Conference turris::womannotes-v3

    
    I'm finding out some things about it. Norplant is an implant made of
    progesterone, the same as the mini-pill. It does not prevent ovulation,
    it simply makes the lining of the uterus hostile to implantation of the
    ovum. (At least I *think* that's what it does. I know it has something
    to do with a mucus.) From what I understand, it has the potential to
    cause mood swings, and what was suggested to me was that I try the
    mini-pill for 2-3 months to see how my body dealt with the medication.
    
    Now, the real kicker with Norplant is that it causes many women to have
    COMPLETELY IRREGULAR PERIODS. As in: you won't know when its coming, or
    how long it will be from period to period. The spacing could be close
    together, far apart or combinations of both. From what I've heard, some
    women don't mind this at all, and others can't stand it.
    
    Norplant comes in a 5 year implant and another, either 1 year or 6
    months. And Fallon Clinic now has it.
     They evidently cause two side
    effects to watch out for.

    
    see also:
    
    Womannotes-V3 (this file)
    
    458 - Birth Control
    577 - oh those great new implants (specifically 577.54)
    
    -Jody
    

    
    There is a maximium weight limit to use it.  I don't remember 
    exactly what it was...  130ish or 140ish sounds familiar.  
    
    Just FYI,
    Amy
    

    >maximum weight limit
    
    Do you have any idea why?

    
    I think it for potency.  The amount that they put in your 
    arm is 'diffused' by the body mass.  I am not sure...this is just 
    a guess. 
    
    I just thought, if it is just that there is not enough drugs in
    the sticks in the arm, why can't they just put in another stick?
    
    Does anyone else know the facts?
    
    Amy

    How utterly useless if that's the case!  1/3 of all American women are
    size 16 and over!
    
    -Jody
    

> How utterly useless if that's the case!  1/3 of all American women are
> size 16 and over!
    
  "Utterly useless" sounds a bit strong.  It seems to exclude from
  consideration the 2/3 of American women who are less than "size 16".
  And when you consider only women of reproductive age, the balance
  may shift even further.

                                   Atlant

    The discussion so far does seem to imply that women who would require a
    higher dosage than  5 `sticks' can provide (based on body weight) just
    can't use Norplant.
    
    Since I don't know why you wouldn't just "add another stick" (as an
    earlier reply suggested), I have to conclude that there isn't a good
    reason.  Personally, I'd call that `unfair' and `inflexible'.
    
    For _many_ women (I'd rather not debate the size of the fraction), it's
    also `useless'.
    
    Now, does anyone know why you can't just add another `stick' to up the
    dosage?
    
    Bob

    re .6, Jody, I'd hardly consider something useless just because it
    can't be utilized by women who wear over a size 16!!!
    
    Tut..tut...even women with skinny thighs need protection from unwanted
    pregnancy!  ;^)
    
    Lorna
    

    
    I hate to start a rathole in this topic, but just because a woman
    weighs over 130-140 pounds dosen't nessesarily mean she is a size 
    16 or over. I wear a size 9/10, I'm 5'10" and weigh 151.
    
    But to continue on with the topic...
    
    I have already had one appointment with my Dr. regarding possibly
    getting Norplant, and he never mentioned the weight limitations, and 
    he is aware of my weight. So, it may not neccesarily be true. But 
    I will be sure to check into it. 
    
    Dina
        
    

    My most *sincere* apologies.
    
    But if anyone wishes to market a computer which can only be used by
    peole who want 5 meg of memory, and they do not design an alternative
    for those who require more, it seems pretty useless to those who
    require more.
    
    Let me rephrase
    
    How utterly useless to people who are size 16 and over, which comprise
    1/3 of all American Women!
    
    Is that better?
    
    -Jody
    
    p.s.  Who said I had to be moderate all the time?  Where did that get
    written into my contract?
    
    

    I don't think being moderate got written into anybody's contract.
    
    Lorna
    

It was not made clear in any of the publicity I've seen why there is a
weight limit - 68kg/150lb was the number I saw.  I suspect that it is
probably due to the maker's not having run trials with greater dosages.
The FDC wouldn't even *think* about okaying something that is untested.

Clearly, body mass is a factor; if we set aside one's being accustomed
to alcohol, it's been demonstrated that one shot of booze will hit a
50kg woman harder than it will hit a 70kg woman.

It is also possible, again purely speculation, that the location of the
implant could enter into things.  How many sticks can be placed in the
forearm close enough to the major vessels so that their emissions will
be absorbed and distributed quickly and effectively?

-d

Hmm, this makes me wonder about my doctor.  When we discussed it, she never 
mentioned a weight limit (my weight "wobbles" around 150).  She did, however, 
say that something she'd read said that it didn't work for all women - but 
nothing about this being weight-based.  Another thing she said (which I 
thought sounded a bit dubious) was that it might not be good for very active 
women because strenuous use of the arm muscles might encourage the sticks to 
move and cause damage(!).

Doses of estrogen/progesterone combination pills are not tied solely to
weight, so I find the weight/dosage connection tenous.  Like Dina, I'm
tall (6') - I wouldn't expect a substance to diffuse too well across my
150 lbs, which consists of a lot of bone and muscle.

    
    Interesting...  Are you sure that "Doses of estrogen/progesterone 
    combination pills are not tied solely to weight"?  When I was at 
    school and 5'10 and average weight, the Dr. mentioned that I could
    not have the lowest potency pill because "I was a big girl".
    
    Boy, do I hate that phrase!  :-)
    
    Amy

    I know that fat (unlike muscle and bone) absorbs and holds onto
    hormones and other chemicals.  So I can believe that having a
    high level of fat might inhibit the distribution of the Norplant
    chemical(s).  And I can understand some people speaking of an
    absolute weight limit instead of saying ~FAT women can't use this~.
    
    Understanding does not mean condoning.
    
    						Ann B.

re: .7
>  "Utterly useless" sounds a bit strong.  It seems to exclude from
>  consideration the 2/3 of American women who are less than "size 16".
>  And when you consider only women of reproductive age, the balance
>  may shift even further.
    
    Does that excuse the discrimination against the other third?  Is 2/3
    enough?  not in my mind.  
    
re: .17
> .  chemical(s).  And I can understand some people speaking of an
>    absolute weight limit instead of saying ~FAT women can't use this~.
    
>    Understanding does not mean condoning.
    
    bingo.
    
    -Jody
    

Jody, I'm not sure I understand what is wrong with a weight limit on
a product.

If a product only serves 2/3 of the population, it is not as useful as
if it served *all* the population, but it is hardly useless.  And if
there is a bona fide medical reason why people of a certain weight or
over can't use it, well, work should be done to lift that limitation,
but in the meantime, why shouldn't those who *can* use it safely do so?

I'm not a doctor, but off the top of my head I can think of a number of
reasons why extremely overweight people might not be able to use some
sort of drug.  As previously mentioned, they will require larger amounts,
and perhaps amounts large enough to be effective on women over a certain
weight them present other difficulties.  Or perhaps being on Norplant
aggravates problems associate with obesity. I know that the Pill is not
generally prescribed for women who smoke or who are over 35, because of
increased risks of blood clots, cancer, heart attacks, etc.  Perhaps
obese people are also at higher risk for such things, and so using Norplant
would not be safe.

D!

Jody,

	General comment about life... If you can offer <something> for 2/3 of
the population in 5 years, but it will take 10 to offer it for 90% (there's
always gonna be some fraction for whom <something> is not going to be the
answer) do you hold off, and let no one benefit for the 5 years?

	2/3 of the female population is a significant chunk.

					--D

    Yeah, but why not work on something for the other third that works as
    well also?
    
    I'm not saying Norplant as it stands is bad  Where did I say it
    shouldn't be used as is?  Where did I refuse it to the women who can
    use it?  Sounds like you're extrapolating something I didn't say.
    
    I'm just saying it may leave many people out in the cold.
    
    That matters to me.
    
    -Jody

Jody:

  No one has said that "nothing is being done" for the 1/3.  I tend
  to agree with a previous reply (-d?) that suggested that it simply
  hasn't been tested yet, and the FDA has a different mindset than
  Digital when it comes to statements like:

    "That configuration is unsupported because we never tested it,
     but we believe it works -- why don't you try it and let us know?"

                                   Atlant

Personally, I think it's irresponsible medicine to phrase restrictions
in terms of weight when the real restriction is in terms of body fat.

Let's suppose that I weighed 125 lbs, within the purported weight limit
for Norplant, but am very short - say, 4'5" or so.  The doctor may then
be led to prescribe it, even though it will not work for me.

Considering what my doctor said about active women (has anyone else heard
anything like that, by the way?), I find the "weight" restriction amusing -
you have to have a low percentage of body fat, but can't exercise too much...

    Sharon  (Mom didn't tell me about things like this when she told me
	     to drink my milk so I'd grow big and tall! :-})

P.S. Jody, have you considered trying to get the insurance companies to
change their height/weight charts, too? ;-)  I haven't been able to find
out what my weight is "supposed to be" for years... I thought I had once
when I saw 6'0" on a women's chart, but it turned out to presume 2" heels.
Since the charts supposedly list the statistically optimal height/weight 
proportions for longevity, I can only conclude that I'd live longest if I
had never existed at all. ;-)

Atlant, in reference to "untested configurations", the FDA has a long
record of allowing medications previously tested only on men to be prescribed
for women.

    Sharon

    Aw, Sharon!   cmon!  if they change the height/weight tables diet
    industries will go out of business by the millions!
    
    ;)
    
    -Jody
    
    

Jody, I hardly think that there are millions of tall women out there
who are dieting to become shorter! ;-)

    Sharon

    
    re .21:
    
>    Yeah, but why not work on something for the other third that works as
>    well also?
    
    This reminds me of the "charitable giving" note.  Let's say I
    give $x to the American Cancer Society.  Are you then going to
    yell at me that I should give equal $ to Aids Action Committee?
    
    Whatever company developed Norplant for the 2/3 of women that
    it works for may be stretched one way or another that it isn't
    feasible for them to go any further at this time.  Besides,
    how do you know they're not working on something for the other
    1/3?
    
    I can't even tell who the "they" is that you're yelling at to
    work on this.  Maybe you have someone or a group of someones
    in mind that's shirking off?
    

re: .27

>    This reminds me of the "charitable giving" note.  Let's say I
>    give $x to the American Cancer Society.  Are you then going to
>    yell at me that I should give equal $ to Aids Action Committee?
        
>    Whatever company developed Norplant for the 2/3 of women that
>    it works for may be stretched one way or another that it isn't
>    feasible for them to go any further at this time.  Besides,
>    how do you know they're not working on something for the other
>    1/3?
    
    Where did I say they're not working on something for the other 1/3?  I
    said they *should*, not that they were or weren't.  I have no clue
    whether they are or not.  Maybe $2.00 more of research will reveal an
    answer.  maybe $2 million.  Maybe it can be stretched and they're too
    lazy to find out.  Maybe tomorrow they'll announce it is available for
    ALL women.  
    
>    I can't even tell who the "they" is that you're yelling at to
>    work on this.  Maybe you have someone or a group of someones
>    in mind that's shirking off?
    
    I'm not yelling at anyone, and I *still* don't know where you're
    getting that idea.  My first response was a hot-button knee-jerk, and I
    apologized for it already.  I feel the medical profession is motivated
    a great deal by greed, and they will *settle* for what's done, rather
    than going an extra mile if it doesn't have the right profit margin.
    
    I certainly have a group of someones in mind who would benefit from
    this invention.
    
    -Jody
    

I can easily garner up my own outrage for a medical-research-institutional-
situation which has generated long-term, less-bother contraception for the 
2/3 of women who approach or meet the culturally dictated appearance standards
(women aren't *supposed* to weigh "too much", remember?) but leaves those who
don't out.  Given the scant funding and pressure-group influenced world of
contraceptive research, I could easily believe less-than-essentially-medical
and more-than-incidentally-political influences in the dosage and research
studies.  And that is outrageous.

DougO 

    To get back to some hard facts...
    
    Norplant is made by the Wyeth-Ayerst company of Philadelphia, PA.
    I called my gyn yesterday who is sending me  more information.  When
    I get it, I will post it (depending on length).  Arguing about what
    percentage of the population that may benefit from this isn't helping
    anyone to make a clear decision.
    
    					Mair
    

Mair, thank you for your offer to post hard information when you
receive it.  

I do not choose to accept your chastisement, however.  In the micro-focus
arena of learning more about Norplant, this 'argument' (its a discussion,
rather) may seem irrelevent.  In the slightly larger picture of attempting
to gain an understanding of the medical establishment's methods to study
and deliver effective medical practice to women, especially in areas
related to contraception, this discussion may awaken some healthy cynicism
in some of our readers.  If even one person is now inspired to demand a 
fuller explanation from her attending physician (as you have) then I think
the discussion has served a larger purpose.

DougO

    I've sat back on this one, but hecky-darn ...
    
    The gyn practice that cares for me [and has done several implants, not
    lots...yet] reports:
    
    Body _weight_ is not a limiting factor in NorPlant effectiveness.  In
    clinical trials, a high percentage of body _fat_ appeared to limit the
    duration of effectiveness.
    
    That is to say that a tall women with low body fat weighing 150 lbs
    would derive the same protection over five years that a short woman
    weighing -- say -- 105 lbs; but a women with high body fat might get
    only 3.5 to 4 years of effectiveness; hence, her blood should be
    monitored and she might require the implant on a more frequent basis.
    
      Annie

I saw something in reply number .1 which I believe is a common incorrect 
statement.  As of a few years ago (and things may have changed), birth control
pills did NOT contain progesterone, but progestigen, a synthetic hormone.
Some women have nasty side effects from progestigen whereas they can tolerate
progesterone.  Progesterone is used for treating PreMenstrual Syndrome (not
the silly thing they talk about on the Midol commercials which is PreMenstrual
Tension, etc).  As I mentioned earlier, newer birth control pills may now
contain progesterone, but I doubt it.  Progesterone does not prevent pregnancy.

-Mary Ann


I'm not sure that I got the spelling of progestigen correct.

    The note following will contain the information I received from my gyn
    about the NORPLANT SYSTEM.  The pamphlet is in 2 parts; the first gives
    the information in a user-friendly format, the second part is patient
    information which goes into all the details of possible side effects
    symptoms to look out for if using this system.  I have typed in most
    of the first part (excluding the introduction, testimonial section,
    tables and diagrams).  This section gave the best general overview.
    
    There were a few bits of information I found in the Patient Labeling
    section that were not clearly mentioned in the first part.  These 
    are quoted below.
    
    "The NORPLANT SYSTEM may be less effective in preventing pregnancy in 
    heavier women.  Discuss this with your health-care provider."
    
    "The NORPLANT System provides five years of protection but can be
    removed at any time.  At the end of the fifth year, the capsules will
    be less effective and must be removed; a new set may be inserted at the 
    time of removal for continued protection."
    
    If anybody is really interested in the Patient Labeling section, or
    wants to enter it here, send me mail and I'll send you a copy.
    
    					Mair
    

NORPLANT SYSTEM (levonorgestrel implants)

The NORPLANT SYSTEM consists of six thin capsules, made of a soft flexible 
material that has been used safely in a variety of medical applications
for over 40 years.

The capsules are placed in a fanlike pattern just under the skin on the inside
surface of the upper arm through a small incision using a local anesthetic.
This is an office procedure that usually takes 10 to 15 minutes.  The capsules
contain a synthetic hormone, levonorgestrel (a progestin), that is also one
of the active ingredients in many oral contraceptives used in the U. S. 
today.  Immediately after insertion of the NORPLANT SYSTEM, a low, continuous
dose of the hormone is released into the body.

Pregnancy is prevented through a combination of mechanisms.  The most 
important ways are by inhibiting ovulation, so eggs will not be produced
regularly, and by thickening the cervical mucus, making it more difficult
for sperm to reach the egg.  When the NORPLANT SYSTEM capsules are removed,
the contraceptive effects cease quickly and you will return to  your previous
level of fertility.

The NORPLANT SYSTEM is one of the most effective methods of reversible birth 
control.  The average annual pregnancy rate over a five-year period for the 
NORPLANT SYSTEM is less than 1%.  This is an average of less than one pregnancy
for every 100 woman during the first year of use.  In comparison ...

[they list a chart showing typical failure rates of different contraceptive
 methods  that I'm skipping.]

Placement of the NORPLANT SYSTEM:
Prior to placement of the NORPLANT SYSTEM capsules, your healthcare provider
will ask  you about your medical history and perform a physical examination. 
To make sure you are not already pregnant the NORPLANT SYSTEM should be 
inserted within 7 days after the onset of menstrual bleeding or immediately
following an abortion.

NORPLANT SYSTEM capsules are placed just under the skin on the inner surface
of the upper arm through a small incision during an office-based procedure 
under sterile conditions.  A local anesthetic is used to numb a small area in 
the upper arm, and a small incision, less than 1/8 inch long, is made in the 
same area.  The six capsules are placed one at a time just under the skin in 
a fan shape using a special instrument.  Placement usually takes 10 to 15 
minutes.  The incision does not require stitches; instead, it is covered with 
a small adhesive bandage and protective gauze.

Because a local anesthetic is used, there should be little or no discomfort
during the placement procedure.  When the anesthetic wears off, there may be
some tenderness in the area of the implants for a day or two.  Some bruising
and swelling may also be present for a few days after the procedure, but this
should not interfere with your usual activities.

After placement, you can resume work and other normal daily activities.  
However, you should not lift heavy objects and should try not to bump the site
of insertion for a few days, just as an extra precaution.  To prevent 
infection, you should keep the protective gauze bandage dry and clean.  It 
should remain in place for 24 hours.  The small adhesive bandage should 
remain dry, clean and in place for 3 days.

After your incision has healed, you do not have to worry about bumping the area
or putting pressure on it.  The skin over the placement site and capsules can 
be touched at any time.  The capsules will stay where they are placed and 
should not move around.

Placement of the NORPLANT SYSTEM leaves a very small scar on the arm which is 
not noticeable in most women.  The capsules themselves are not visible.
However, the outline of the capsules under the skin can be felt and sometimes 
seen.  In some women, discoloration occurs over the placement site, and is
usually reversed when the NORPLANT SYSTEM is removed.

The contraceptive effect of the NORPLANT SYSTEM begins within 24 hours if 
the capsules are placed during your period.  Therefore, you may resume sexual 
relations without fear of pregnancy as soon as you wish.  The capsules may
be placed at other times (during your menstrual cycle) as long as you are
not pregnant.  However, then an alternate form of contraception must be used 
for the remainder of that cycle.

Removal of the NORPLANT SYSTEM:
The capsules must be removed at the end of five years.  They can be removed
at any time before then, however, if you want to stop using the NORPLANT
SYSTEM for any reason.

Just as for the placement procedure, your healthcare provider will use a local
anesthetic.  Under sterile conditions, a small (1/8 inch) incision will be made
through which all six capsules will be removed.  The removal procedure usually
takes 15 to 20 minutes but may take longer.  If some of the capsules are more 
difficult to remove, an additional visit and incision may be required.

As after placement, avoid bumping the incision site for a few days.  The area 
should be kept clean, dry and bandaged until healed (3 to 5 days) to avoid
infection.

If you want to continue using the NORPLANT SYSTEM, you may receive a new set 
of capsules at the same time as the old set is removed.  The second set can 
be placed in the same arm, through the incision from which the earlier set was
removed, or in the other arm.  If you do not want to continue using the 
NORPLANT SYSTEM and do not want to become pregnant, make sure your healthcare 
provider recommends another contraceptive method.

Once the capsules are removed, the contraceptive effects cease quickly and
pregnancy can occur as rapidly as in women who have not used the NORPLANT
SYSTEM.

Who Can Use the NORPLANT SYSTEM:
The NORPLANT SYSTEM is a new contraceptive option that offers convenience
and comfort.  It is a particularly good option for a woman who:

  o Is considering sterilization, but is not ready to make a final decision;
  o Wants long-term, reversible contraception;
  o Wants to avoid daily contraceptive use or coitus-related contraceptive
    methods;
  o Wants a form of hormonal contraception but does not wish to use estrogen-
    containing contraceptives;
  o Is not an appropriate candidate for IUD use.

Who Should Not Use the NORPLANT SYSTEM:
Some women should not use the NORPLANT SYSTEM.  You should not have the 
capsules placed if you are pregnant or think you may be pregnant.  You 
should not use the NORPLANT SYSTEM if you have:

  o Acute liver disease; noncancerous liver tumors;
  o Unexplained vaginal bleeding (until a diagnosis is reached by your health-
    care provider);
  o Breast cancer;
  o Blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), or
    eyes.

Other considerations before choosing the NORPLANT SYSTEM:
Tell your healthcare provider if you or any family member has ever had:

  o Breast nodules, fibrocystic disease of the breast, an abnormal breast
    x-ray or mammogram;
  o Diabetes;
  o Elevated cholesterol or triglycerides;
  o High blood pressure;
  o Headaches;
  o Gallbladder, heart, or kidney disease;
  o History of scanty or irregular periods.

Women with any of these conditions may need to be checked more often by their
healthcare provider.

Also, be sure to tell your healthcare provider if you smoke cigarettes or
are taking any medications.

Acceptability of the NORPLANT SYSTEM:
[This section contains paragraphs telling that general patient acceptance
is high world wide.  It also contains unidentified quotes saying how
wonderful this is.  I chose not to type in this section.]

Side Effects of the NORPLANT SYSTEM:
The most frequently reported side effects during NORPLANT SYSTEM use are
menstrual cycle irregularities.  Such changes vary from woman to woman and
may include:

  o Prolonged menstrual bleeding (more days than you usually experience), 
    commonly during the first months of use use;
  o Unexpected bleeding or spotting between periods;
  o No bleeding or spotting between periods;
  o A combination of these patterns.

The type of bleeding pattern you will have with the NORPLANT SYSTEM cannot be 
predicted.  Many women can expect an altered bleeding pattern to become more 
regular after 9 to 12 months.  Despite the increased frequency of bleeding in
some women, the monthly blood loss is usually less than normal menses.

In clinical studies, the following conditions have been reported in some
women using the NORPLANT SYSTEM.  These conditions are probably related to
the NORPLANT SYSTEM:

  o Headache;
  o Nervousness;
  o Nausea;
  o Dizziness;
  o Enlargement of the ovaries and/or fallopian tubes;
  o Dermatitis (inflamation of the skin);
  o Acne;
  o Change in appetite;
  o Weight gain;
  o Mastalgia (breast tenderness);
  o Hirsutism (excessive growth of body or facial hair) or alopecia 
    (hair loss);
  o Discoloration of the skin over the placement site (usually reversible).

Occasionally, an infection may occur at the placement site, or there may be a
brief incidence of pain or itching.  This, if it occurs at all, will usually 
happen soon after the placement procedure.

A few other conditions have been reported by NORPLANT SYSTEM users or 
discovered by healthcare providers and are possibly related to its use:  
breast discharge, cervicitis (inflamation of the cervix), muscle and skeletal 
pain, abdominal discomfort, whitish vaginal discharge, and vaginitis 
(inflamation of the vagina).

It is unknown whether the side effects associated with oral contraceptives,
which contain estrogen and progestin, would also occur with a progestin-only
method like the NORPLANT SYSTEM.  You should discuss this issue and any other
side effect issues with your healthcare provider and see patient labeling.

General Precautions with the NORPLANT SYSTEM:

Missed periods
	There may be times when you may miss one or more periods while using 
the NORPLANT SYSTEM.  However, if you think you are pregnant, you should 
contact your healthcare provider.

While breast-feeding
	Women who are breast-feeding or intend to breast-feed should discuss
this with their healthcare provider when considering the use of the NORPLANT
SYSTEM.  Studies have shown no significant effects of the growth or health of
infants whose mother used the NORPLANT SYSTEM beginning six weeks after
childbirth.  There is no experience to support the use of the NORPLANT SYSTEM 
in breast-feeding mothers earlier than six weeks after childbirth.

Drug interactions
	Certain drugs may interact with the hormone delivered by the NORPLANT
SYSTEM, making the method less than effective in preventing pregnancy.  Such 
agents include drugs used for epilepsy, such as phenytion (Dilantin is one 
brand) and carbamazepine (Tegretol is one brand).  You may need to use 
additional contraception when you take drugs that can make the NORPLANT
SYSTEM less effective.  Discuss this with your healthcare provider.

    I've heard that Norplant is quite expensive, in the hundreds of
    dollars.  Does anyone have any ballpark figures?  Does anyone know how
    much an HMO member might have to pay?  
    
    			Bb

    
    Quite expensive?  If BCP's are $15/month x 12 months x 5 years, then
    anything under $900 is reasonable!
    
    But if you'll hold on a minute, I'll find out what it costs from
    Fallon.

    
    I just called Fallon Clinic - the procedure and implants cost $350 there. 

    In one of the Scandanavian countries a Norplant implant costs $24!
    I heard Ellie Smeal talking about this at a workshop at a NOW
    convention.  Apparently, the drug company is claiming that the high
    costs in the U.S. are to train the physicians who perform the
    procedure.  I won't hold my breath at the price going down after this
    initial training period...
    
    judy
    
    

    
    >train the physicians
    
    what a crock. they're just trying to keep the profit margin high..

    	Or, maybe they're anticipating the avalanche of lawsuits from the
    circling buzzards (American lawyers).
    						John