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USP announces new tool to help prevent medication mix-ups due to look alike/sound alike drug names

In a follow up to a previous blog entry, from EurekAlert:

The U.S. Pharmacopeial (USP) Convention today announces a new drug safety tool designed to help patients, caregivers, pharmacists, physicians and others in avoiding medication errors that may occur because of drug names that look alike and/or sound alike. This "Drug Error Finder" is a searchable database of almost 1,500 commonly used drugs reported to be involved in medication mix-ups in the U.S. health care system since 2003. The database is publicly available at no cost on USP's Web site at www.usp.org/hqi/similarProducts/drugErrorFinderTool.html.

The Drug Error Finder is derived from a list of 1,470 unique drugs that were implicated in medication errors due to brand and/or generic drug names that look or sound alike and reported to USP's MEDMARX®—an anonymous database used by hospitals and health care systems across the United States to report, track and analyze medication errors—or to USP's Medication Errors Reporting Program. The list was included in USP's 8th annual MEDMARX Data Report, released in January 2008, which examined more than 26,000 error records related to similar drug names submitted to the database from 2003 to 2006. This is the largest known list of look alike, sound alike drug names in the world based on actual medication error reports.

"As more medications are approved for market each year and become available to Americans, the opportunity for potentially dangerous or even deadly errors due to drug mix-ups from look alike or sound alike names becomes increasingly high," said Diane Cousins, R.Ph., USP vice president of healthcare quality and information. "While one drug name may be nearly identical to that of another drug, the two could be used for completely different conditions. This presents a major public health threat, and we think this new tool can play an important role in helping to reduce patient risk associated with this problem."

One example of a drug involved in such errors reported to MEDMARX is Clonidine, a high blood pressure medication. In actual instances reported to USP, this drug was confused with multiple drugs, including Colchicine (used for gout), Cetirizine (an antihistamine), and Clonazepam and its brand name, Klonopin (used for anxiety and seizures). "As one can imagine, for someone with hypertension, receiving the wrong medication could present a potentially severe consequence," noted Cousins. "This is exactly the type of mix-up we think could be avoided through tools such as our Drug Error Finder. This may be useful to parties across the health care system who are involved in dispensing and administering medications—and especially to caregivers and to patients, who should always remain vigilant and participate actively in their care." The 2008 MEDMARX Report found 25 different levels of individuals involved in similar name errors, from pharmacy technicians, nurses and physicians to patients and family members.
Posted: 8/27/2008 3:16:00 PM

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College presidents spark debate on drinking age

From the Associated Press:

The college presidents said they wanted a national debate on the 21-year-old drinking age. They got it.

For years, former Middlebury College President John McCardell has been criticizing the law, saying it only encourages binge drinking and pushes alcohol into the shadows.

But then McCardell quietly enlisted about 100 college presidents in a campaign calling for the drinking age to be reconsidered. After The Associated Press reported on the effort this week, the issue erupted into the biggest discussion on the subject in years — in blogs, over e-mail, in newspaper editorials and around office water coolers.

College presidents usually avoid contentious topics because alienating alumni and politicians poses big risks and offers few rewards. So it was big news when so many leaders of the nation's best-known institutions signed on to McCardell's "Amethyst Initiative," named for the Greek gemstone said to ward off intoxication.

Supporters included presidents of private universities such as Duke, Dartmouth and Johns Hopkins, and public schools including Ohio State and the University of Maryland.

"No matter where you stand on this issue, it's impossible to look at what has happened over the last three or four days and say this is a settled question," McCardell said Friday in one of nearly a dozen scheduled media interviews.

"It's also impossible to say the public isn't ready to participate in the debate the presidents are calling for."

Critics led by Mothers Against Drunk Driving got their view across, too, accusing the presidents of seeking to avoid the unpleasant work of cracking down on campus lawbreakers.

MADD marshaled critics, including the acting chairman of the National Transportation Safety Board, who called changing the law "a terrible idea" that would "jeopardize the lives of more teens." On Friday, the International Association of Chiefs of Police issued a statement opposing a lower drinking age.

Amid the backlash, two presidents — Robert Franklin of Morehouse College and Kendall Blanchard of Georgia Southwestern State — withdrew their support.

But at least 20 presidents have added their names this week, including the presidents of Montclair State in New Jersey and the University of Massachusetts system, bringing the total to at least 123.

Whether the debate will lead anywhere is unclear. Opinion polls suggest most Americans support enforcing current drinking laws.

In a MADD press release, Rep. James Oberstar, a Minnesota Democrat and chairman of the House Committee on Transportation and Infrastructure, said he would not consider any effort to repeal or weaken "this lifesaving law."

Efforts in states including Minnesota, Wisconsin and Vermont to relax the drinking age have been rebuffed. A 1984 federal law limits a state's access to federal highway funds if it sets a drinking age lower than 21.

But that law is up for reauthorization next year. McCardell wants it changed so states can decide for themselves the best drinking age, without fear of losing federal money. He hopes the drinking age will become an issue in the fall election campaign.

A number of newspaper editorials this week criticized the presidents, calling enforcement a better answer.

But other editorial pages, including The Houston Chronicle, were more sympathetic — at least to the presidents' call for debate, if not to lowering the drinking age.

Posted: 8/26/2008 8:44:00 AM

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Vitamin D's wild days: Who to test, what to take?

From the Associated Press:

Don't be surprised if your doctor orders a vitamin D test during your next physical. Blood tests to check levels of the so-called sunshine vitamin are on the rise as doctors and patients react to headline-grabbing research that suggests having too little may not only hurt your bones - it might increase your risk of certain cancers or heart disease.

But there are problems with deciding next steps: As intriguing as the research is, it's far from proof that vitamin D really is that powerful. Also, it's not clear just how much is enough - and megadoses can harm.

Nor are there guidelines on exactly who should be tested, or how. Test during winter, for example, and in much of the country people will harbor considerably less vitamin D than if they were tested in the sunny summer.

Still, "the hope is so high that it will have some effect that everybody's asking for it," says Dr. Clifford Rosen of the Maine Medical Center, who is helping government researchers evaluate the research. "It's pretty much the wild, wild West right now."

Dr. James Underberg, a New York University internist, once checked vitamin D levels mostly in people at risk of thinning bones. Over the past year, he's begun screening more patients, especially those at risk of heart disease, as he closely watches the evolving research.

"We don't have any data yet that says taking an otherwise healthy adult who's vitamin D deficient and supplementing them prevents cancer, reduces the risk of heart disease," Underberg acknowledges.

"You just have to keep your eyes and ears open to make sure something doesn't show up counterintuitive to what people thought," he adds, noting that other once-touted heart protections - estrogen therapy after menopause, for example - failed when more rigorously researched.

Dr. Ann Marie Gordon, a Washington, D.C., internist, isn't hesitating. She has made a vitamin D test a routine part of every physical, and she estimates that 60 percent of her patients are low.

Vitamin D and calcium go hand in hand. You need a lifetime of both to build strong bones. We get D in three ways: sun exposure, dietary supplements or certain foods, particularly D-fortified milk, orange juice and cereals.

Scientists have been interested in vitamin D's possibly broader effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. In recent years, studies have linked low levels of vitamin D with breast, prostate and colon cancer, heart disease, diabetes and certain other ailments - as well as an overall increased risk of death.

The increasing interest in vitamin D parallels increasing concern that people aren't getting enough - and increasing confusion about how much that might be.

Currently, the government and other health authorities recommend consuming anywhere from 200 to 600 international units a day from food or supplements, depending on your age - levels that many vitamin D proponents say are too low.

The government has begun discussions with the Institute of Medicine to determine if the daily recommended intake needs changing.

Meanwhile, because megadoses may be toxic, the government considers 2,000 IUs a day the upper limit, although doctors may recommend 10,000 or even 50,000 IUs for a short period if someone needs a rapid boost.

Posted: 8/25/2008 12:48:00 PM

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"Touch DNA" a relatively new analysis

From The Denver Post:

The fresh DNA evidence prosecutors say clears the Ramsey family in JonBenet's death was analyzed using a new process known as "touch DNA" testing.

The name "touch DNA" reflects that investigators extract samples from only a few cells left behind by a person who briefly touched an object, such as clothing.

Boulder District Attorney Mary Lacy decided to pursue the new line of testing in August after learning DNA could be analyzed from areas where there was no observable stain or other indication of DNA.

Forensic scientists from the Bode Technology Group, the lab that performed the DNA testing, scraped areas of JonBenet's long johns that investigators suggested would be where a person would touch if pulling down her pants.

Bode informed the district attorney's office in October that genetic material had been identified off the long johns.

That DNA matched the DNA earlier found on JonBenet's underpants.

Bode has performed "touch DNA" testing for about three years.

Linda Wheeler-Holloway, a former Fort Collins detective who became involved in the Tim Masters DNA-based exoneration case, said she and DNA forensic specialists Richard and Selma Eikelenboom of Holland presented "touch DNA" testing to the Boulder County district attorney's office in October 2006.

The district attorney's office never followed up, according to Wheeler-Holloway. Until Wednesday, she was unaware that Boulder County had pursued such a method.

"We were hoping the Boulder DA office would try it," Wheeler-Holloway said. "That is the best technology to use to solve that case."

Posted: 8/22/2008 9:30:00 AM

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Low level cadmium exposure linked to lung disease

From the China View:

New research suggests that cadmium is one of the critical ingredients causing emphysema, and even low-level exposure attained through second-hand smoke and other means may also increase the chance of developing lung disease.

The University of Michigan study released on Wednesday suggests that higher cadmium levels in the body as much as double the risk of developing a pulmonary disease diagnosis such as emphysema or chronic bronchitis.

Though some studies have linked high levels of cadmium with decreased lung function in occupationally exposed workers, this study showed that subjects with even slightly increased levels of cadmium had decreased lung function.

"The study suggests that the critical ingredient in smoking that may be causing emphysema is cadmium, a well-known contaminant of cigarette smoke," said Howard Hu, the lead researcher. "The worry is if you are exposed to this (cadmium) through other sources you can also be at risk for emphysema."

Non-smokers are exposed to cadmium when they eat contaminated foods or inhale second-hand smoke, as well as through a host of occupational exposures. Cadmium is a metal that is difficult for the body to dispel, Hu said, because kidneys tend to retain cadmium, and it recycles into the body.

The study looked at 96 men randomly selected from within the Normative Aging Study, a project that began in 1961 and includes approximately 2,280 healthy, male volunteers.

Researchers tested lung function using three different measures. Subjects with higher levels of urinary cadmium showed evidence of a reduced ability to exhale, irrespective of whether they smoked but with an effect that was greatest and clearest among current and former smokers.

The next step is a much larger, population-based study with more subjects and multiple measurements of cadmium exposure and lung function over time, Hu said.

Posted: 8/21/2008 11:44:00 AM

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F.D.A. Weighs Training to Dispense Narcotics

From The New York Times:

Should doctors be required to undergo special education in order to prescribe powerful narcotics? The Food and Drug Administration may soon recommend that they do so, though such a move would most likely prove controversial.

“I think it is a good idea, and it is something we are considering,” said Dr. Bob Rappaport, the director of the division of Anesthesia, Analgesia and Rheumatology Products at the F.D.A. But the agency itself does not have the authority to take such a step, Dr. Rappaport said.

Typically, state medical boards, rather than the federal government, impose licensing requirements on doctors, including the type of continuing education they must receive. A few states, including California, now provide doctors with education about the treatment of pain patients. But nationally, state medical boards have shown little interest in mandating added training in the use of potent pain medications or in screening patients for those prone to drug abuse.

Pain experts say they support increased education for doctors, but some fear that mandatory training may harm pain patients by limiting the number of doctors prescribing such drugs.

Under current federal law, doctors need only show they are licensed to practice medicine in order to register with the Drug Enforcement Administration, which will permit them to prescribe narcotics.

An exception is if a doctor wants to prescribe the drug buprenorphine as in-office treatment for narcotics addiction; federal rules require eight hours of specialized training first. Prescribing that same drug for pain treatment, however, does not require such training.

Dr. Rappaport said the F.D.A. was most concerned about potent and longer-acting narcotics like methadone, fentanyl and certain formulations of the drug oxycodone, the active ingredient in OxyContin.

With methadone, fentanyl, which is available in patches, has been associated with patient deaths and injuries resulting from physician misprescribing or inadvertent patient misuse.

In recent years, the F.D.A. has faced pressure to take added steps on such drugs. Dr. Rappaport said recommending additional education was one of the responses the agency might unveil by early next year.

He said the F.D.A. would probably require that makers of such drugs develop programs to monitor how they are prescribed.

In the last two years, the agency has sent out alerts to doctors about both methadone and fentanyl, but officials acknowledged that preventable patient deaths were continuing.

“We are putting out communications,” said Dr. Gerald Dal Pan, who directs the F.D.A.’s office of surveillance and epidemiology. “We don’t know why they are failing.”

Posted: 8/19/2008 9:10:00 AM

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Parkinson's case offers glimmer of hope for future research

From The Dallas Morning News:

Matthew Greenstein is living a story about illness, failure and a chance at redemption. He’s also an example of how, in an era when medical research is mostly about crowds of scientists and millions of dollars, a little luck might still make a difference.

Some of the details of his life are like an anti-lottery ticket: Matt has Parkinson’s disease at an age — 32 —when almost nobody has it. He has psychological issues that require medication — but most of the medicines are either bad for people with Parkinson’s or not strong enough to treat Matt’s problem.

But here’s the kicker: A couple of months ago, right after his Dallas psychiatrist prescribed his one remaining choice of medication, Matt’s Parkinson’s got a lot better.

And while nobody knows if one is related to the other, a top Parkinson’s researcher is interested and wants to find out if there’s a connection.

Parkinson’s is a degenerative disease that seems to be related to the unexplained death of brain cells and the loss of an important chemical called dopamine. Doctors don’t know the cause, but genetics, prior infections and other environmental factors may all play some role.

And while there are medications that help relieve symptoms in many people, there is no cure.

Matt had been hitting the New Jersey casinos since he was 21. What had been a gambler’s itch became a serious psychological addiction — and a way to escape his PD.

It was also a side of his life that he kept hidden. These days, Matt uses words like “betrayal” to describe how he treated his friends and family.

Last year, Rachel found out about the gambling and Matt stopped for a while. Nine months later, he fell off the wagon and had what he calls “a 10-day manic episode.” His family convinced him to see a Dallas psychiatrist, Dr. Robert Schwartz.

Dr. Schwartz quickly diagnosed him with moderate to severe manic symptoms, which seemed at the time like another piece of particularly bad luck:  Some newer medications used to treat manic symptoms can make PD symptoms worse, others aren’t strong enough to help Matt. That left one older drug, lithium, that also has some potentially severe side effects — including Parkinson’s-like symptoms in some people who don’t have PD.

Psychological relief from the drug started after a day or two. But the medical mystery began after a week: Matt’s PD symptoms suddenly got better.

“I got out of bed in the morning and started to walk, normally, to the bathroom,” Matt said.

Mornings, before his PD pills kicked in, had been very bad. And yet, that morning, he was more fluid, more normal. Ditto for that night, long after the day’s PD pills should have worn off. And so on. For the past two months.

Someone who meets Matt in the morning these days sees a soft-spoken man who walks with only the slightest hint of a limp and who lifts his daughter over his head with only a slight tremor.

Could it have been the standard cocktail of medications suddenly working better? Could it have been a spontaneous remission – doctorspeak for “We don’t know why you got better”? Or maybe, just maybe, the lithium had something to do with it?

“It isn’t crazy,” Dr. Bressman said. “We don’t know everything about Parkinson’s disease, and we don’t know everything about how lithium works.”

And Matt’s particular run of medical bad luck — PD plus severe manic symptoms requiring lithium — is very unusual, she said. Unusual enough that a beneficial effect on Parkinson’s from lithium may have been missed until now.

But there may not be anything useful to others in Matt’s case, she warned.

There are at least two tantalizing hints about lithium and PD in the medical literature:   Dr. De-Maw Chuang is a researcher with the National Institutes of Health who has published reports that lithium protects and even contributes to regeneration of mouse brain cells afflicted with conditions that look something like Parkinson’s.

And earlier this year, Italian researchers reported remarkable results in a small study of lithium of patients with ALS, better known as Lou Gehrig’s disease. The researchers said they’d like to try the drug on PD, if they could get the money.

Dr. Bressman is in the middle of a research study about PD and mood disorders – such as Matt’s manic symptoms. His case is prompting her to go back into the data looking for any cases similar to Matt’s. And to informally ask her colleagues if they’ve heard of similar cases. But whether Matt’s case turns out to be a trigger for productive treatment or just another blind alley will take years to answer.

Posted: 8/19/2008 9:00:00 AM

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FDA Again Finds BPA Safe Despite Critics' Concerns

From ConsumerAffairs.com:

Although parents, consumer groups and many retailers are shunning bisphenol A — commonly called BPA — the U.S. Food and Drug Administration (FDA) has once again asserted that the chemical is safe.

BPA is a "hardening agent," widely used in baby bottles, canned food and other consumer products. It acts as both a seal to keep contaminants out of canned goods and makes plastics shatterproof.

Its defenders say it makes modern life safer, especially for infants. Its detractors say babies would be safer without it.

The FDA has previously found that the substance was not cause for concern. And now, after revisiting the question, it has come to the same conclusion. An outside committee of experts will study the FDA's latest findings in September and issue recommendations. But that's not likely to settle the question.

Dozens of state and national environmental health organizations in the U.S. and Canada are calling for an immediate moratorium on the use of bisphenol A in baby bottles and other food and beverage containers; they say studies show that the chemical leaches from popular plastic baby bottles when heated.

Canada plans to ban its use in baby bottles. California, New Jersey and other states are considering bills that would restrict its use. And many retailers are shying away from products containing BPA.

Wal-Mart says it plans to drop baby bottles that contain it and Toys R Us is considering a similar move.

Concern about BPA began to grow after a study by the Centers for Disease Control and Prevention (CDC) found that trace amounts of the chemical could be found in 93 percent of Americans. But the FDA insists that the trace amounts are thousands of times below dangerous levels.

Dow Chemical, Bayer and other large chemical companies produce more than six million pounds of BPA in the United States each year. Critics charge the FDA has gotten too cozy with industry and relies too extensively on industry-financed studies.

In testimony before a Senate subcommittee earlier this year, FDA Associate Commissioner for Science Norris Alderson said the agency is relying on a "large body of scientific evidence" that shows the chemical can safely be used in plastics that hold food and beverages.

But critics say there are plenty of studies that have, at the very least, raised questions about potential health problems in laboratory animals exposed to BPA. A study by the federal National Toxicology Program found "some concern" about the chemical's use in baby products.

Posted: 8/18/2008 11:33:00 AM

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Cough-medicine ingredient eases disease symptoms

From The Vancouver Sun:

Fibromyalgics aren't known for being energetic, but there's Iris Koyko, juggling a job, the care of two elderly in-laws, regular exercise, and painting as a hobby.

Cheryl Kowalewski, another fibromyalgic, works, leads a local support group and is organizing a conference later this month.

They can do all this, they say, because of guaifenesin, an expectorant and mucous thinner found in many cough medicines, which some doctors and researchers believe helps relieve symptoms of fibromyalgia.

Before guaifenesin, Koyko, 64, says she was tired all the time.

Koyko has been taking guaifenesin for almost two years. "The very first night I took it, it was amazing. I woke up and it was like, 'Oh my God I slept,' " Koyko says.

Kowalewski says she still gets tired, "but I'm still doing things." Before guaifenesin she couldn't get out of bed.

Kowalewski, a registered nurse, had to stop working for two years, but went back about two years ago. Last winter she went on a Mexican cruise, climbed a mountain using a rope, and descended on seven zip lines. She's still amazed.

According to Dr. Paul St. Amand, a California endocrinologist, who pioneered the use of guaifenesin for fibromyalgia, an average two months on the drug reverses one year of the disease.

Koyko, was diagnosed with fibromyalgia 25 years ago and figures she tried at least half a dozen different prescriptions, none of which worked or had terrible side-effects, before discovering guaifenesin. Fibromyalgia, also known as the "aching-all-over disease," is a syndrome or collection of symptoms that occur together, but not all patients have them. It's one of the reasons why fibromyalgia is difficult to diagnose. Patients, most of them women, often bounce from doctor to doctor who may tell them they have chronic fatigue, myofascial pain or irritable bowel syndrome, because there is no diagnostic laboratory test for fibromyalgia.

Some doctors think it's psychosomatic, or all in the patient's head. They tell these patients to get a good night's sleep, start exercising, and put them on antidepressants, Kowalewski says. The causes of fibromyalgia are unknown, but there are probably a number of factors involved.

Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. People with rheumatoid arthritis and other autoimmune diseases, such as lupus, are particularly likely to develop fibromyalgia. For others, fibromyalgia seems to occur spontaneously.

Researchers are examining other causes, including problems with how the central nervous system processes pain. Some scientists speculate that a person's genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful.

St. Amand, 80, and a fibromyalgic himself, believes in a genetic cause and says a geneticist he works with has uncovered at least three gene mutations that appear to be connected to the syndrome. His findings have yet to be published, but information on the findings can be found on St. Amand's website, fibromyalgiatreatment.com.

"If we're right, this is a problem in phosphate metabolism," he says on the phone from his clinic, The Fibromyalgia Treatment Center, in Los Angeles.

As phosphates build up, the body stores them in the bones, and then eventually the muscles, tendons and ligaments. The excess hinders the cells' ability to produce ATP (energy) causing muscles to go into spasm.

Eventually lumps and bumps of built-up phosphate form in the muscles, St. Amand explains.

Guaifenesin helps the kidneys to excrete phosphates, thereby restoring normal cell function, boosting a fibromyalgic's energy, he adds.

Posted: 8/18/2008 11:17:00 AM

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Dr. Barry Logan Joins NMS Labs

From Citybiz:

NMS Labs is pleased to announce that Dr. Barry K. Logan, one of the world’s foremost authorities on alcohol and drug impaired driving, has joined the organization as its Director of Toxicological Services. Dr. Logan is certified by the American Board of Forensic Toxicology (ABFT), and has over 80 publications in the peer-reviewed literature including treatises on the effects of methamphetamine, cocaine, marijuana, alcohol, hallucinogens and depressant drugs on drivers. He will be guiding a well-seasoned group of toxicologists at NMS Labs to provide clients with forensic test results in accordance with the high standards of the American Board of Forensic Toxicology (ABFT) and other accrediting bodies.

After earning his BS and PhD from the University of Glasgow in Scotland, Dr. Logan conducted postdoctoral research at the University of Tennessee before moving to Washington State where he served for 19 years as State Toxicologist and Director, Forensic Laboratory Services Bureau for the last nine years. He also directed the state’s Drug Recognition Expert (DRE) Program successfully establishing links between blood toxicology results and observed impairment in individual drivers.

Dr. Logan has testified in civil and criminal cases on behalf of prosecutors and defense attorneys, plaintiffs and defendants in over 200 trials in seven states and in federal court. He also serves on the boards of the National Safety Council’s Committee on Alcohol and Other Drugs, the International Council on Alcohol, Drugs, and Traffic Safety (ICADTS) as well as the editorial boards of the Journal of Forensic Sciences and the Journal of Analytical Toxicology. He is a Fellow of the American Academy of Forensic Sciences and an active member of other professional groups including the Society of Forensic Toxicologists, and the International Association of Forensic Toxicologists (TIAFT). Dr. Logan was the recipient of TIAFT's 2003 mid- career achievement award for excellence in forensic toxicology.

Since 2001, Dr Logan has served as Executive Director of Indiana University's Center for Studies of Law in Action, where he has hosted experts in alcohol and drug impairment from around the world as members of the faculty. Dr. Logan continues to teach and conduct and publish research in areas including drug use and driving impairment, and postmortem toxicology.

Posted: 8/15/2008 2:47:00 PM

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