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<p class="MsoNormal"><span style="color:#000099">Perspective on the pharmaceutical issue would seem to be the key here. From a pollution prevention standpoint, trash disposal probably does use less energy than incineration. From an environmental perspective,
it’s better than sewer disposal in that it delays entry into the surface and ground waters, but not nearly as good as incineration for removal. Maine did a study in 2010 and found pharmaceuticals in the leachate from their landfills (<a href="http://eponline.com/articles/2010/02/10/maine-dep-finds-pharmaceuticals-in-landfill-leachate.aspx">http://eponline.com/articles/2010/02/10/maine-dep-finds-pharmaceuticals-in-landfill-leachate.aspx</a>),
so we know that many drugs are present potentially years after disposal. Typically, landfill leachate is piped or trucked to a wastewater treatment plant, which cannot remove all of the pharmaceuticals either, so they get discharged in the effluent to the
receiving stream. Incineration destroys the pharmaceuticals and results in a waste product that is less of a concern environmentally, and of negligent concern to health and law enforcement.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#000099"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#000099">Another issue is safety at landfills. Pharmaceuticals are not always disguised by additional packaging when they are tossed by the home owner, or may simply become visible with all of the manipulations of waste
collection trucks and landfill equipment. They can become recognizable and available to “scroungers”, both human and wildlife, creating health concerns and potentially criminal issues. Our landfill inspectors have seen people raking through the garbage looking
for drugs and alcohol, which creates a safety issue for all involved.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#000099"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#000099">This study was interesting, and useful for looking at the carbon footprint of the disposal methods. However, I feel that incineration is still the best option we have for drug destruction.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#000099"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#000099"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;color:navy">Deborah L. DeBiasi</span><span style="font-size:10.0pt;color:#000099">,
</span><span style="font-size:10.0pt;color:navy">Virginia DEQ</span><span style="font-size:10.0pt;color:#000099">
<br>
</span><span style="font-size:10.0pt;color:navy">Office of Water Permit and Compliance Assistance Programs</span><span style="font-size:10.0pt;color:#000099"><br>
</span><b><span style="font-size:10.0pt;color:navy">Email: Deborah.DeBiasi@deq.virginia.gov</span></b><b><i><span style="font-size:10.0pt;color:#000099"><br>
</span></i></b><span style="font-size:10.0pt;color:navy">PH: 804-698-4028</span><span style="font-size:10.0pt;color:#000099"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:#000099"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us]
<b>On Behalf Of </b>Volkman, Jennifer (MPCA)<br>
<b>Sent:</b> Friday, May 18, 2012 1:55 PM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black">Discussion is good.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black">I don't know if it has been peer-reviewed and whether they took into account everything we've all looked at. If collection is at a pharmacy that someone is going to already to
pick up refills or other items, I don't see how the emissions factor in there. Most law enforcement collection points are located in population centers that people travel to as well. I could see that some people might just make one direct trip, but most people
run a string of errands and naturally plan out a route that wouldn't seem to add significantly to emissions.
<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black">Growing up outside a small town, there were times where you went to town for a carton of milk if you really needed it, but generally we'd go to the store, post office, gas station,
bakery, pharmacy and, hopefully, the Dairy Queen. Still do, even though I'm in a larger town.
<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black">If law enforcement and pharmacies are already properly managing their waste or confiscated drugs, the amounts collected by take back just add to the outbound shipment already
going for incineration. <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black">But I do always appreciate a study that looks at the carbon footprint, so I'm looking forward to reading the details. <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Calibri","sans-serif";color:black"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> pharmwaste-bounces@lists.dep.state.fl.us
[pharmwaste-bounces@lists.dep.state.fl.us] on behalf of Fredrick L. Miller [millerfl@tricity.wsu.edu]<br>
<b>Sent:</b> Friday, May 18, 2012 12:48 PM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back</span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Sorry for using the wrong address, Laurie. I’ll try to keep it straight in the future.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">I realize my position isn’t plain vanilla and may draw a little push-back. I take sole responsibility for it and ask that any who have strong feelings about
the matter please feel free to contact me via the list or in private. I don’t take negative or opposing feedback personally or lightly. I’ve been known to learn from it when people find holes in my logic or knowledge. After all, if all we consumed was our
own product how would we learn and grow?</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Fred</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us]
<b>On Behalf Of </b>Tenace, Laurie<br>
<b>Sent:</b> Friday, May 18, 2012 10:06 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] FW: OH MY - For Medication Disposal, New Advice Is Trash BeatsTake-Back</span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:black"> <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D">Please note that Fred Miller’s email did not originate with me – Laurie</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="color:black"> <o:p></o:p></span></p>
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<p class="MsoNormal"><em><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">Please take a few minutes to share your comments on the service you received from the department by clicking on this link
<a href="http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us" target="_blank">
DEP Customer Survey</a>.</span></em><span style="color:black"><o:p></o:p></span></p>
</div>
<div>
<p class="MsoNormal" style="margin-left:.5in"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> Fredrick L. Miller
<a href="mailto:[mailto:millerfl@tricity.wsu.edu]" target="_blank">[mailto:millerfl@tricity.wsu.edu]</a>
<br>
<b>Sent:</b> Friday, May 18, 2012 12:29 PM<br>
<b>To:</b> <a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">
pharmwaste-bounces@lists.dep.state.fl.us</a><br>
<b>Subject:</b> RE: OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back</span><span style="color:black"><o:p></o:p></span></p>
</div>
<p class="MsoNormal" style="margin-left:.5in"><span style="color:black"> <o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">As an environmental management practitioner I have no problem with landfilling pharmaceuticals in cells constructed to modern standards.
By the time they make their way through the biological and chemical processes going on in the landfill itself and the leachate collection/treatment system it’s at least as well degraded as in many of the thermal treatment options (waste to energy and other
non-RCRA permitted burners). The UM study is a good start at examining the costs, both fiscal and environmental, of take-back programs but its limited scope precludes full examination of the problem. I must say their work is a great start to launching a
rational discussion of the problem rather than simply continuing down the knee-jerk path to take-back. Let’s not let the bureaucrats promulgate regulations the normal way but rather use our brains and voices to influence the outcome this time ‘round.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><a href="http://www.epa.gov/epawaste/nonhaz/municipal/landfill.htm" target="_blank">http://www.epa.gov/epawaste/nonhaz/municipal/landfill.htm</a></span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Fred Miller</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">USTUR</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-left:.5in"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">
<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">pharmwaste-bounces@lists.dep.state.fl.us</a> [<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">mailto:pharmwaste-bounces@lists.dep.state.fl.us</a>]
<b>On Behalf Of </b>Lotzer Donna M<br>
<b>Sent:</b> Friday, May 18, 2012 8:45 AM<br>
<b>To:</b> Lotzer Donna M<br>
<b>Subject:</b> [Pharmwaste] OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back</span><span style="color:black"><o:p></o:p></span></p>
</div>
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<p class="MsoNormal" style="margin-left:.5in"><span style="color:black"> <o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:.5in"><span style="color:black"> <o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">18 May 2012
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">Returning extra medicine to the pharmacy for disposal might not be worth the extra time, money or greenhouse gas emissions, according to a University of
Michigan study that is the first to look at the net effects of so-called take-back programs. The new evidence suggests that discarding unused drugs in the trash is a better option to limit the risk of poisoning and at the same time curb pollution of both water
and air. </span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">To arrive at this conclusion, the researchers compared the total emissions created by take-back, trash and toilet disposal methods. This included emissions
of pharmaceutical active ingredients as well as releases of other water and air pollutants. "National policy seems to be changing to support take-back programs, and we don't know if that's justified," said Sherri Cook, a doctoral student in the U-M Department
of Civil and Environmental Engineering. Cook is first author of a paper on the findings published in Environmental Science & Technology.
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">U.S. households accumulate an estimated 200 million pounds of unused pharmaceuticals every year, the researchers say. In most cases today, the FDA recommends
throwing them away, but only if you don't have access to a take-back program. Cities, states and even some stores have initiated them. From collection sites, the returned drugs are transferred to another facility where they're incinerated as hazardous waste.
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">Health officials caution that unused pills should be out of the house as soon as possible to prevent poisoning and drug abuse by other family members. But
that need must be balanced with pollution control, both for human health and environmental reasons. Flushing unused pills down the toilet is no longer advised, as the active ingredients in drugs have been found in drinking water and aquatic environments.
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">The new study found:
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">* If half of people threw away unused medications and half took them back to the drug store, the amount of active pharmaceutical ingredients in the
environment would be reduced by 93 percent compared with today. </span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">* If everyone trashed their extra drugs, those amounts would be reduced by 88 percent.
</span><span style="color:black"><br>
</span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">* That 5 percent improvement in pharmaceutical emission reduction due to take-back programs would come at a significant cost, possibly more than a billion dollars annually,
along with a 300 percent increase in other emissions such as greenhouse gases and smog-forming substances.
</span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">"Nobody has ever added up all the emissions associated with disposing of medication," said Steve Skerlos, a professor in the departments of Mechanical Engineering
and Civil and Environmental Engineering and a co-author of the study. "When you look at the available evidence to support take-back, it just doesn't add up." The researchers focused on a 50 percent take-back compliance rate based on actual practice in Sweden,
which has had a national take-back program for 40 years. The compliance rate there is just 43 percent. Drugs that aren't returned tend to stay in the medicine cabinet, defeating the goal of getting unused medications out of the home quickly, the researchers
say. </span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">The U-M researchers considered a wide range of factors, including how often people would return medication, how far they live from take-back sites, how rainfall
might affect landfill leachate leaking into groundwater, and what percentage of residents could be expected to comply. The results surprised the team. "We didn't expect that landfilling would be the best option, because when you incinerate something, it's
gone, and when it's in a landfill, it can remain for some time," said Nancy Love, a professor in the Department of Civil and Environmental Engineering and a co-author of the study. "However, once we considered all the environmental emissions for the three
options, the results made sense." </span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">The researchers encourage policymakers to focus on getting more people to get rid of medicines by trash, rather than take-back. "Trashing unused medications
reduces the consumer's inconvenience relative to take-back, and if there is a clear message perhaps we could increase the percentage of people putting them in the trash," Cook said. Currently, about 60 percent of people already use trash disposal, while 40
percent of people still flush unused medication down the toilet. When discarding pills in the trash, the FDA recommends mixing them with an unpalatable substance such as coffee grounds in a plastic bag. This helps to deter would-be abusers from picking them
out of the garbage. </span><span style="color:black"><o:p></o:p></span></p>
<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">References:</span><span style="color:black">
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</span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">The paper is titled, "Life Cycle Comparison of Environmental Emissions from Three Disposal Options for Unused Pharmaceuticals."
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<p style="margin-left:.5in"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">University of Michigan <</span><span style="color:black"><a href="http://www.umich.edu/" target="_blank"><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">http://www.umich.edu/</span></a></span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:black">>
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<p style="margin-left:.5in"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Donna Lotzer, Senior Clinical Pharmacist</span></b><span style="color:black">
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Poison Education Coordinator</span></b><span style="color:black">
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">University of WI Hospital & Clinics</span></b><span style="color:black">
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Poison Prevention & Education Center</span></b><span style="color:black">
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">600 Highland Avenue, MC # 9475</span></b><span style="color:black">
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Madison, WI 53792</span></b><span style="color:black">
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<a href="mailto:dlotzer@uwhealth.org" target="_blank"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif"">dlotzer@uwhealth.org</span></b></a>
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</span><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Phone: 608-265-8160</span></b><span style="color:black">
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