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<title>Solution to killer superbug found in Norway</title>
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<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>This is good to have posted. There are
many implications and ties in with the Tamiflu findings re potential viral
mutations. Note how long this has been known.<o:p></o:p></span></font></p>
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10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b><span style='font-weight:
bold'>On Behalf Of </span></b>DeBiasi,Deborah<br>
<b><span style='font-weight:bold'>Sent:</span></b> Monday, January 11, 2010
10:04 AM<br>
<b><span style='font-weight:bold'>To:</span></b>
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Subject:</span></b> [Pharmwaste] Solution to
killer superbug found in <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region></span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>This philosophy would certainly make our waters cleaner!</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>*******</span></font><o:p></o:p></p>
<p><font size=3 face="Times New Roman"><span style='font-size:12.0pt'><a
href="http://news.yahoo.com/s/ap/20091231/ap_on_he_me/when_drugs_stop_working_norway_s_answer"><font
color=navy><span style='color:navy'>http://news.yahoo.com/s/ap/20091231/ap_on_he_me/when_drugs_stop_working_norway_s_answer</span></font></a><o:p></o:p></span></font></p>
<p><b><font size=5 color=navy face=Arial><span style='font-size:18.0pt;
font-family:Arial;color:navy;font-weight:bold'>Solution to killer superbug
found in Norway</span></font></b><o:p></o:p></p>
<p><i><font size=3 color=navy face="Times New Roman"><span style='font-size:
12.0pt;color:navy;font-style:italic'>By MARTHA MENDOZA and MARGIE MASON,
Associated Press Writers</span></font> <font color=navy><span style='color:
navy'>Martha Mendoza And Margie Mason, Associated Press Writers</span></font></i>
<font color=navy><span style='color:navy'>Wed Dec 30,
9:04 pm ET</span></font> <o:p></o:p></p>
<p><st1:City w:st="on"><font size=3 color=navy face="Times New Roman"><span
style='font-size:12.0pt;color:navy'>OSLO</span></font></st1:City><font
color=navy><span style='color:navy'>, <st1:country-region w:st="on">Norway</st1:country-region>
–</span></font> <st1:place w:st="on"><st1:PlaceName w:st="on"><font
color=navy><span style='color:navy'>Aker</span></font></st1:PlaceName><font
color=navy><span style='color:navy'> <st1:PlaceType w:st="on">University</st1:PlaceType>
<st1:PlaceType w:st="on">Hospital</st1:PlaceType></span></font></st1:place><font
color=navy><span style='color:navy'> is a dingy place to heal. The floors are
streaked and scratched. A light layer of dust coats the blood pressure
monitors. A faint stench of urine and bleach wafts from a pile of soiled
bedsheets dropped in a corner.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Look closer, however, at a microscopic level, and this place is
pristine. There is no sign of a dangerous and contagious</span></font> <font
color=navy><span style='color:navy'>staph infection that killed tens of
thousands of patients in the most sophisticated hospitals of</span></font> <font
color=navy><span style='color:navy'>Europe, North America and <st1:place w:st="on">Asia</st1:place>
this year, soaring virtually unchecked.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>The reason:</span></font> <font color=navy><span style='color:navy'>Norwegians
stopped taking so many drugs.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Twenty-five years ago, Norwegians were also losing their lives to
this bacteria. But</span></font> <st1:country-region w:st="on"><st1:place
w:st="on"><font color=navy><span style='color:navy'>Norway</span></font></st1:place></st1:country-region><font
color=navy><span style='color:navy'>'s public health system fought back with an
aggressive program that made it the most infection-free country in the world. A
key part of that program was cutting back severely on the</span></font> <font
color=navy><span style='color:navy'>use of antibiotics.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Now a spate of new studies from around the world prove that
Norway's model can be replicated with extraordinary success, and</span></font> <font
color=navy><span style='color:navy'>public health experts are saying these
deaths — 19,000 in the U.S. each year alone, more than from</span></font>
<font color=navy><span style='color:navy'>AIDS — are unnecessary.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"It's a very sad situation that in some places so many are
dying from this, because we have shown here in</span></font> <font color=navy><span
style='color:navy'>Norway that Methicillin-resistant Staphylococcus aureus
(MRSA) can be controlled, and with not too much effort," said Jan
Hendrik-Binder, Oslo's MRSA</span></font> <font color=navy><span
style='color:navy'>medical adviser. "But you have to take it seriously,
you have to give it attention, and you must not give up."</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>The World Health Organization says</span></font> <font color=navy><span
style='color:navy'>antibiotic resistance is one of the</span></font> <font
color=navy><span style='color:navy'>leading public health threats on the
planet. A six-month investigation by The Associated Press found overuse and
misuse of medicines has led to mutations in once curable diseases like</span></font>
<font color=navy><span style='color:navy'>tuberculosis and</span></font> <font
color=navy><span style='color:navy'>malaria, making them harder and in some
cases impossible to treat.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Now, in <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>'s
simple solution, there's a glimmer of hope.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>---</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Dr. John Birger Haug shuffles down Aker's scuffed corridors,
patting the pocket of his baggy white scrubs. "My bible," the</span></font>
<font color=navy><span style='color:navy'>infectious disease specialist says,
pulling out a little red</span></font> <font color=navy><span style='color:
navy'>Antibiotic Guide that details this country's impressive MRSA solution.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>It's what's missing from this book — an array of antibiotics
— that makes it so remarkable.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"There are times I must show these golden rules to our doctors
and tell them they cannot prescribe something, but our patients do not suffer
more and our nation, as a result, is mostly infection free," he says.</span></font><o:p></o:p></p>
<p><st1:country-region w:st="on"><st1:place w:st="on"><font size=3 color=navy
face="Times New Roman"><span style='font-size:12.0pt;color:navy'>Norway</span></font></st1:place></st1:country-region><font
color=navy><span style='color:navy'>'s model is surprisingly straightforward.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>• Norwegian doctors prescribe fewer antibiotics than any
other country, so people do not have a chance to develop resistance to them.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>• Patients with MRSA are isolated and medical staff who test
positive stay at home.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>• Doctors track each case of MRSA by its individual strain,
interviewing patients about where they've been and who they've been with,
testing anyone who has been in contact with them.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Haug unlocks the dispensary, a small room lined with boxes of
pills, bottles of syrups and tubes of ointment. What's here? Medicines
considered obsolete in many developed countries. What's not? Some of the
newest, most expensive antibiotics, which aren't even registered for use in <st1:country-region
w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>,
"because if we have them here, doctors will use them," he says.</span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>He points to an antibiotic. "If I treated someone with an
infection in <st1:country-region w:st="on"><st1:place w:st="on">Spain</st1:place></st1:country-region>
with this penicillin I would probably be thrown in jail," he says,
"and rightly so because it's useless there."</span></font> <o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Norwegians are sanguine about their</span></font> <font color=navy><span
style='color:navy'>coughs and colds, toughing it out through low-grade
infections. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"We don't throw antibiotics at every person with a fever. We
tell them to hang on, wait and see, and we give them a Tylenol to feel
better," says Haug. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Convenience stores in downtown</span></font> <font color=navy><span
style='color:navy'>Oslo are stocked with an amazing and colorful array — 42
different brands at one downtown 7-Eleven — of soothing, but
non-medicated, lozenges, sprays and tablets. All workers are paid on days they,
or their children, stay home sick. And drug makers aren't allowed to advertise,
reducing patient demands for prescription drugs. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>In fact, most marketing here sends the opposite message:</span></font>
<font color=navy><span style='color:navy'>"Penicillin is not a</span></font>
<font color=navy><span style='color:navy'>cough medicine," says the tissue
packet on the desk of <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>'s
MRSA control director, Dr. Petter Elstrom. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>He recognizes his country is "unique in the world and best in
the world" when it comes to MRSA. Less than 1 percent of</span></font> <font
color=navy><span style='color:navy'>health care providers are positive carriers
of MRSA staph. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>But Elstrom worries about the bacteria slipping in through other
countries. Last year almost every diagnosed case in <st1:country-region w:st="on"><st1:place
w:st="on">Norway</st1:place></st1:country-region> came from someone who had
been abroad. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"So far we've managed to contain it, but if we lose this, it
will be a huge problem," he said. "To be very depressing about it, we
might in some years be in a situation where MRSA is so endemic that we have to
stop doing advanced surgeries, things like</span></font> <font color=navy><span
style='color:navy'>organ transplants, if we can't prevent infections. In the
worst case scenario we are back to 1913, before we had antibiotics." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>--- </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Forty years ago, a new spectrum of antibiotics enchanted</span></font>
<font color=navy><span style='color:navy'>public health officials, quickly
quelling one infection after another. In wealthier countries that could afford
them, patients and providers came to depend on antibiotics. Trouble was, the
more antibiotics are consumed, the more resistant bacteria develop. </span></font><o:p></o:p></p>
<p><st1:country-region w:st="on"><st1:place w:st="on"><font size=3 color=navy
face="Times New Roman"><span style='font-size:12.0pt;color:navy'>Norway</span></font></st1:place></st1:country-region><font
color=navy><span style='color:navy'> responded swiftly to initial MRSA
outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of
the infection, the rest of the world fell behind. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>In <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>,
MRSA has accounted for less than 1 percent of</span></font> <font color=navy><span
style='color:navy'>staph infections for years. That compares to 80 percent in <st1:country-region
w:st="on">Japan</st1:country-region>, the world leader in MRSA; 44 percent in <st1:country-region
w:st="on">Israel</st1:country-region>; and 38 percent in <st1:country-region
w:st="on"><st1:place w:st="on">Greece</st1:place></st1:country-region>. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>In the <st1:country-region w:st="on"><st1:place w:st="on">U.S.</st1:place></st1:country-region>,
cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2
percent in 1974 to 63 percent in 2004. And in the <st1:country-region w:st="on"><st1:place
w:st="on">United Kingdom</st1:place></st1:country-region>, they rose from
about 2 percent in the early 1990s to about 45 percent, although an aggressive
control program is now starting to work. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>About 1 percent of people in developed countries carry MRSA on
their skin. Usually harmless, the bacteria can be deadly when they enter a
body, often through a scratch. MRSA spreads rapidly in hospitals where sick
people are more vulnerable, but there have been outbreaks in prisons, gyms,
even on beaches. When dormant, the bacteria are easily detected by a quick nasal
swab and destroyed by antibiotics. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Dr. John Jernigan at the</span></font> <font color=navy><span
style='color:navy'>U.S. Centers for Disease Control and Prevention said they
incorporate some of Norway's solutions in varying degrees, and his agency
"requires hospitals to move the needle, to show improvement, and if they
don't show improvement they need to do more." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>And if they don't? </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"Nobody is accountable to our recommendations," he said,
"but I assume hospitals and institutions are interested in doing the right
thing." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Dr. Barry Farr, a retired epidemiologist who watched a successful
MRSA control program launched 30 years ago at the <st1:place w:st="on"><st1:PlaceType
w:st="on">University</st1:PlaceType> of <st1:PlaceName w:st="on">Virginia</st1:PlaceName></st1:place>'s
hospitals, blamed the</span></font> <font color=navy><span style='color:navy'>CDC
for clinging to past beliefs that hand washing is the best way to stop the
spread of infections like MRSA. He says it's time to add screening and
isolation methods to their controls. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>The CDC needs to "eat a</span></font> <font color=navy><span
style='color:navy'>little crow and say, 'Yeah, it does work,'" he said.
"There's example after example. We don't need another study. We need
somebody to just do the right thing." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>--- </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>But can <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>'s
program really work elsewhere? </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>The answer lies in the busy laboratory of an aging little public
hospital about 100 miles outside of <st1:City w:st="on"><st1:place w:st="on">London</st1:place></st1:City>.
It's here that microbiologist Dr. Lynne Liebowitz got tired of seeing the
stunningly low Nordic MRSA rates while facing her own burgeoning cases. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>So she turned <st1:place w:st="on"><st1:PlaceName w:st="on">Queen</st1:PlaceName>
<st1:PlaceName w:st="on">Elizabeth</st1:PlaceName> <st1:PlaceName w:st="on">Hospital</st1:PlaceName></st1:place>
in Kings Lynn into a petri dish, asking doctors to almost completely stop using
two antibiotics known for provoking</span></font> <font color=navy><span
style='color:navy'>MRSA infections. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>One month later, the results were in: MRSA rates were tumbling. And
they've continued to plummet. Five years ago, the hospital had 47 MRSA</span></font>
<font color=navy><span style='color:navy'>bloodstream infections. This year
they've had one. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"I was shocked, shocked," says Liebowitz, bouncing onto
her toes and grinning as colleagues nearby drip blood onto slides and peer
through microscopes in the hospital laboratory. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>When word spread of her success, Liebowitz's phone began to ring.
So far she has replicated her experiment at four other hospitals, all with the
same dramatic results. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"It's really very upsetting that some patients are dying from
infections which could be prevented," she says. "It's wrong." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Around the world, various medical providers have also successfully
adapted <st1:country-region w:st="on"><st1:place w:st="on">Norway</st1:place></st1:country-region>'s
program with encouraging results. A medical center in <st1:place w:st="on"><st1:City
w:st="on">Billings</st1:City>, <st1:State w:st="on">Mont.</st1:State></st1:place>,
cut MRSA infections by 89 percent by increasing screening, isolating patients
and making all staff — not just doctors — responsible for
increasing hygiene. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>In <st1:country-region w:st="on"><st1:place w:st="on">Japan</st1:place></st1:country-region>,
with its cutting-edge technology and modern hospitals, about 17,000 people die from
MRSA every year. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Dr. Satoshi Hori, chief infection control doctor at</span></font> <st1:PlaceName
w:st="on"><font color=navy><span style='color:navy'>Juntendo</span></font></st1:PlaceName><font
color=navy><span style='color:navy'> <st1:PlaceType w:st="on">University</st1:PlaceType>
<st1:PlaceType w:st="on">Hospital</st1:PlaceType> in <st1:City w:st="on"><st1:place
w:st="on">Tokyo</st1:place></st1:City>, says doctors overprescribe antibiotics
because they are given financial incentives to push drugs on patients. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Hori now limits antibiotics only to patients who really need them
and screens and isolates high-risk patients. So far his hospital has cut the
number of MRSA cases by two-thirds. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>In 2001, the</span></font> <font color=navy><span style='color:
navy'>CDC approached a Veterans Affairs hospital in <st1:City w:st="on"><st1:place
w:st="on">Pittsburgh</st1:place></st1:City> about conducting a small test
program. It started in one unit, and within four years, the entire hospital was
screening everyone who came through the door for MRSA. The result: an 80
percent decrease in MRSA infections. The program has now been expanded to all
153 VA hospitals, resulting in a 50 percent drop in MRSA</span></font> <font
color=navy><span style='color:navy'>bloodstream infections, said Dr. Robert
Muder, chief of</span></font> <font color=navy><span style='color:navy'>infectious
diseases at the VA Pittsburgh Healthcare System. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"It's kind of a no-brainer," he said. "You save
people pain, you save people the work of taking care of them, you save money,
you save lives and you can export what you learn to other hospital-acquired
infections." </span></font><o:p></o:p></p>
<p><st1:City w:st="on"><st1:place w:st="on"><font size=3 color=navy
face="Times New Roman"><span style='font-size:12.0pt;color:navy'>Pittsburgh</span></font></st1:place></st1:City><font
color=navy><span style='color:navy'>'s program has prompted all other major
hospital-acquired infections to plummet as well, saving roughly $1 million a
year. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"So, how do you pay for it?" Muder asked. "Well, we
just don't pay for MRSA infections, that's all." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>--- </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Beth Reimer of <st1:place w:st="on"><st1:City w:st="on">Batavia</st1:City>,
<st1:State w:st="on">Ill.</st1:State></st1:place>, became an advocate for MRSA
precautions after her 5-week-old daughter Madeline caught a cold that took a
fatal turn. One day her beautiful baby had the sniffles. The next? </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"She wasn't breathing. She was limp," the mother
recalled. "Something was terribly wrong." </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>MRSA had invaded her little lungs. The antibiotics were useless.
Maddie struggled to breathe, swallow, survive, for two weeks. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"For me to sit and watch Madeline pass away from such an
aggressive form of something, to watch her fight for her little life — it
was too much," Reimer said. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Since Madeline's death, Reimer has become outspoken about the need
for better precautions, pushing for methods successfully used in</span></font> <st1:country-region
w:st="on"><st1:place w:st="on"><font color=navy><span style='color:navy'>Norway</span></font></st1:place></st1:country-region><font
color=navy><span style='color:navy'>. She's stunned, she said, that anyone
disputes the need for change. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>"Why are they fighting for this not to take place?" she
said. </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>____ </span></font><o:p></o:p></p>
<p><font size=3 color=navy face="Times New Roman"><span style='font-size:12.0pt;
color:navy'>Martha Mendoza is an AP national writer who reported from <st1:country-region
w:st="on">Norway</st1:country-region> and <st1:country-region w:st="on"><st1:place
w:st="on">England</st1:place></st1:country-region>. Margie Mason is an AP
medical writer based in <st1:country-region w:st="on">Vietnam</st1:country-region>,
who reported while on a fellowship from The Nieman Foundation at</span></font> <st1:place
w:st="on"><st1:PlaceName w:st="on"><font color=navy><span style='color:navy'>Harvard</span></font></st1:PlaceName><font
color=navy><span style='color:navy'> <st1:PlaceType w:st="on">University</st1:PlaceType></span></font></st1:place><font
color=navy><span style='color:navy'>.</span></font><o:p></o:p></p>
<p><a name=""><font size=2 color=navy face="Times New Roman"><span
style='font-size:10.0pt;color:navy'>Deborah L. DeBiasi</span></font></a><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><b><font size=2 color=navy><span style='font-size:10.0pt;
color:navy;font-weight:bold'>Email:
Deborah.DeBiasi@deq.virginia.gov</span></font><i><span
style='font-style:italic'> </span></i></b><b><i><font size=2 color=red><span
style='font-size:10.0pt;color:red;font-weight:bold;font-style:italic'>(NEW!)<br>
</span></font></i></b><font size=2 color=navy><span style='font-size:10.0pt;
color:navy'>WEB site address: www.deq.virginia.gov</span></font><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><st1:place w:st="on"><st1:PlaceName w:st="on"><font size=2
color=navy><span style='font-size:10.0pt;color:navy'>Virginia</span></font></st1:PlaceName><font
size=2 color=navy><span style='font-size:10.0pt;color:navy'> <st1:PlaceName
w:st="on">Department</st1:PlaceName></span></font></st1:place><font size=2
color=navy><span style='font-size:10.0pt;color:navy'> of Environmental Quality</span></font><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>Office
of Water Permit Programs</span></font><font color=navy face=Arial><span
style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>Industrial
Pretreatment/Whole Effluent Toxicity (WET) Program</span></font><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>PPCPs,
EDCs, and Microconstituents</span></font><o:p></o:p></p>
<p><font size=2 color=navy face="Times New Roman"><span style='font-size:10.0pt;
color:navy'>www.deq.virginia.gov/vpdes/microconstituents.html</span></font><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>Mail:
<st1:address w:st="on"><st1:Street w:st="on">P.O. Box 1105</st1:Street>, <st1:City
w:st="on">Richmond</st1:City>, <st1:State w:st="on">VA</st1:State> <st1:PostalCode
w:st="on">23218</st1:PostalCode></st1:address></span></font><br>
<font size=2 color=navy><span style='font-size:10.0pt;color:navy'>Location:
<st1:address w:st="on"><st1:Street w:st="on">629 E. Main Street</st1:Street>, <st1:City
w:st="on">Richmond</st1:City>, <st1:State w:st="on">VA</st1:State> <st1:PostalCode
w:st="on">23219</st1:PostalCode></st1:address></span></font><font color=navy
face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>PH: 804-698-4028</span></font><font
color=navy face=Arial><span style='font-family:Arial;color:navy'><br>
</span></font><font size=2 color=navy><span style='font-size:10.0pt;color:navy'>FAX:
804-698-4032</span></font><font color=navy face=Arial><span
style='font-family:Arial;color:navy'> </span></font><o:p></o:p></p>
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