Prescription heroin helps addicts off street drugs

Prescription heroin helps addicts off street drugs
By Frederik Joelving Frederik Joelving Fri?May?28, 5:18?am?ET

?
NEW YORK (Reuters Health) – Prescribing heroin to addicts who can't kick their habit helps them stay off street drugs, British researchers said Friday.
So far, doctors have had little hope of treating the 10 percent or more of heroin users who don't respond to methadone, the standard anti-addiction medication. Fueled by drug cravings, those users often spiral downward into crime and diseases spread by dirty needles and unhealthy living.
Short of actually getting addicts off the drug, "heroin clinics" can at least get them off the streets.
"What we are dealing with here is a very severe group of heroin addicts, where all of the treatments have been tried and have failed," said Dr. John Strang, an addiction expert at King's College London, who led the new study.
"They are like oil tankers heading for disaster," he added. "The question we were asking was, 'Can we change the trajectory of these tankers?' And the answer was, 'Yes we can.'"
To test how prescription heroin would work for this group, Strang and his colleagues invited 127 addicts into supervised injecting clinics. The researchers then randomly chose who would get heroin, injected methadone or typical swallowed methadone.
After six months, 101 addicts had stuck with their treatment. More than two-thirds of those on heroin had no sign of street heroin in their urine at least half the time they were tested; before the study, they had been using the street drug almost every day.
In comparison, less than a third of the addicts on either type of methadone had a similar number of "clean" tests.
At this point, said Strang, several users have continued in the program for more than two years. He did not have exact numbers, but told Reuters Health that some had been able to get jobs and reconnect with their families.
"These sorts of changes are typical of what we are seeing," he said. "People are not only physically getting better, but they're getting back into society."
The researchers had to treat about two addicts for each one who get off of street drugs at least half of the time.
An estimated 3.7 million people in the US have used heroin at some point in their lives, according to the National Institute on Drug Abuse. Of current users, studies suggest that some 200,000 spend time in jails each year.
The most common drug treatment for heroin users is methadone, a synthetic drug related to heroin. Although methadone decreases the cravings for its chemical cousin, it doesn't produce the same high, according to experts. This could help explain why a substantial proportion of addicts in treatment backslide.
Before the new study, a handful of other reports had indicated that prescription heroin could help these people. But the scientific community wasn't completely convinced, in part because earlier urine tests weren't very sophisticated.
"What this study did is that it used a very novel urine test that can differentiate between street heroin and prescription heroin," said Thomas Kerr, director of the Urban Health Research Initiative at the University of British Columbia in Vancouver, Canada. Street heroin contains papaverine, a remnant of the opium poppy that can be detected in the urine.
Now, he said, "the evidence is quite clear that there is a place for prescription heroin for the treatment of individuals who do not respond to methadone."
Only a few European countries prescribe heroin to addicts, and in the US this practice has been illegal since before World War I.
Many argue that giving addicts more of the substance they abuse makes little sense, and would be like treating an alcoholic with whiskey.
But Kerr said that analogy wasn't apt. "I would argue it's completely immoral and unethical to fail to treat those individuals and to allow them to suffer and allow the community around them to suffer," Kerr said.
Strang said he supported the UK Government's 2008 Drug Strategy, which proposes rolling out prescription heroin.
"Now that we know that it works, we have to debate whether or not we should use it," he said.Prescription heroin helps addicts off street drugsOriginally from: http://www.nursinglink.monster.com/news/articles/13025-prescription-heroin-helps-addicts-off-street-drugs

View this post on my blog: http://travelnursesuccess.com/prescription-heroin-helps-addicts-off-street-drugs

Prescription heroin helps addicts off street drugs

Prescription heroin helps addicts off street drugs
By Frederik Joelving Frederik Joelving Fri?May?28, 5:18?am?ET

?
NEW YORK (Reuters Health) – Prescribing heroin to addicts who can't kick their habit helps them stay off street drugs, British researchers said Friday.
So far, doctors have had little hope of treating the 10 percent or more of heroin users who don't respond to methadone, the standard anti-addiction medication. Fueled by drug cravings, those users often spiral downward into crime and diseases spread by dirty needles and unhealthy living.
Short of actually getting addicts off the drug, "heroin clinics" can at least get them off the streets.
"What we are dealing with here is a very severe group of heroin addicts, where all of the treatments have been tried and have failed," said Dr. John Strang, an addiction expert at King's College London, who led the new study.
"They are like oil tankers heading for disaster," he added. "The question we were asking was, 'Can we change the trajectory of these tankers?' And the answer was, 'Yes we can.'"
To test how prescription heroin would work for this group, Strang and his colleagues invited 127 addicts into supervised injecting clinics. The researchers then randomly chose who would get heroin, injected methadone or typical swallowed methadone.
After six months, 101 addicts had stuck with their treatment. More than two-thirds of those on heroin had no sign of street heroin in their urine at least half the time they were tested; before the study, they had been using the street drug almost every day.
In comparison, less than a third of the addicts on either type of methadone had a similar number of "clean" tests.
At this point, said Strang, several users have continued in the program for more than two years. He did not have exact numbers, but told Reuters Health that some had been able to get jobs and reconnect with their families.
"These sorts of changes are typical of what we are seeing," he said. "People are not only physically getting better, but they're getting back into society."
The researchers had to treat about two addicts for each one who get off of street drugs at least half of the time.
An estimated 3.7 million people in the US have used heroin at some point in their lives, according to the National Institute on Drug Abuse. Of current users, studies suggest that some 200,000 spend time in jails each year.
The most common drug treatment for heroin users is methadone, a synthetic drug related to heroin. Although methadone decreases the cravings for its chemical cousin, it doesn't produce the same high, according to experts. This could help explain why a substantial proportion of addicts in treatment backslide.
Before the new study, a handful of other reports had indicated that prescription heroin could help these people. But the scientific community wasn't completely convinced, in part because earlier urine tests weren't very sophisticated.
"What this study did is that it used a very novel urine test that can differentiate between street heroin and prescription heroin," said Thomas Kerr, director of the Urban Health Research Initiative at the University of British Columbia in Vancouver, Canada. Street heroin contains papaverine, a remnant of the opium poppy that can be detected in the urine.
Now, he said, "the evidence is quite clear that there is a place for prescription heroin for the treatment of individuals who do not respond to methadone."
Only a few European countries prescribe heroin to addicts, and in the US this practice has been illegal since before World War I.
Many argue that giving addicts more of the substance they abuse makes little sense, and would be like treating an alcoholic with whiskey.
But Kerr said that analogy wasn't apt. "I would argue it's completely immoral and unethical to fail to treat those individuals and to allow them to suffer and allow the community around them to suffer," Kerr said.
Strang said he supported the UK Government's 2008 Drug Strategy, which proposes rolling out prescription heroin.
"Now that we know that it works, we have to debate whether or not we should use it," he said.Prescription heroin helps addicts off street drugsOriginally from: http://www.nursinglink.monster.com/news/articles/13025-prescription-heroin-helps-addicts-off-street-drugs

View this post on my blog: http://travelnursesuccess.com/prescription-heroin-helps-addicts-off-street-drugs

Storm over J&J's child drug recall only grows

?

Print
Back to story

Storm over J&J's child drug recall only grows
?Susan Heavey 33?mins?ago

?
WASHINGTON (Reuters) – Johnson & Johnson Late last month, J&J recalled 40 widely used nonprescription products for children and infants, such as Tylenol and Motrin, after Food and Drug Administration inspectors found filthy equipment and contaminated ingredients at a Pennsylvania factory.
"This is an issue of trust," House Oversight and Government Reform Committee Chairman Edolphus Towns told a hearing held to investigate the recall. "When parents and grandparents give these medicines to their children, they want to be confident that they are not harmful."
A J&J executive told the panel that the company had not lived up to its reputation and apologized for the concern and inconvenience created by the recall.
The FDA says there have been hundreds of complaints but no children have been known to be harmed.
Investors, previously confident the problems were a minor financial concern for the diversified maker of medical and consumer products, are beginning to be cautious.
JP Morgan analysts said on Tuesday that the recall could shave J&J's sales by $300 million this year to nearly $62.3 billion. It is also likely to dent earnings by 3 cents per share or more depending on how much it costs to fix the problems, they said.
Shares of J&J closed down 0.2 percent at $59.03 on the New York Stock Exchange on Thursday, underperforming the S&P Pharmaceuticals Sub-Industry Index which rose 1.3 percent on a day of broad stock gains.
"I think it's beginning to be" an issue, Noble Financial Group analyst Jan Wald said of the recall. "The more serious the government is going to take it, the more serious investors are going to take it."
Lawmaker said the episode highlighted the need to give FDA more power over drugmakers. Towns said he would introduce legislation to expand FDA's ability to order a drug recall, something that now requires a lengthy legal process and court orders if a drugmaker refuses to voluntarily issue a recall.
Since the nationwide recall was announced last month, 136 million bottles of medicine have been recalled in the fourth company recall in the last 12 months.
QUALITY PROBLEMS
Food and Drug Administration officials told lawmakers it was the latest evidence of systemic quality problems at J&J and its McNeil Consumer Healthcare unit and demonstrated a failure to comply with basic good manufacturing principles.
FDA "has had growing concerns about the quality of the company's manufacturing process," Deputy Commissioner Joshua Sharfstein testified, citing poor inspection results and multiple consumer recalls.
"Although the public risk from these quality problems is low, these problems should never have occurred," Sharfstein said, calling the manufacturing failures "unacceptable."
The agency is weighing whether to penalize the company through either civil or criminal charges, but no decision has been made yet, he added.
Colleen Goggins, worldwide chairman of J&J's consumer group, said the company has not lived up to its reputation but has taken drastic steps to clean up its manufacturing process and shake up management.
"I apologize to all the mothers, fathers, and caregivers for the concern and inconvenience caused by the recall," she said.
EXTRAORDINARY STEPS
Sharfstein said the FDA has been concerned by J&J's history of problems, with FDA inspectors checking McNeil's facilities increasingly often. In February it took the "extraordinary" step of meeting with top management at its J&J parent company.
In late April, FDA cited McNeil's Fort Washington, Pennsylvania, plant for a variety of lapses that included bacterial contamination of ingredients, grimy facilities and the potential for medicines to be too potent.
Sharfstein said the FDA cited similar problems at McNeil before 2009, but added the unit resolved the issues. But in May and June 2009, FDA again found multiple problems, including the "failure to meet its own standard for quality," he said.
Both Democrats and Republicans blasted J&J for allowing widespread lapses at its McNeil unit even as it touts itself as serving patients first.
"When a parent gives her child a Tylenol Product or other children's medicine produced by Johnson & Johnson, they are relying on the 120-year-old reputation of a company who claims that it puts 'the needs and well-being of the people we serve first,'" said the committee's ranking Republican, Representative Darrell Issa.
McNeil appears to have "a culture of mediocrity," said Representative Elijah Cummings, a Democrat.
J&J's Goggins said the company worked quickly to ensure recalled products were removed from stores and the public informed. McNeil has also "made significant organizational changes," hiring six new top officials to oversee quality and plant operations, she said.
The companies have been working to improve product quality and will "expend whatever resources are necessary to ensure" the Pennsylvania plant can resume production, she said.
(Reporting by Susan Heavey; Additional reporting by Lewis Krauskopf in New York; Editing by Lisa Von Ahn, Phil Berlowitz and Tim Dobbyn)

Storm over J&J's child drug recall only growsOriginally from: http://www.nursinglink.monster.com/news/articles/13004-storm-over-jjs-child-drug-recall-only-grows

View this post on my blog: http://travelnursesuccess.com/storm-over-jjs-child-drug-recall-only-grows-2

Storm over J&J's child drug recall only grows

?

Print
Back to story

Storm over J&J's child drug recall only grows
?Susan Heavey 33?mins?ago

?
WASHINGTON (Reuters) – Johnson & Johnson Late last month, J&J recalled 40 widely used nonprescription products for children and infants, such as Tylenol and Motrin, after Food and Drug Administration inspectors found filthy equipment and contaminated ingredients at a Pennsylvania factory.
"This is an issue of trust," House Oversight and Government Reform Committee Chairman Edolphus Towns told a hearing held to investigate the recall. "When parents and grandparents give these medicines to their children, they want to be confident that they are not harmful."
A J&J executive told the panel that the company had not lived up to its reputation and apologized for the concern and inconvenience created by the recall.
The FDA says there have been hundreds of complaints but no children have been known to be harmed.
Investors, previously confident the problems were a minor financial concern for the diversified maker of medical and consumer products, are beginning to be cautious.
JP Morgan analysts said on Tuesday that the recall could shave J&J's sales by $300 million this year to nearly $62.3 billion. It is also likely to dent earnings by 3 cents per share or more depending on how much it costs to fix the problems, they said.
Shares of J&J closed down 0.2 percent at $59.03 on the New York Stock Exchange on Thursday, underperforming the S&P Pharmaceuticals Sub-Industry Index which rose 1.3 percent on a day of broad stock gains.
"I think it's beginning to be" an issue, Noble Financial Group analyst Jan Wald said of the recall. "The more serious the government is going to take it, the more serious investors are going to take it."
Lawmaker said the episode highlighted the need to give FDA more power over drugmakers. Towns said he would introduce legislation to expand FDA's ability to order a drug recall, something that now requires a lengthy legal process and court orders if a drugmaker refuses to voluntarily issue a recall.
Since the nationwide recall was announced last month, 136 million bottles of medicine have been recalled in the fourth company recall in the last 12 months.
QUALITY PROBLEMS
Food and Drug Administration officials told lawmakers it was the latest evidence of systemic quality problems at J&J and its McNeil Consumer Healthcare unit and demonstrated a failure to comply with basic good manufacturing principles.
FDA "has had growing concerns about the quality of the company's manufacturing process," Deputy Commissioner Joshua Sharfstein testified, citing poor inspection results and multiple consumer recalls.
"Although the public risk from these quality problems is low, these problems should never have occurred," Sharfstein said, calling the manufacturing failures "unacceptable."
The agency is weighing whether to penalize the company through either civil or criminal charges, but no decision has been made yet, he added.
Colleen Goggins, worldwide chairman of J&J's consumer group, said the company has not lived up to its reputation but has taken drastic steps to clean up its manufacturing process and shake up management.
"I apologize to all the mothers, fathers, and caregivers for the concern and inconvenience caused by the recall," she said.
EXTRAORDINARY STEPS
Sharfstein said the FDA has been concerned by J&J's history of problems, with FDA inspectors checking McNeil's facilities increasingly often. In February it took the "extraordinary" step of meeting with top management at its J&J parent company.
In late April, FDA cited McNeil's Fort Washington, Pennsylvania, plant for a variety of lapses that included bacterial contamination of ingredients, grimy facilities and the potential for medicines to be too potent.
Sharfstein said the FDA cited similar problems at McNeil before 2009, but added the unit resolved the issues. But in May and June 2009, FDA again found multiple problems, including the "failure to meet its own standard for quality," he said.
Both Democrats and Republicans blasted J&J for allowing widespread lapses at its McNeil unit even as it touts itself as serving patients first.
"When a parent gives her child a Tylenol Product or other children's medicine produced by Johnson & Johnson, they are relying on the 120-year-old reputation of a company who claims that it puts 'the needs and well-being of the people we serve first,'" said the committee's ranking Republican, Representative Darrell Issa.
McNeil appears to have "a culture of mediocrity," said Representative Elijah Cummings, a Democrat.
J&J's Goggins said the company worked quickly to ensure recalled products were removed from stores and the public informed. McNeil has also "made significant organizational changes," hiring six new top officials to oversee quality and plant operations, she said.
The companies have been working to improve product quality and will "expend whatever resources are necessary to ensure" the Pennsylvania plant can resume production, she said.
(Reporting by Susan Heavey; Additional reporting by Lewis Krauskopf in New York; Editing by Lisa Von Ahn, Phil Berlowitz and Tim Dobbyn)

Storm over J&J's child drug recall only growsOriginally from: http://www.nursinglink.monster.com/news/articles/13004-storm-over-jjs-child-drug-recall-only-grows

View this post on my blog: http://travelnursesuccess.com/storm-over-jjs-child-drug-recall-only-grows

'The pill' tops in US, even more popular elsewhere

'The pill' tops in US, even more popular elsewhere
By MIKE STOBBE, AP Medical Writer Mike Stobbe, Ap Medical Writer 52?mins?ago

?
ATLANTA – The pill is still the No. 1 contraceptive for American women, but it's even more popular in other countries, according to the first government report comparing nations.
More U.S. women, however, get their tubes tied than elsewhere, the Centers for Disease Control and Prevention reported Wednesday.
In the U.S., 16 percent of married women say they use the pill. That compares to 29 percent in the United Kingdom and more than 40 percent in the Netherlands and France.
About one in four U.S. married women opt for sterilization, also known as tubal ligation, or tube-tying. Sterilization rates were below 10 percent for most of the six countries included who collect those figures.
The patterns appear to be similar for all women, not just the married ones, said William Mosher, an author of the new report.
International comparisons are sometimes difficult because some nations only have information on married women, added Mosher, a statistician with the CDC's National Center for Health Statistics.
The U.S. numbers are based on in-person interviews of more than 7,300 women of childbearing age nationwide from 2006 through 2008. The rates were compared to those of eight other industrialized countries — France, Belgium, Norway, Spain, Portugal, Australia, the Netherlands and the United Kingdom.
The new report is the government's first national data on contraception use in more than five years. It found that the pill was the most used contraceptive by all women, but sterilization was a close second. About 17 percent of women say they use the pill, and nearly the same proportion said they were sterilized.
The United States has seen a variety of new contraception options for women in the last decade, including a vaginal ring and a skin patch. Though many women have tried them, fewer than 2 percent said they used one of those methods.
Contraception choices by U.S. women have remained remarkably stable for decades, Mosher said.
"We seem to be stuck in this pattern of the pill and sterilization are the leading methods," he said.
The pill was much more popular among women who have never had children — more than half of them use it. It was also more commonly used by white women and those who were more educated.
More popular among older women is sterilization.
Many Americans get their tubes tied after they have children, as a don't-have-to-worry-about-it-anymore measure, experts say. Younger women with less education more often turn to sterilization, as well.
Why is the sterilization rate in European countries so much lower?
"It may be that surgical options are less acceptable to European women, and not as promoted by European doctors," said Karin Ringheim, a senior policy adviser with the Population Reference Bureau, in an e-mail to the Associated Press.
Meanwhile, the CDC report found that in the United States, the diaphragm has virtually become extinct. But the IUD, or intrauterine device, is making something of a comeback.
The IUD is a T-shaped plastic sperm-killer that a doctor inserts into a woman's uterus. IUDs fell out of favor in the 1970s, after one brand, the Dalkon Shield, was blamed for serious and sometimes deadly infections.
___'The pill' tops in US, even more popular elsewhereOriginally from: http://www.nursinglink.monster.com/news/articles/13006-the-pill-tops-in-us-even-more-popular-elsewhere

View this post on my blog: http://travelnursesuccess.com/the-pill-tops-in-us-even-more-popular-elsewhere

'The pill' tops in US, even more popular elsewhere

'The pill' tops in US, even more popular elsewhere
By MIKE STOBBE, AP Medical Writer Mike Stobbe, Ap Medical Writer 52?mins?ago

?
ATLANTA – The pill is still the No. 1 contraceptive for American women, but it's even more popular in other countries, according to the first government report comparing nations.
More U.S. women, however, get their tubes tied than elsewhere, the Centers for Disease Control and Prevention reported Wednesday.
In the U.S., 16 percent of married women say they use the pill. That compares to 29 percent in the United Kingdom and more than 40 percent in the Netherlands and France.
About one in four U.S. married women opt for sterilization, also known as tubal ligation, or tube-tying. Sterilization rates were below 10 percent for most of the six countries included who collect those figures.
The patterns appear to be similar for all women, not just the married ones, said William Mosher, an author of the new report.
International comparisons are sometimes difficult because some nations only have information on married women, added Mosher, a statistician with the CDC's National Center for Health Statistics.
The U.S. numbers are based on in-person interviews of more than 7,300 women of childbearing age nationwide from 2006 through 2008. The rates were compared to those of eight other industrialized countries — France, Belgium, Norway, Spain, Portugal, Australia, the Netherlands and the United Kingdom.
The new report is the government's first national data on contraception use in more than five years. It found that the pill was the most used contraceptive by all women, but sterilization was a close second. About 17 percent of women say they use the pill, and nearly the same proportion said they were sterilized.
The United States has seen a variety of new contraception options for women in the last decade, including a vaginal ring and a skin patch. Though many women have tried them, fewer than 2 percent said they used one of those methods.
Contraception choices by U.S. women have remained remarkably stable for decades, Mosher said.
"We seem to be stuck in this pattern of the pill and sterilization are the leading methods," he said.
The pill was much more popular among women who have never had children — more than half of them use it. It was also more commonly used by white women and those who were more educated.
More popular among older women is sterilization.
Many Americans get their tubes tied after they have children, as a don't-have-to-worry-about-it-anymore measure, experts say. Younger women with less education more often turn to sterilization, as well.
Why is the sterilization rate in European countries so much lower?
"It may be that surgical options are less acceptable to European women, and not as promoted by European doctors," said Karin Ringheim, a senior policy adviser with the Population Reference Bureau, in an e-mail to the Associated Press.
Meanwhile, the CDC report found that in the United States, the diaphragm has virtually become extinct. But the IUD, or intrauterine device, is making something of a comeback.
The IUD is a T-shaped plastic sperm-killer that a doctor inserts into a woman's uterus. IUDs fell out of favor in the 1970s, after one brand, the Dalkon Shield, was blamed for serious and sometimes deadly infections.
___'The pill' tops in US, even more popular elsewhereOriginally from: http://www.nursinglink.monster.com/news/articles/13006-the-pill-tops-in-us-even-more-popular-elsewhere

View this post on my blog: http://travelnursesuccess.com/the-pill-tops-in-us-even-more-popular-elsewhere-2

Doctors: Biomass Power Plants May Be Harmful to Health

TRAVERSE CITY -- A group of local doctors raised concerns about the health impact of a proposed biomass power plant.

The Traverse City Light & Power board in April voted to pursue plans for a wood-burning plant. But area physicians and medical personnel pointed out potentially harmful health effects associated with air pollution from such a plant.

Dr. Laura Shea, a city resident and family medicine physician, said research indicates air pollution has a more adverse effect on health than previously thought. Exposure to particulate matter can harm the heart and lung.

An early May letter to the planning and city commission signed by nearly a dozen local medical professionals asked city commissioners to vote against the Light & Power budget in June "until further specific data regarding emissions is provided and the potential human health and local air quality impact is analyzed." Shea said more physicians since have added their signatures.

Shea urged officials "at a bare minimum" to agree to test ambient air quality for pollutant levels, a step not governmentally mandated because of the area's rural size.

She encouraged: "If they feel they need to move forward on the biomass facility that at least they engage in ongoing regular ambient air quality monitoring in the city to make sure we are not exceeding recommended guidelines."

Mayor Chris Bzdok said the health issues raised by doctors "are compelling and grave." Medical professionals should be among those involved in the ongoing review of biomass, he said.

Many things -- cars, barbecue grills and fireplaces -- make particulate emissions, Bzdok said, but officials need to know more details before assessing how much, if at all, the concentration of pollution will increase.

"You can, on paper, you could locate this on a site and under conditions that would be very adverse or ... in a site where any increment would be negligible," he said. "If there's a significant impact on public heath for any site, no one's going to agree to site it there."

Particulate matter can impair the lung's defenses and increase inflammation in the airways, said Karen Kain, a pulmonary education specialist and president of the Asthma Coalition of Northwest Michigan.

"We have seen that it's the particulate matter that is the culprit, and we've seen increased use of asthmatic medication in children because with increase particulate matter levels (there is a) decline in respiratory function," Kain said.

Light & Power Executive Director Ed Rice said he does not think the proposed 10-megawatt plant poses legitimate health concerns, but the utility will seek "expert testimony" regarding the impact. It would be a minimum of about four years before a Grand Traverse County plant is operational, he said.

"It's about as clean as we are going to get with any kind of a generating plant," Rice said.

Shea pointed to a recent scientific statement from the American Heart Association regarding particulate matter air pollution and its link to cardiovascular disease. Even short-term exposure "can trigger heart attacks or disease," she said. Shea said a "linear relationship" has been shown to exist between exposure to finer particles and mortality, indicating "there is no safe lower limit in ambient air."

Rice said the intention is for the proposed plant to fall under the Clean Air Act's classification as a "minor source" of emissions. Some of the health questions raised by local doctors cannot be answered until the utility continues its "due diligence process," Bzdok said.

"It needs to be front and center," he said, of health concerns. "It needs to be addressed adequately and comprehensively ... and it will be."

Doctors: Biomass Power Plants May Be Harmful to HealthOriginally from: http://www.nursinglink.monster.com/news/articles/13008-doctors-biomass-power-plants-may-be-harmful-to-health

View this post on my blog: http://travelnursesuccess.com/doctors-biomass-power-plants-may-be-harmful-to-health