Friday, December 15, 2006

Video games ease sick kids', parents' pain

Video games ease sick kids', parents' pain

By Lisa BaertleinFri Dec 15, 5:45 PM ET

When 11-year-old Gus Luna was able to play one of his favorite video games while recovering from exploratory brain cancer surgery in intensive care, his mother breathed a big sigh of relief.

"It was brain surgery... it was so scary. That made me feel like things seemed OK," said Marcela Luna, whose son has been undergoing chemotherapy since last year, when surgeons were unable to remove his tumor.

Gus, an all-star soccer player and tae kwon do green belt, was president of his fifth-grade class before falling ill. Now being home schooled, he cannot imagine getting through his treatments without video games: "It would be really hard without this ... You never know what's going to happen next."

Games let him focus on something other than the illness, doctors and hospital visits that dominate his life.

Gus is being treated at Los Angeles' Cedars-Sinai Medical Center, which is among 1,000 hospitals worldwide with video game Fun Centers that roll from bed to bed, just like regular hospital equipment.

"You're like a regular kid," he said. "You forget about needles, you forget about what's all around you."

NOT JUST KIDS STUFF

Over the last decade, researchers around the world have done hundreds of studies probing the value of video games and other forms of virtual reality to help children, and their parents, cope with medical-related anxiety and pain.

Results have been mostly positive and continue rolling in.

The University of Southern California's Keck School of Medicine earlier this year published details from a study of 20 children having an intravenous line inserted.

Half of them underwent the procedure while playing "Street Luge," a fully-immersive virtual reality game in which players control characters who race downhill while reclining on a big skateboard. The children wore a helmet fitted with headphones and glasses that delivered game sounds and images. They also used a rumbling joystick.

Children who did not play the game reported a four-fold increase in pain intensity from the procedure, while those who used virtual reality distraction reported no change in pain intensity.

The University of South Australia's Center of Allied Health Evidence did a study of children with serious burn injuries and found "strong evidence" supporting the use of virtual reality-based games in pain management.

In similar fashion, doctors at Israel's Chaim Sheba Medical Center used Sony Corp (NYSE:SNE - news).'s (6758.T) PlayStation II EyeToy -- a camera that connects to a video game console allowing users to see themselves on TV -- as a rehabilitation tool for patients with severe burns. In a published article they said it proved to be an efficient and affordable alternative.

GAMING FOR GOOD

Nintendo Co. Ltd. (7974.OS) executive Don James designed the current Fun Center and said the company will start shipping units that include its new Wii video game console in mid-2007.

The Japanese game giant sponsors more than 3,500 of the 5,000-plus Fun Centers in hospitals through a program created and run by Starlight Starbright Children's Foundation, whose aim is to combat the isolation and fear experienced by hospitalized kids.

A donation of $3,250 covers a current-generation Fun Center with a GameCube console, flat-screen monitor and DVD player, as well as its lifetime upkeep, a Starlight spokeswoman said.

Jeffrey Gold, program psychologist for the pediatric pain management clinic at USC-affiliated Childrens Hospital Los Angeles, was on the team that did the university's virtual reality pain study and continues to research the subject.

Hospitalized children are in a foreign environment with none of the familiar comforts of home, he said.

"There is no normalcy. When you roll in a video game, there is some normalcy," Gold said.

Parents also benefit, he added. "If you have children and you see them in distress, then you're in distress. If they're more calm, you're more calm."

That's something all moms -- from Marcela Luna to movie star and author Jamie Lee Curtis, a Starlight proponent -- know first-hand.

Five years ago, Curtis' son was hospitalized with a ruptured spleen and nurses wheeled in a Fun Center.

"It made him forget he was in the hospital ... It changed our experience," she said.

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Wednesday, December 13, 2006

ePharm eXtra: Blog states "We love Pfizer in our house": Real or fake?

SOURCE: ePharm5 Newsletter: Blog states "We love Pfizer in our house": Real or fake?
(IMPORTANT NOTE: The following article, in its entirety, comes from the ePharm5 newsletter published by HCPPro. In no way do the contents of this article reflect the views or opinions of Ignite Health.)

http://www.hcpro.com/

The ePharm team came across an interesting blog yesterday, one that read: "We love Pfizer in my house because your exotic anti-arrhythmic drug Tikosyn has changed my wife's life. It's genuinely a miracle drug for her." The author, Glenn Reynolds, a law professor at the University of Tennessee, writes the blog called Instapundit and was responding to a Pfizer employee's inquiry about a book Reynolds recently wrote.

The posting goes on to describe the grateful e-mail Reynolds received from the Pfizer employee, who related how he would "pass your thanks along to the guys in the lab. You have no idea how much this kind of message matters to them." Reynolds goes on to say that "while so-called 'Big Pharma' may not be perfect, drug companies have done a lot more to make my life better than their critics have. Maybe someone should point that out more often."

We wonder if this is proof that the industry's reputation is slowly improving. If it is, these kinds of posts are what will make a difference in altering the reputation of the industry. However, ePharm also is aware that the industry hires third parties to monitor blogs in order to gauge consumer attitudes and company reputation (ePharm5, 9/12/06). We have also heard experts caution pharma against hiring bloggers--who are not identified as having connections to the industry--to spread a more positive message throughout the blogosphere and to perform damage control when disparaging remarks are made.

Yesterday's blog, which has several posts from other bloggers, is an example of one or the other or even both. Pfizer is reportedly using software to monitor blogs and user-generated-content (ePharm5, 6/1/05) and is likely aware of this blog interchange. However, we thought the industry would find the posts interesting.

In a responding post, a blogger named Tigerhawk took the blogging ball and ran with it to include a long post about how "pharmaceutical companies deliver extraordinary value to their customers, yet there is apparently great political advantage in bashing them. It is not obvious why this is so." The post elicits several other similar responses, as well as a bit about legalizing marijuana. Tigerhawk also claims that, "In our household, the miracle drug is called Copaxone. Not only do we owe this miracle to a pharmaceutical company, we owe it to an Israeli pharmaceutical company. Apart from George W. Bush and Dick Cheney, in some precincts it's tough to get more evil than that." Visit Tigerhawks's blog here.

M. Simon (a 62-year-old Illinois male with an engineering background who is trying to publish a book on drug wars) posted a couple of his anti-pharma articles for review, to which a poster named John replied, "Big Pharma may rent-seek, but that's at least in part because they have godawful expenses. Consider Pfizer, they recently pulled Torcetrapib from trials after 800 million dollars in testing. That's $800,000,000 in expense that they cannot get back. That's a lot of money, even by government standards."

Another post from Howard in Boston also shows an in-depth knowledge of pharma: "And, speaking of Copaxone, I'm not entirely sure of the nature of the deal but it isn't only an Israeli drug. While Teva Neurosciences was involved, there is some sort of licensing with Sanofi-aventis (again, not sure of their role in all of this but they are definitely involved). So, the miracle drug is actually a combined effort between Israeli pharma and French pharma. Wow."

And from a pharma consultant: "Thanks for including the post about helpful drugs. I work with a lot of pharma companies and get pretty tired of all the negative press. I, too, have profoundly benefited from what these companies have produced, as have millions of others (who have little or no voice in our media environment)."

All in all, it was a pretty warm and fuzzy endorsement for pharma!

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Online doc portal poll finds majority say "no" to DTC ads

Online doc portal poll finds majority say "no" to DTC ads
 
With new survey results showing that 84% of polled physicians say prescription drugs should not be advertised to consumers, the physician online community Sermo (ePharm5, 10/17/06) continues to be a hotbed for debate. Physicians who oppose DTC ads said that they feel pressure to prescribe new and more expensive medicines, and DTC ads interfere with their role as a "learned intermediary," according to Sermo. However, 28% of physicians who disagree with DTC ads say that they may change their opinion if the ads made clear the difference between individual risk and relative risk of drugs. Only 16% of surveyed physicians agreed that prescriptions should be advertised directly to consumers. These physicians cite DTC ads' educational benefits. They also point out that ultimately, it's up to the physicians whether or not a patient receives a drug.
 
[FULL STORY]
 
Sermo Acts as Conduit for Physicians Nationwide to Hotly Debate Recommendations around Regulations for DTC Ads

Business Wire via NewsEdge Corporation :

Education about Individual Vs. Relative Risks of Prescription Drugs Business Editors/Health/Medical Writers CAMBRIDGE, Mass.--(BUSINESS WIRE)--Dec. 11, 2006--Sermo (http://www.sermo.com), the fastest growing online community created by physicians for physicians, has quickly become the destination for physicians nationwide to share their opinions and insights about the latest trends in medicine -24/7. A recent hotly debated topic on Sermo is the American Medical Association's recommendations to regulate direct-to-consumer (DTC) prescription drug advertisements. The new guidelines include imposing a temporary moratorium on the advertising of newly approved drugs and guidelines for pharmaceutical companies to follow when preparing DTC advertising. In general, physicians on Sermo focused on one aspect of the AMA's recommendations - the delay of advertising until drugs have been proven effective.

Sermo is a new online forum where physicians from across the country are working together to improve patient care and save lives -- by instantly comparing notes about different medications, approaches to care, and changes in pathogen resistance. A Sermo member recently posted a question to ask other physicians: Do you think prescription drugs should be directly advertised to consumers?"

To date, more than 100 physicians across specialties and geography have weighed in and shared their opinion on this topic. Poll results span the spectrum of possibilities, though many respondents are voicing the same concerns and agreeing on opportunities for better education about risk and benefits and improved physician-patient interactions. Perhaps the most compelling finding from the poll is that many physicians who voted "no" to prescription drug advertising said they could be swayed if the difference between relative risk (the risk to the population) and individual risk (the risk to an individual) was made more clear to consumers.

Sermo Physician Poll Results:

84% of the physicians polled on Sermo have stated "NO", prescription drugs should not be advertised to consumers, citing the challenges they encounter in their practice. Respondents have indicated that:

-- Physicians feel pressure to prescribe new, expensive medications that patients will have to pay out of pocket for and may not realize it.

-- Direct advertising interferes with the physician's role as the "learned" intermediary. According to one physician, "Commercials on TV are intended to sell the product. Therefore, the product is presented as being desirable, at least to a person with a particular problem. There is no attempt to explain to the public the complexities of prescribing and why we may not wish to put a particular patient on that particular drug. I would very much like to see prescription drug advertising banned."

-- Patients come to a doctor's visit with unrealistic expectations of a drug's performance: Said one Sermo member, "The lay public sees only septuagenarians doing cartwheels in a field of daisies while their husbands sneer longingly in a bathtub with renewed sexual vigor. Patients allow their common mild ailment to be pathologized to the point of life-or-death, only to be rescued by this wonderful new drug."

16% have stated, "YES", promoting education benefits and underscoring physician's responsibility to refuse to prescribe:

-- Drugs require prescriptions. Physicians are unlikely to prescribe them unless they are indicated (to treat a condition.) One Sermo doctor encourages colleagues to, "Be strong in your knowledge of medicine. Be firm in your approach to patients. A solid, 'NO' works well. If I have done my job right, my patients know that I am honest and to be trusted."

-- The patient must buy into the treatment and take the medication. Advertising can support this. A Sermo physician explained, "The Physician is only one intermediary in a patient's treatment and all must come together. The prescriber is required to initiate the medication use ... but ultimately the patient must agree to take the medication recommended."

An unexpected, major finding among the practicing physician community: A large segment, 28%, could be swayed from their NO vote if a critical, physician-driven aspect is made clear in direct-to-consumer ads: the difference between relative risk and individual risk.

-- According to these physicians, there is no counter-balancing information that reminds people that relative risk and individual risk are two different universes for making treatment decisions and most of the data (patients) see on TV shows only relative risk.



Patients may not know that less costly alternatives often have as good if not greater efficacy than those advertised, and that new medications are often not reimbursed and expensive to pay for out of pocket.



Patients may be on another medication that is contra-indicated (might result in expected side effects that can be serious). Explains one Sermo physician, "It is impossible to fully inform someone in a 30-second TV spot to a degree sufficient for them to make an educated judgment. They are reacting only to hype and that is not the way we want to make our therapeutic decisions."

-- All agree that only physicians are in the position to correctly evaluate an individual patient's risk surrounding a medication, and this needs to be underscored.

"Sermo is a new and powerful medium by which physicians nationwide have a collective voice and the ability to influence major constituencies including the healthcare industry, financial industry and regulatory bodies," said Dr. Daniel Palestrant, founder and CEO, Sermo. "Here, physicians are taking stances on the latest issues, and getting feedback from their peers instantly. This is providing a strong "physician voice" to the industry that has not existed before -- and is already improving patient care."

About Sermo:

Launched September 2006, Sermo is the fastest growing online community, created by physicians for physicians. Its Web-based platform provides a medium for physicians to aggregate observations from daily practice then -- rapidly and in large numbers -- challenge or corroborate each other's opinions, accelerating the discovery of emerging trends and new insights on medications, devices, and treatments. Through Sermo, physicians exchange knowledge with each other the minute it is learned, and gain insights from colleagues as they happen instead of waiting to read about them in conventional media sources. Sermo harnesses the power of collective wisdom and enables physicians to discuss new clinical findings, report unusual events, and work together to dramatically impact patient care. For more information visit www.sermo.com.

Resources: For more information on Sermo visit: www.sermo.com. Credentialed physicians can join the discussion by joining the Sermo community, at no cost, and begin responding immediately to posts on this subject.

For more information on the AMA visit: http://www.ama-assn.org/

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Dorland Healthcare Information Launches Dorland's Healthcare Website Guide

Dorland Healthcare Information Launches Dorland's Healthcare Website Guide

Tuesday December 12, 12:18 am ET

Publication Answers Need for a Patient Education Tool That Rates the Best Websites on Health Conditions

PHILADELPHIA, Dec. 12 /PRNewswire/ -- In a move that redefines the way consumers search for online health information, Dorland Healthcare Information has launched Dorland's Healthcare Website Guide, a series of books that identifies, describes, filters and rates the best websites on the 60 most common diseases and health conditions. This series is the first of its kind, directing consumers to only the most credible Web information.

Source: Dorland Healthcare Information

"Finding reliable online health information is no easy task," says Robert Graham, CEO of Dorland Healthcare Information. "Results from major search engines can be overwhelming. How much time can you allot to sorting through thousands of deceptive, random and often outdated results, and how do you know if the information found is credible? Dorland's Healthcare Website Guide has solved this problem for Web users who are increasingly going online for health information."

Dorland's Healthcare Website Guide is designed to direct consumers to the most reliable online health information in a matter of seconds. "Users can be confident in the recommended sites," says Robert C. Smith Jr., Ph.D., Editor- in-Chief of Dorland's Healthcare Website Guide. "Created by an experienced staff of physicians, medical editors and website analysts, the series contains the most reliable information from a trusted and independent third party source." Smith added that "80 percent of the online population searched for health information last year, and less than 50 percent was satisfied with the results they found. This is clearly the right product at the right time."

The guide is also a great resource for time-stressed physicians as it helps doctors efficiently care for their patients by directing them to health websites vetted and pre-screened by Dorland's group of medical experts. "Total Health Rewards is excited to partner with Dorland Healthcare in the launch of the Website Guide. Providing the means to quickly and confidently direct patients to appropriate online information is undoubtedly a benefit to both physician and patient," says Mary Tooman, Director of Materials Management for Total Health Rewards.

Dorland's Healthcare Website Guide also provides pharmaceutical sales representatives with a new and relevant marketing tool. It saves healthcare professionals hundreds of hours, which would otherwise be spent searching the Web for objective and reliable disease-specific websites. "Time is perhaps the greatest gift to anyone, especially physicians. Their time is so much in demand," says Harry J. Alba Jr., Executive Vice President of Sales at Dorland Healthcare Information. "The guide will be invaluable for both patients and health professionals and will help create ongoing opportunities for pharmaceutical sales representatives to gain more face-time with physicians. Most importantly, it will help professionals care for their patients." Alba added that "the rules have changed regarding the kinds of advertising premiums and gifts that can be given to health professionals. Fortunately, a patient education tool featuring medically relevant health information is perfectly suited to today's marketplace and PhRMA guidelines."

Available now in print, and online beginning January 2007, consumers can purchase individual copies of Dorland's Healthcare Website Guide by calling toll free at 800.784.2332. Physicians are encouraged to visit http://www.totalhealthrewards.com to redeem certificates or purchase the guides most appropriate to their specialty.

About Dorland Healthcare Information

Dorland Healthcare Information (DHI), based in Philadelphia, is a nationally recognized publisher known as the leader in healthcare business information for the past 50 years. DHI publishes several magazines - enrich, your Health & Life distributed quarterly to over 1,000,000 consumers, Case in Point for medical professionals in case management, and the Good Neighbor Health Guide for multi-cultural marketing. DHI also publishes a variety of industry print and online reference books, such as the Case Management Resource Guide; Dorland's Medical Directory; Medical & Healthcare Marketplace Guide and Dorland's Healthcare Website Guide.

About Total Health Rewards

Total Health Rewards (formerly Medsite Rewards(TM)) is the leading provider of medically relevant incentives for the Pharmaceutical Industry. Their programs provide outsourced fulfillment primarily designed to attract medical professionals to pharmaceutical promotional events. As the industry leader, Total Health Rewards reaches more doctors and handles more volume than any of their competitors, and their brand recognition significantly increases recruitment efficacy for all types of pharmaceutical programs.

Total Health Rewards' Redemption catalog contains 40,000 medical products (supplies and textbooks) specifically geared to aid physicians in the treatment of their patients, making Total Health Rewards a smart and flexible way to create awareness, encourage activity, and build goodwill among medical professionals in a manner that is compliant with existing guidelines.

Source: Dorland Healthcare Information

 
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Seevast Rolls Out Sponsored Links For Video

Seevast Rolls Out Sponsored Links For Video
Wednesday, Dec 13, 2006 6:00 AM ET

PULSE 360, A UNIT OF Internet marketing company Seevast Corp., has begun offering advertisers the ability to place sponsored links before or after online video clips. The static links can be targeted based on context, geography, behavior or demographic profile. Pay-per-click rates for the sponsored video links will be the same as existing rates through Pulse 360--ranging from five cents to more than $10, depending on the level of targeting and other factors. Advertisers can now reach their audience in this highly desirable space, and publishers can add another way to monetize their content," said Seevast CEO Lance Podell, in a prepared statement. Mark Josephson, chief marketing officer for Seevast, said advertisers will be able to add listings to all the video inventory on sites in its ad network including MarketWatch.com, MSNBC.com, USAToday.com and sites of the Dow Jones Online Network. 
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Study: More Than Three In Four Now On Broadband

Study: More Than Three In Four Now On Broadband
Media Post News Brief
Wednesday, Dec 13, 2006 6:00 AM ET

SEVENTY-EIGHT PERCENT OF ACTIVE HOME Web users connected via a high-speed line last month--up from 65% one year ago, according to new data from Nielsen//NetRatings. The broadband users also spent an average of 34 hours and 50 minutes online last month--33% more than dial-up users, who averaged 26 hours and 13 minutes per person. Broadband users also viewed 1,574 Web pages on average--more than double the 681 pages per person average for narrowband users. 

source:
http://publications.mediapost.com/index.cfm?fuseaction=Articles.san&s=52494&Nid=25811&p=212886

 

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Google beta tests AdWords-style radio advertising model

Google beta tests AdWords-style radio advertising model
 
Google is shifting its reign from the Web to the radio by enabling some of its current marketers to advertise on radio using its automated ad system, reports CNetNews.com. Like AdWords online, advertisers can bid on air spots and target the ads to their listeners based on factors such as listener demographics and geography. The ad system allows marketers the flexibility to see real-time reports about their ads and change aspects of them, such as the time they are played or the geographical target. The test of Google Audio Ads is limited to just more than 20 AdWords customers and more than 730 radio stations. Among those stations is XM Satellite radio, according to the report. The ads will be running in 87% of the country--more than 260 metropolitan markets.
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Merck tool aims to "transform" diabetes education

Merck tool aims to "transform" diabetes education
 
Merck is developing tools that it says will transform the way diabetes educators teach patients about diabetes and making lifestyle modifications. The company is partnering with healthcare education company Healthy Interactions for the diabetes Conversation Map tools, which aim to help patients manage their chronic illness. The tools are hard-copy maps, a Merck spokesperson tells ePharm5, that healthcare providers and diabetes educators can use to provide visual learning and active dialogue. The content was developed and reviewed by the American Diabetes Association, and the maps are scheduled to be launched across the United States in 2007. The maps will first be offered to 2,800 American Diabetes Association-recognized diabetes education programs, with a goal of having them used by at least 9,500 diabetes educators within the next three years.
 
[FULL STORY]
 
Merck and Healthy Interactions Announce Collaboration to Transform Diabetes Patient Education

Business Wire via NewsEdge Corporation :

Patients in Sustainable Behavior Change for Better Control of Diabetes Business Editors/Health/Medical Writers WHITEHOUSE STATION, N.J. & SYLVANIA, Ohio--(BUSINESS WIRE)--Dec. 8, 2006--Today, Merck & Co., Inc. and Healthy Interactions Inc. announced that they have entered into a multi-year agreement to transform how diabetes educators and other healthcare professionals engage patients in learning about diabetes and making lifestyle modifications that lead to improved self-management. This initiative will utilize a series of diabetes Conversation Map(TM) tools, which Healthy Interactions and the American Diabetes Association (ADA) have been developing since early 2006. In addition to being extremely effective at engaging patients, the Conversation Map tools are aligned with the reimbursement curriculum for healthcare professionals as defined by Medicare.

"We at the ADA believe Conversation Maps are one of the most important innovations in patient and physician education in a decade," said Karmeen Kulkarni, immediate past-president, Healthcare & Education, American Diabetes Association.

The diabetes Conversation Map tools, with content developed and reviewed by the ADA, are scheduled to be launched across the United States in 2007, initially being offered to 2,800 ADA recognized diabetes education programs (ERPs) as well as to other healthcare professionals. The goal is to have at least 9,500 diabetes educators incorporate the Conversation Map tools into their diabetes education programs within the next three years.

Conversation Map tools increase patients' ability to understand and manage chronic diseases and other health conditions. They combine visual learning techniques and active dialogue between patients and healthcare professionals to engage patients in sustainable behavior change. The Conversation Map tools help patients to decipher the complexities of diabetes, empower them to draw new insights for better disease management, and inspire them to develop a personal plan for change. The underlying philosophy of the approach is that patients will make better healthcare decisions when they self-determine why change is necessary, what has to change and who else needs to be involved in the change process.

"We have a unique opportunity to make a very real and important difference in the lives of millions of people with diabetes and in the lives of the healthcare professionals who care for them," said Peter Gorman, president of Healthy Interactions Inc. "Patients increasingly need to become better self-managers of their diabetes. Together, Merck and Healthy Interactions will transform diabetes education, enabling patients to advance their awareness and knowledge about their disease, to assume greater personal ownership for lifestyle changes and to employ practical actions to improve their health."

"We are excited to be able to provide proven patient education resources at the level of the healthcare provider," said Patrick P. Magri, vice president, Diabetes and Obesity Franchise, U.S. Human Health, Merck & Co., Inc. "Merck is proud to be the first and only healthcare company to make these innovative educational tools available in the United States."

About Healthy Interactions

Healthy Interactions Inc. (Healthyi) is revolutionizing healthcare education in the United States and around the world. Founded in 2003, Healthyi's mission is to improve healthcare decision-making of patients and healthcare professionals by transforming the way in which they experience and internalize health-related information. Healthyi achieves this mission by developing and distributing small-group Conversation Map tools, web 2.0 tools, and tools specifically created for pharmacy and retail settings. Healthyi also builds and maintains learning networks and venues. Conversation Map is a trademark of Healthy Interactions Inc. Visit Healthyi at www.healthyi.com.

About Merck

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit www.merck.com.

Forward-looking statement

This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise. Forward-looking statements in this press release should be evaluated together with the many uncertainties that affect Merck's business, particularly those mentioned in the cautionary statements in Item 1 of Merck's Form 10-K for the year ended Dec. 31, 2005, and in its periodic reports on Form 10-Q and Form 8-K, which the Company incorporates by reference.

Conversation Map is a trademark of Healthy Interactions Inc.

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