask the doctor, “What else could this be?”

Read the entire article here

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December 8, 2013 Posted by | health care | , | Leave a comment

[Journal article] How Basic Scientists Help the Pharmaceutical Industry Market Drugs

Excerpt from the December 2013 PLoS article by Adriane Fugh-Berman 

In the 1970s, a Baltimore city senator who also owned a tavern backed legislation that helped his business. Accused of having a conflict of interest, Joseph J. Staszak, responded, “What conflict of interest? How does this conflict with my interest?” [1].

According to the Institute of Medicine, a conflict of interest is “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary influence” [2]. More simply, conflicts of interest may be seen as circumstances in which “individuals’ professional responsibilities diverge from their personal interests (or when different professional responsibilities clash)” [3].

In biomedicine, discourse on conflicts of interest (also called competing interests) has focused on relationships between industry and physicians or clinical researchers. However, basic scientists are not immune to industry influence on research and publications, and may be important to industry in the production and dissemination of marketing messages.

Depending on Industry

In 2007, industry was the largest funder of biomedical research, paying for nearly twice as much research (58%) as the federal government (33%) [4]. Most of this funding goes to clinical research; the share of spending by pharmaceutical and device industry on preclinical research has decreased from about half (55%) in 1998 to a quarter (25%) in 2010 [5]. A 2007 survey of 3,080 academic life science researchers found that half (53%) have some form of relationship with industry [6]. Among the 1,663 research faculty at academic medical centers, 42% of basic scientists had a relationship with industry. This number was similar to health services researchers/clinical epidemiologists (40%), but less than clinical researchers (67%) translational researchers (61%), or “multimodal” researchers (71%) [7]. At the 50 universities that received the most NIH research funding, 43% of 2,167 life science researchers reported receiving a research-related gift in the late 1990s [8]. Gifts included biomaterials (24% of respondents), discretionary funds (15%), equipment (11%), travel funds to professional meetings (11%), student support (9%), and other (3%).

Researchers were aware that something was expected in return for the gift. Sponsor expectations that the gift be used for its intended purpose and not be re-gifted, and that the sponsor be acknowledged in publications, are certainly reasonable. Disturbingly, however, about a third (32%) of gift recipients reported that the funder wanted prepublication review of any articles or reports stemming from the use of the gift. This expectation was higher for gifts of biomaterials: 40% of respondents reported that the firm wanted to receive prepublication review of articles or reports. Also, 44% of firms wanted assurances that the biomaterial was not to be used for applications that competed with company products [8].

Industry Funding Affects Results

In clinical research, investigators who receive industry funding are more likely to publish results that favor a sponsor’s marketing goals than are investigators who do not receive industry funding. The Cochrane Collaboration, renowned for creating and publishing high-quality systematic reviews, analyzed 48 clinical studies, systematic reviews, and meta-analyses that compared results from studies of drugs or medical devices based on sponsorship. This systematic review found that industry-sponsored studies, compared to non-industry-sponsored studies, were more likely to report favorable efficacy results for drugs or medical devices; less likely to find harms; and more likely to conclude that a therapy was beneficial [9].

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Selective Publication

Selective presentations and publications are important tactics for industry. Industry relies on abstracts and posters to convey marketing messages at scientific meetings, because abstracts and posters are usually not peer-reviewed and can be easily altered up to the time of presentation. Posters and abstracts are often used for preclinical studies, case reports, or preliminary results of clinical trials. Promising preliminary results might be presented as a poster, and the results may be publicized, but if the final results of the study do not support commercial goals, the full study may never be published – or may be buried in an obscure, low-impact journal. In either case, scientists may have a positive impression of a therapy from a poster, and never learn that the therapy failed to show efficacy in the final study.

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Perhaps because negative outcomes from industry-funded studies are less likely to be submitted for publication, industry-funded clinical trials overall are less likely to be published. An analysis of 546 drug trials listed in ClinicalTrials.gov found that within two years of study completion, about a third of studies that received full (32%) or partial (39%) industry support were published. In contrast, more than half (54%) of trials funded by government, and 56% of trials funded entirely through nonprofit/nonfederal funds, were published [19].

The majority of meeting abstracts and posters are never published. Posters and abstracts with positive results are far more likely to be published than negative studies [14],[15].

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Once a drug is on the market, it can be prescribed “off-label” – that is, for any condition other than that for which the drug was approved. Although it is legal for physicians and other prescribers to prescribe a drug off-label, it is illegal for pharmaceutical companies to promote drugs off-label. Off-label use is common, accounting for about one in five prescriptions [23]. It is unknown how much off-label use is due to promotion.

Pharmaceutical companies use paid speakers, consultants, and researchers to promote off-label use [24].

,,,

Companies have paid billions of dollars in fines for off-label promotion, often using company-generated research, company-paid speakers, and ghostwritten articles to imply clinical benefits in the absence of clinical trials (or the presence of negative trials); fines have also been imposed for suppressing risks or misleading clinicians about risks [34].

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Read the entire article here

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December 8, 2013 Posted by | Biomedical Research Resources | , , , , , , , | Leave a comment

Resources from the Association of Health Care Journalists

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From the Resource page

The Association of Health Care Journalists offers a wide range of resources – many of which are available exclusively to members.

AHCJ publications include our newsletter, HealthBeat, as well as several guides to covering specific aspects of health and health care.

Members share ideas and ask questions of fellow members on the AHCJ electronic mailing list. Tip sheets are prepared for our conferences and workshops, often offering sources and information about covering specific stories.

Contest entries are from the Awards for Excellence in Health Care Journalism, recognizing the best health reporting in print, broadcast and online media. We have links to past winners and information culled from questionnaires submitted with the entries about how each story was researched and written.

We include links to some recent reports and studies of interest to our membership, as well as links to Web sites relevant to health care.

Members and other journalists write articles specifically for AHCJ about how they have reported a story, issues that our members are likely to cover and other important topics.

 

 

 

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December 8, 2013 Posted by | Educational Resources (High School/Early College(, Health Education (General Public), Health Statistics, Librarian Resources, Medical and Health Research News, Tutorials/Finding aids | , , , , | Leave a comment

[Reblog] Social inequality: A blind spot for health reporters

Joe Rojas-Burke

Joe Rojas-Burke is AHCJ’s core topic leader on the social determinants of health. To help journalists broaden the frame of health coverage to include factors such as education, income, neighborhood and social network, Rojas-Burke will hunt for resources, highlight excellent work and moderate discussions with journalists and experts. Send questions or suggestions to joe@healthjournalism.org or tweet to @rojasburke.

Dozens of news stories over the past year have reported on the disturbing data showing that Americans are dying younger than people in other wealthy countries and falling behind in many other measures of population health.

But much of the reporting I’ve seen shies away from covering a crucial part of the story: How social inequality may be the most important reason why the health status of Americans is failing to keep up with progress elsewhere.

Being born into poverty, growing up with curtailed opportunities for education and employment, living in a disadvantaged neighborhood – these social determinants of health are like the cards you’re dealt in a game of poker. It’s hard to win if the deck is stacked against you.

Researchers in sociology and public health have developed a fair amount of evidence that social status (typically measured by income or education) may be the most significant shaper of health, disability and lifespan at the population level. In the picture that is emerging, social status acts through a complicated chain of cause-and-effect. Education equips people with knowledge and skills to adopt healthy behaviors. It improves the chances of securing a job with healthy working conditions, higher wages, and being able to afford housing in a neighborhood secure from violence and pollution. The job security and higher income that tend to come with more education provide a buffer from chronic stress – a corrosive force that undermines health among lesser educated, lower income people. Research consistently shows that more education gives people a greater sense of personal control. Positive beliefs about personal control have a profound impact on how people approach life, make decisions about risky behavior, and cope with illness.

Since 1980, virtually all gains in life expectancy in the U.S. have occurred among highly educated groups. In a revealing analysis published in 2008, researchers looked at long-term changes in infant mortality and adult deaths before age 65 and found a widening gap between haves and have-nots over the past 30 years. If all people in the U.S. population experienced the same health gains as the most advantaged, they found that 14 percent of the premature deaths among whites and 30 percent of premature deaths among people of color would have been prevented.

But news outlets seem almost afraid to dig into questions about social inequality. Take, for example, CNN’s coverage of the Institute Of Medicine’s “Shorter Lives, Poorer Health” report in January. The IOM experts examined many measures in which the United States is lagging behind gains in other nations: infant mortality, disabilities, homicides, teen pregnancy, drug-related deaths, obesity, prevalence of AIDS, and life expectancy.

When the CNN coverage got around to explaining likely causes, it tossed out a range of possibilities, most of them blaming individual behavior. Compared with other wealthy nations we eat too much, spend more time driving than walking, fail to use seat belts, abuse more drugs, and use guns to shoot each other more. In the middle of this laundry list, the CNN report makes a glancing reference to the social determinants of health: “Americans benefit much less from social programs that could negate the effects of poverty.”

In July, a headline-garnering paper in the Journal of the American Medical Association explained how the U.S. lapsed from 20th to 27th among wealthy nations in terms of life expectancy at birth, and from 18th to 27th in terms of premature deaths.

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December 8, 2013 Posted by | Public Health | , , , , , , | Leave a comment

[Reblog] Nuts and death – journal animated video explanation

From the 22 November post at HealthNewsReview.blog

You probably saw, read, or heard about news of an observational study in the New England Journal of Medicine pointing to a statistical association between nut consumption and lower death rate.  Larry Husten did a good job explaining the study on Forbes.com.

The NEJM itself posted a YouTube video that had journal editor Jeffrey Drazen’s voice over an animated explanation.  I hadn’t seen such NEJM videos before.  Take a look. Drazen ends:  “I would be nuts to think that eating nuts alone would add years to my life.”

I wish I had that kind of budget. Frankly, I wish I had any budget.

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Comments

Ellen Goldbaum posted on November 22, 2013 at 11:37 am

Thank you for posting this wonderful video! It was everything a press release should be but so much more enjoyable! To your point about budgets, even those of us who work for large institutions are wondering, how did NEJM make that video, how much personpower and money does it take? curious.

Reply

Brad F posted on November 22, 2013 at 8:26 pm

they ript off Blank on Blank
http://blankonblank.org/pbs/

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December 8, 2013 Posted by | Nutrition, Uncategorized | , , , , , | Leave a comment

[News article] Surprising Discovery: Skin Communicates With Liver

From the 6 December 2013 ScienceDaily article

 Researchers from the University of Southern Denmark have discovered that the skin is capable of communicating with the liver. The discovery has surprised the scientists, and they say that it may help our understanding of how skin diseases can affect the rest of the body.

Professor Susanne Mandrup and her research group in collaboration with Nils Færgeman’s research group at the Department of Biochemistry and Molecular Biology at the University of Southern Denmark was actually studying something completely different when they made the groundbreaking discovery: That the skin, which is the body’s largest organ, can “talk” to the liver.

“We have showed that the skin affects the metabolism in the liver, and that is quite a surprise,” say Susanne Mandrup and Ditte Neess, a former student in the Mandrup research group and now laboratory manager in Professor Nils Færgeman’s group.

The phenomenon was observed in the researcher’s laboratory mice. The Mandrup and Færgeman groups work with so-called knock-out mice, in which a specific fat binding protein called acyl CoA binding protein has been removed (knocked out). Some knock-out mice produced by the researchers had a strange greasy fur, and they had difficulties being weaned from their mother. In the weaning period they gained less weight and showed a failure to thrive. Analyses also showed that the mice accumulated fat in the liver at weaning.

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“We believe that the leaking of water from the skin makes the mice feel cold, and that this leads to breaking down of fat in their adipose (fat) tissue. The broken down fat is then moved to the liver. The mice move energy from the tissues to the liver,” Susanne Mandrup and Ditte Neess explain.

Read the entire article here

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December 8, 2013 Posted by | Medical and Health Research News | , , , , , , , , , | Leave a comment

[Article] Multiple Chemical Sensitivities Under Siege

While I do not have these sensitivities, I have met a few folks who do. One was a worker at a local food co-op. She said it was very difficult to find employment at places where she did not react to the chemicals in their environments.
This story also brings to mind how I was able to add hours to my part time non-faculty library position a few years back. The new hire  (faculty) was unable to work, she had bad reactions to the new carpeting. It was the beginning of the academic year and the library was desperate to at least get the reference desk covered. So, I was asked, and I accepted.

This is a very long article, but it seems well researched.  The power of the chemical/pharamaceutical  industry in influencing policies was not totally surprising. However it is disturbing to see how far reaching it is with the cooperation of quite a few physicians and physician organizations.
It is also sad to see how folks with this condition are not taken seriously. I admit that I had not been as compassionate as I could have in the past.
Am thinking now, how are hospitals and other institutions open to the public addressing this? How responsible should they be in having buildings that are relatively free of sensitivity triggers? Would few triggering chemicals benefit us all?

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By Ann McCampbell, MD, Chair, Multiple Chemical Sensitivities Task Force of New Mexico
Published in Townsend Letter for Doctors and Patients, January 2001, Issue #210

From the publication page of Dr. McCampbell

Movies like Erin Brockovich and A Civil Action depict the true stories of communities whose members became ill after drinking water contaminated with industrial waste. Their struggles clearly show how difficult it is for people to hold corporations responsible for the harm they have caused. Whether individuals are injured by exposures to contaminated air or water, silicone breast implants, cigarettes, or other chemicals, their quest for justice is usually a David versus Goliath battle that pits average citizens against giant corporations.

When confronted with the harm they have caused, corporations typically blame the victims, deny the problem, and try to avoid responsibility for the harm caused. The corporate response to people with multiple chemical sensitivities (MCS) has been no different. People with MCS are made sick from exposures to many common products, such as pesticides, paints, solvents, perfumes, carpets, building materials, and many cleaning and other products. But the manufacturers of these products would rather silence the messenger than acknowledge the message that their products are not safe.

To that end, the chemical manufacturing industry has launched an anti-MCS campaign designed to create the illusion of controversy about MCS and cast doubt on its existence. What has been said about the tobacco industry could easily apply to the chemical industry regarding MCS, that is, “the only diversity of opinion comes from the authors with … industry affiliations (1).”

It is a credit to the chemical industry’s public relations efforts that we frequently hear that multiple chemical sensitivities (MCS) is “controversial” or find journalists who feel obligated to report “both sides” of the MCS story, or attempt to give equal weight to those who say MCS exists and those who say it does not. But this is very misleading, since there are not two legitimate views of MCS. Rather, there is a serious, chronic, and often disabling illness that is under attack by the chemical industry.

The manufacturers of pesticides, carpets, perfumes, and other products associated with the cause or exacerbation of chemical sensitivities adamantly want MCS to go away. Even though a significant and growing portion of the population report being chemically sensitive, chemical manufacturers appear to think that if they can just beat on the illness long enough, it will disappear. To that end, they have launched a multipronged attack on MCS that consists of labeling sufferers as “neurotic” and “lazy,” doctors who help them as “quacks,” scientific studies which support MCS as “flawed,” calls for more research as “unnecessary,” laboratory tests that document physiologic damage in people with MCS as “unreliable,” government assistance programs helping those with MCS as “abused,” and anyone sympathetic to people with MCS as “cruel” for reinforcing patients’ “beliefs” that they are sick. They also have been influential in blocking the admission of MCS testimony in lawsuits through their apparent influence on judges.

Like the tobacco industry, the chemical industry often uses non-profit front groups with pleasant sounding names, neutral-appearing third party spokespeople, and science-for-hire studies to try to convince others of the safety of their products. This helps promote the appearance of scientific objectivity, hide the biased and bottom-line driven agenda of the chemical industry, and create the illusion of scientific “controversy” regarding MCS. But whether anti-MCS statements are made by doctors, researchers, reporters, pest control operators, private organizations, or government officials, make no mistake about it – the anti-MCS movement is driven by chemical manufacturers. This is the real story of MCS.

CHEMICAL INDUSTRY

In 1990, the Chemical Manufacturers Association (now the American Chemistry Council) vowed to work to prevent the recognition of MCS out of concern for potential lost profits and increased liability if MCS were to become widely acknowledged

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PHARMACEUTICAL INDUSTRY

The pharmaceutical industry is also involved in the effort to suppress MCS. Drug companies, which usually work with the medical profession to try to help patients, are working to deny help for those with MCS. This is extraordinary, but can be explained by the fact that the pharmaceutical industry is intimately linked to the chemical industry. That is, many companies that make medications also manufacture pesticides, the chemicals most implicated in causing MCS and triggering symptoms in people who are chemically sensitive.

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Pfizer and Abbott Laboratories make both pharmaceuticals (14) and pesticides (15), while BASF makes pharmaceutical ingredients and pesticides (16). Even Bayer, famous for making aspirin, manufactures the popular neurotoxic pyrethroid insecticide Tempo (active ingredient cyfluthrin) (17). Novartis, Ciba, Dow, Eli Lilly, BASF, Aventis, Zeneca, and Bayer are all members of the American Chemical Council (formerly the Chemical Manufacturers Association), as are other pharmaceutical manufacturers, such as Dupont, Merck, Procter & Gamble, and Roche (18).

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A recent editorial in the New England Journal of Medicine outlined a myriad of ways that financial ties with the pharmaceutical industry may influence physicians (27). “The ties between clinical researchers and industry include not only grant support, but also a host of other financial arrangements. Researchers serve as consultants to companies whose products they are studying, join advisory boards and speakers’ bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghost written by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings” (p. 1516)

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Even though MCS has gone by that name for over a decade, industry associates would have you believe that it goes by a myriad of other names, so many that it must not be describing anything legitimate. In fact, if an article starts out with a long list of possible names for MCS, you can be almost positive it is going to be critical of MCS. Referring to MCS as a “phenomenon” rather than an illness and using the term “multiple chemical sensitivity syndrome” also tend to be code for “it doesn’t really exist” or if it does, “it’s all in people’s heads.” Articles using these names are usually accompanied by other myths and put-downs, such as MCS has no definition, no objective findings, and no known prevalence, and is “only symptom-based,” a “belief system,” or “chemophobia.” People with MCS are also frequently dismissed as having an “unexplained illness,” as if they, rather than their physicians, were to blame for not adequately “explaining” it.

Since 1996, however, the chemical industry has taken a bold new approach to the name for MCS. It has made a concerted effort to rename MCS “idiopathic environmental intolerances (IEI).” It is quite clear that its motivation is to get the word “chemical” out of the name. This would be analogous to the tobacco industry trying to change the name of “smokers cough” to “idiopathic respiratory paroxysms.” Anything to try to distance the disease from its products.

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MCS IN COURT

Perhaps the area where the chemical industry is most aggressively fighting MCS is in the courts. This is not surprising considering the fact that ESRI was founded to assist industries involved in MCS litigation. MCS cases commonly involve workers compensation, social security, toxic tort, disability or health insurance, and disability accommodations. MCS can also arise in divorce proceedings, child custody battles, and landlord-tenant and other disputes. In lawsuits where chemical manufacturers are directly involved, for example, when they are being sued for harm caused by their products, it is clear that attacks on the plaintiff’s credibility and medical condition, including MCS, come from the manufacturers. It is often unrecognized, however, how much the chemical industry is also involved in suppressing MCS in other lawsuits, through filing of briefs, supplying “expert” witnesses, and distributing anti-MCS literature to attorneys and witnesses.

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IMPACTS OF MCS

The impact of MCS on individuals and society is huge, both in terms of its potential severity and the number of people affected. Many people with MCS have lost everything – including their health, homes, careers, savings, and families. They are chronically ill and struggle to obtain the basic necessities of life, such as food, water, clothing, housing, and automobiles, that they can tolerate. Finding housing that does not make them sicker, that is, housing that is not contaminated with pesticides, perfume, cleaning products, cigarette smoke residues, new carpets or paint, and formaldehyde-containing building products, is especially difficult. Many people with MCS live in cars, tents, and porches at some time during the course of their illness. In addition, people with MCS usually have financial difficulties. One of the most unjust aspects of the anti-MCS movement is that many expert witnesses are paid $500 per hour to testify against people disabled with MCS who are seeking that much money to live on per month.

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And this medical condition is not rare. Prevalence studies in California (56) and New Mexico (57) found that 16% of the respondents reported being chemically sensitive. Additionally, in New Mexico 2% of the respondents reported having been diagnosed with MCS — the more severe form of chemical sensitivities — and in California, 3.5% reported having been diagnosed with MCS and being chemically sensitive. Although women report being chemically sensitive twice as often as men, which contributes to its “hysteria” label, those reporting chemical sensitivities are otherwise evenly distributed with respect to age, education, income, and geographic areas. Chemical sensitivities are also evenly reported among ethnic and racial groups, except for Native Americans, who reported a higher prevalence in both studies.

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Read the entire article here

Resources (from http://annmccampbell.com/resourceslinks/)

Chemical Sensitivity Foundation – Dedicated to raising public awareness about multiple chemical sensitivity (MCS)  www.chemicalsensitivityfoundation.org

Human Ecology Action League -Concerned about the health effects of environmental exposures  www.healnatl.org

National Center for Environmental Health Strategies -Working to protect the public health and improve the lives of people affected by chemical and environmental exposures www.ncehs.org

Indoor Environmental Quality (IEQ) Report – Recommendations for constructing and maintaining public buildings to be more accessible for people with chemical and electromagnetic sensitivities, project of the National Institute of Building Sciences with funding from the federal Access Board –www.access-board.gov/research/ieq

Beyond Pesticides -Information and advocacy, identifying the risks of conventional pesticides and promoting non-chemical and least–toxic management alternatives www.beyondpesticides.org

Northwest Coalition for Alternatives to Pesticides- Works to protect people and the environment by advancing healthy solutions to pest problems, pesticide fact sheets www.pesticide.org

Healthy Hospitals –Controlling Pests Without Harmful Pesticides .  Report by Beyond Pesticides and Health Care Without Harm  www.beyondpesticides.org/hospitals/Healthy_Hospitals_Report.pdf

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December 8, 2013 Posted by | environmental health | , , , , , , | 8 Comments

   

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