Wanda Sykes has undergone a double mastectomy after being diagnosed with breast cancer earlier this year.

In an interview on The Ellen DeGeneres Show set to air Monday, the comedian reveals for the first time that she found out she had breast cancer in February when she went in for a breast reduction.

Check out all the familiar faces returning to TV this year

“I had real big boobs and I just got tired of knocking over stuff. Every time I eat — oh, Lord. I’d carry a Tide stick everywhere I go. My back …

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Other Links From TVGuide.com

• Wanda Sykes
• Ellen DeGeneres Show

Laurie Metcalf and her husband and Roseanne co-star Matt Roth are divorcing after six years of marriage, People reports.

Roth filed papers on Sept. 12, citing “irreconcilable differences,” and requested joint physical and legal custody of their children, Will, 17, Donovan, 11, and Mae, 6. He also listed the date of separation as November 2008.

Check out all the familiar faces returning to TV this year

Metcalf and Roth met on …

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• Roseanne
• Jeff Perry
• Laurie Metcalf
• Matt Roth
• The Big Bang Theory

Cheers to Michael K. Williams for a double shot of high-caliber roles.

Read More >

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• The Wire
• John Goodman
• Michael K. Williams
• David Simon
• Isiah Whitlock Jr.
• Dan Harmon
• Community
• Treme
• Boardwalk Empire
• Cedar Rapids

Have you ever wanted to love someone, but everything they do turns you off?

Meet Whitney.

Read More >

Other Links From TVGuide.com

• Whitney Cummings
• 2 Broke Girls
• Whitney

TRENTON, N.J. (AP) — A severe shortage of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy life-saving medications from secondary suppliers at huge markups because they can’t get them any other way.

An Associated Press review of industry reports and interviews with nearly two dozen experts found at least 15 deaths in the past 15 months blamed on the shortages, either because the right drug wasn’t available or because of dosing errors or other problems in administering or preparing alternative medications.

The shortages, mainly involving widely-used generic injected drugs that ordinarily are cheap, have been delaying surgeries and cancer treatments, leaving patients in unnecessary pain and forcing hospitals to give less effective treatments. That’s resulted in complications and longer hospital stays.

Just over half of the 549 U.S. hospitals responding to a survey this summer by the Institute for Safe Medication Practices, a patient safety group, said they had purchased one or more prescription drugs from so-called “gray market vendors”— companies other than their normal wholesalers. Most also said they’ve had to do so more often of late, and 7 percent reported side effects or other problems.

Hospital pharmacists “are really looking at this as a crisis. They are scrambling to find drugs,” said Joseph Hill of the American Society of Health-System Pharmacists.

A hearing on the issue was set for Friday before the health subcommittee of the House Energy and Commerce Committee. The Food and Drug Administration is holding a meeting Monday with medical and consumer groups, researchers and industry representatives to discuss the shortages and strategies to fight them.

The FDA says the primary cause of the shortages is production shutdowns because of manufacturing problems, such as contamination and metal particles that get into medicine.

Other reasons:

— Companies abandoning the injected generic drug market because the profit margins are slim. Producing these sterile medicines is far more complicated and expensive than stamping out pills, and it can take about three weeks to produce a batch. Making things worse, companies don’t have to notify customers or the FDA that they’ve stopped making a medicine. That means neither FDA nor competitors can fill the gap in time.

— Only a half-dozen companies make the vast majority of injected generics. Even if other companies wanted to begin making a generic drug in short supply, they’re discouraged by the lengthy, expensive process of setting up new manufacturing lines and getting FDA approval.

— Theft of prescription drugs from warehouses or during shipment.

— Secondary, “gray market” vendors who buy scarce drugs from small regional wholesalers, pharmacies or other sources and then market them to hospitals, often at many times the normal price. These sellers may not be licensed, authorized distributors.

Hospitals that buy scarce medicines from the “gray market” are taking a gamble.

The drugs may be stolen and hospitals can’t always tell whether a medicine was properly refrigerated — as required for many injectable drugs — or whether it’s past the expiration date, said Michael R. Cohen, a pharmacist and president of the institute. Either way, the active ingredient might have degraded and the drug might not work well or could harm the patient, he said.

Cohen attributes at least 15 recent deaths to drug shortages based on reports by medical personnel, but says many deaths and injuries go unreported.

In the worst known case, Alabama’s public health department this spring reported nine deaths and 10 patients harmed due to bacterial contamination of a hand-mixed batch of liquid nutrition given via feeding tubes because the sterile pre-mixed liquid wasn’t available.

So far this year, 210 drugs have been added to the list of drugs in short supply, one less than the total for all of last year, according to the University of Utah Drug Information Service, which tracks the shortages. That’s triple the roughly 70 a year from 2003 to 2006, when shortages began to climb steadily.

“The shortages aren’t resolving. They’re piling up on top of existing ones,” said Erin Fox, a pharmacist who manages the service. She said at least 55 drugs from shortages before this year are still unavailable or scarce.

The average price markup on drugs sold by secondary distributors was 650 percent, according to an Aug. 16 report by the Premier Healthcare Alliance, a group that helps U.S. hospitals and other health providers improve their patient care and finances. The report is based on an analysis of 636 unsolicited sales offers that were faxed and emailed to hospitals from secondary distributors in April and May.

Virtually every offer was for at least double the normal price, the survey found. The drugs with the highest markups were for critically ill patients needing anesthesia or other medicines for surgery or for emergency care, cancer, infectious diseases and pain management.

In an extreme case, one vendor was offering a generic drug for dangerously high blood pressure, normally priced at $25.90 per dose, for $1,200.

So far, hospitals have been absorbing the extra costs, but they’ll soon have to start passing them on to insurers and patients, according to the American Hospital Association.

Hospitals sometimes have to cave in to save patients, according to Cohen and several hospital pharmacy directors.

The FDA says it must uphold quality standards but also works hard to prevent shortages.

“When FDA detects a contaminant, whether it be shards of glass or metal particles or an infectious agent, we have to take action to protect the public,” said Dr. Peter Lurie, a senior adviser in the FDA commissioner’s office.

When such problems force a company to shut down production, the FDA urges other manufacturers to boost their output and expedites any approvals needed, said Valerie Jensen, associate director of FDA’s drug shortage program. When raw materials used to make drugs are in short supply, the FDA tries to find new sources.

The agency averted 38 shortages last year, Jensen added.

Legislation pending in the House and Senate would increase penalties for drug thefts from warehouses and tractor-trailers. Another proposal, which has bipartisan support, would require drug manufacturers anticipating a shortage to immediately notify the FDA.

Sen. Amy Klobuchar, D.-Minn., the primary sponsor of the Senate version of the notification bill, said other solutions being considered include better tracking of medicine shipments, mandatory accreditation of distributors, stockpiling of key drugs and allowing routine imports of prescription drugs from countries such as Canada.

Distributors that supply about 90 percent of prescription drugs to hospitals buy direct from drug manufacturers and deliver only to customers with appropriate licenses, said John Parker, a spokesman for the Healthcare Distribution Management Association. He said HDMA members don’t participate in the “gray market” but would not comment further.

The pitches hospitals get from the secondary distributors generally say they have small batches of specific drugs that are hard or impossible to find. “Are you enjoying this crazy ‘roller coaster ride’ of pharmaceutical shortages? … I utilize over 60 vendors to locate and procure needed pharmaceuticals to assist when you have shortage needs,” one reads.

Several distributors who sent hospitals solicitations for scarce drugs didn’t return calls from the AP. One representative said he wasn’t authorized to discuss the issue.

One company, Novis Pharmaceuticals, defended the higher prices, saying secondary distributors have to charge far more because they don’t get the big rebates manufacturers give primary distributors. They also have high costs to locate and transport batches of scarce drugs, although the company, which mainly distributes blood plasma, would not disclose its profit margin.

It’s illegal for companies to create a monopoly or collude to create a medicine shortage and raise prices, but there’s no evidence of that. There’s no federal law against price-gouging on prescription drugs, according to the FDA, but it does urge pharmacists to report cases to its Office of Criminal Investigation. An agency spokeswoman said she could not discuss whether any cases are being investigated.

The top three wholesalers say they try to alleviate problems by working with drug manufacturers, updating hospitals on shortages and rationing scarce supplies by giving their regular hospital customers a portion of their normal order. McKesson Corp. and Cardinal Health Inc. say they halt sales to any smaller distributors found to be diverting drugs or otherwise breaking rules. AmerisourceBergen Corp. does background checks on customers.

The hospital association and other groups urge hospitals not to buy from unaccredited vendors, to insist on documentation of the drug’s source if they must, and to report price gouging to state authorities. But only three states — Kentucky, Maine and Texas — have price-gouging laws that specifically cover medicines.

“Something has to be done here,” said pharmacist Michael O’Neal, head of drug procurement for Vanderbilt University Medical Center in Nashville, which has had to purchase medicines from secondary suppliers about 70 times over the past two years.

“This is unethical,” he said. “We’re talking about people’s lives.”

____

Summary of state price-gouging laws: http://www.ncsl.org/default.aspx?tabid=14434

Institute for Safe Medication Practices consumer site: http://www.consumermedsafety.org/

Associated Press

LONDON (AP) — A lawyer for many of Britain’s phone hacking victims said Friday that legal action would be launched in the United States against Rupert Murdoch’s News Corp.

Mark Lewis told The Associated Press that lawyers in the United States would be pursuing the case within the next week.

In a brief telephone interview he said that he had hired Norman Siegel, who represents the families of many of those killed on Sept. 11, 2001, to take on News Corp. in the United States.

Lewis said that the case would be contested in New York.

In an earlier interview with Sky News television, Lewis said that he expected that “the first hearings will be in the next two to three months.”

Associated Press

UNITED NATIONS (AP) — Defying U.S. and Israeli opposition, Palestinians asked the United Nations on Friday to accept them as a member state, sidestepping nearly two decades of troubled negotiations in the hope this dramatic move on the world stage would reenergize their quest for an independent homeland.

In the West Bank, the core of that hoped-for state, a Palestinian man was shot dead in a clash with Israeli soldiers and settlers as antagonisms flared over the statehood bid.

Earlier in the week, Palestinian President Mahmoud Abbas rebuffed an intense, U.S.-led effort to sway him from the statehood bid, saying he would submit the application to U.N. chief Ban Ki-moon as planned.

“We’re going without any hesitation and continuing despite all the pressures,” Abbas told members of the Palestinian diaspora at a hotel in New York on Thursday night. “We seek to achieve our right and we want our independent state.” Shortly before noon on Friday, Ban’s spokesman tweeted, “President Abbas just handed the Palestinian application to the Secretary-General UNSG.”

In his letter to Ban accompanying the application, Abbas asked the U.N. chief to immediately forward the request for full U.N. membership to the Security Council and the General Assembly, according to a top aide, who spoke on condition of anonymity before the documents were submitted. The General Assembly will likely be asked to approve a more modest status upgrade if the bid in the council founders as expected.

Palestinian officials said they were not authorized to release copies of the document until Ban delivers it to the Security Council at an unspecified time.

To be sure, Abbas’ appeal to the U.N. to recognize Palestinian independence in the West Bank, east Jerusalem and Gaza Strip would not deliver any immediate changes on the ground: Israel would remain an occupying force in those first two territories and continue to severely restrict access to Gaza, ruled by Palestinian Hamas militants.

Beyond that, Security Council action on the membership request could take weeks or months.

The strategy also put the Palestinians in direct confrontation with the U.S., which has threatened to veto their membership bid in the Council, reasoning, like Israel, that statehood can only be achieved through direct negotiations between the parties to end the long and bloody conflict.

Also hanging heavy in the air was the threat of renewed violence over frustrated Palestinian aspirations, in spite of Abbas’ vow — perceived by Israeli security officials as genuine — to prevent Palestinian violence. The death on Friday of 35-year-old Issam Badram, in gunfire that erupted after rampaging Jewish settlers destroyed trees in a Palestinian grove, was the type of incident that both Palestinians and Israelis had feared would spark widespread violence. There were three other incidents of small-scale unrest, but most of the West Bank was quiet.

Yet by seeking approval at a world forum overwhelmingly sympathetic to their quest, Palestinians hope to make it harder for Israel to resist already heavy global pressure to negotiate the borders of a future Palestine based on lines Israel held before capturing the West Bank, east Jerusalem and Gaza in 1967.

In recent weeks, international mediators have been furiously trying to piece together a formula that would let the Palestinians abandon their plan to ask the Security Council for full U.N. membership, and instead make do with asking a sympathetic General Assembly to elevate their status from permanent observer to nonmember observer state. The other part of that formula would include the resumption of negotiations in short order.

The U.S. and Israel have been pressuring Council members to either vote against the plan or abstain when it comes up for a vote. The vote would require the support of nine of the Council’s 15 members to pass, but even if the Palestinians could line up that backing, a U.S. veto is assured.

The resumption of talks seems an elusive goal, with both sides digging in to positions that have tripped up negotiations for years. Israel insists that negotiations go ahead without any preconditions. But Palestinians say they will not return to the bargaining table without assurances that Israel would halt settlement building and drop its opposition to basing negotiations on the borders it held before capturing the West Bank, east Jerusalem and the Gaza in 1967.

Israel has warned that the Palestinian appeal to the U.N. will have a disastrous effect on negotiations, which have been the cornerstone of international Mideast policy for the past two decades. Netanyahu, who is to address the General Assembly later Friday, shortly after Abbas makes his own address, opposes negotiations based on 1967 lines, saying a return to those frontiers would expose Israel’s heartland to rocket fire from the West Bank.

He also fears that if that principle becomes the baseline for negotiations, then Palestinians won’t settle for anything less, despite previous understandings between the Palestinians and previous Israeli governments to swap land where settlement blocs stand for Israeli territory.

Talks for all intents and purposes broke down nearly three years ago after Israel went to war in the Gaza Strip and prepared to hold national elections that ultimately propelled Netanyahu to power for a second time. A last round was launched a year ago, with the ambitious aim of producing a framework accord for a peace deal, but broke down just three weeks later after an Israeli settlement construction slowdown expired.

Quartet envoy Tony Blair cautioned that the move at the U.N. must be followed by negotiations.

“You can pass whatever resolution you like at the United Nations, or at the Security Council, and it doesn’t actually deliver you a state,” Blair told BBC Radio. “And if you don’t have a negotiation, whatever you do at the U.N. is going to be deeply confrontational.”

The U.N. recognition bid has won Abbas broad popular support at home, but it is opposed by his main political rival, the Islamic militant Hamas movement that violently wrested control of Gaza in 2007.

Gaza’s Hamas prime minister, Ismail Haniyeh, accused Abbas on Friday of relinquishing Palestinian rights by seeking recognition for a state in the pre-1967 borders. Hamas’ founding charter calls for the destruction of Israel and a state in all of the territory between the Mediterranean and the Jordan River, though some Hamas officials have suggested they would support a peace deal based on the 1967 lines.

“The Palestinian people do not beg the world for a state, and the state can’t be created through decisions and initiatives,” Haniyeh said. “States liberate their land first and then the political body can be established.”

_____

AP correspondent Tarek el-Tablawy contributed to this report from the United Nations.

Associated Press

UNITED NATIONS (AP) — Defying U.S. and Israeli opposition, Palestinians were determined to ask the United Nations on Friday to accept them as a member state, sidestepping nearly two decades of troubled negotiations in the hope this dramatic move on the world stage would reenergize their quest for an independent homeland.

In the West Bank, the core of that hoped-for state, a Palestinian man was shot dead in a clash with Israeli soldiers and settlers as antagonisms flared over the statehood bid.

Earlier in the week, Palestinian President Mahmoud Abbas rebuffed an intense, U.S.-led effort to sway him from the statehood bid, saying he would submit the application to U.N. chief Ban Ki-moon as planned.

A top aide, speaking on condition of anonymity in order to discuss the move, said in a letter to Ban accompanying the application, Abbas asks the U.N. chief to immediately send on the request for full U.N. membership to the Security Council and the General Assembly, which is likely to be asked to approve a more modest status upgrade if the bid in the Council founders as expected.

“We’re going without any hesitation and continuing despite all the pressures,” Abbas told members of the Palestinian diaspora at a hotel in New York on Thursday night. “We seek to achieve our right and we want our independent state.”

To be sure, Abbas’ appeal to the U.N. to recognize Palestinian independence in the West Bank, east Jerusalem and Gaza Strip would not deliver any immediate changes on the ground: Israel would remain an occupying force in those first two territories and continue to severely restrict access to Gaza, ruled by Palestinian Hamas militants.

Beyond that, Security Council action on the membership request could take weeks or months.

The strategy also put the Palestinians in direct confrontation with the U.S., which has threatened to veto their membership bid in the Council, reasoning, like Israel, that statehood can only be achieved through direct negotiations between the parties to end the long and bloody conflict.

Also hanging heavy in the air was the threat of renewed violence over frustrated Palestinian aspirations, in spite of Abbas’ vow — perceived by Israeli security officials as genuine — to prevent Palestinian violence. The death on Friday of 35-year-old Issam Badram, in gunfire that erupted after rampaging Jewish settlers destroyed trees in a Palestinian grove, was the type of incident that both Palestinains and Israelis had feared within this volatile diplomatic context, worried that it would touch off more widespread violence.

Yet by seeking approval at a world forum overwhelmingly sympathetic to their quest, Palestinians hope to make it harder for Israel to resist already heavy global pressure to negotiate the borders of a future Palestine based on lines Israel held before capturing the West Bank, east Jerusalem and Gaza in 1967.

In recent weeks, international mediators have been furiously trying to piece together a formula that would let the Palestinians abandon their plan to ask the Security Council for full U.N. membership, and instead make do with asking a sympathetic General Assembly to elevate their status from permanent observer to nonmember observer state. The other part of that formula would include the resumption of negotiations in short order.

The U.S. and Israel have been pressuring Council members to either vote against the plan or abstain when it comes up for a vote. The vote would require the support of nine of the Council’s 15 members to pass, but even if the Palestinians could line up that backing, a U.S. veto is assured.

Prime Minister Pedro Passos Coelho of Portugal, a Security Council member, met with Israeli Prime Minister Benjamin Netanyahu in New York last night. Afterward, he said his country wouldn’t take a position on the statehood bid until the Quartet of Mideast mediators — the U.S., European Union, United Nations and Russia — concluded their efforts to find a formula to get talks moving again.

The resumption of talks seems an elusive goal, with both sides digging in to positions that have tripped up negotiations for years. Israel insists that negotiations go ahead without any preconditions. But Palestinians say they will not return to the bargaining table without assurances that Israel would halt settlement building and drop its opposition to basing negotiations on the borders it held before capturing the West Bank, east Jerusalem and the Gaza in 1967.

Israel has warned that the Palestinian appeal to the U.N. will have a disastrous effect on negotiations, which have been the cornerstone of international Mideast policy for the past two decades. Netanyahu, who is to address the General Assembly later Friday, shortly after Abbas makes his own address, opposes negotiations based on 1967 lines, saying a return to those frontiers would expose Israel’s heartland to rocket fire from the West Bank.

He also fears that if that principle becomes the baseline for negotiations, then Palestinians won’t settle for anything less, despite previous understandings between the Palestinians and previous Israeli governments to swap land where settlement blocs stand for Israeli territory.

Talks for all intents and purposes broke down nearly three years ago after Israel went to war in the Gaza Strip and prepared to hold national elections that ultimately propelled Netanyahu to power for a second time. A last round was launched a year ago, with the ambitious aim of producing a framework accord for a peace deal, but broke down just three weeks later after an Israeli settlement construction slowdown expired.

Palestinians say they turned to the U.N. in desperation over 18 failed years of peace talks. But Israelis say the Palestinians are to blame for their own predicament and accuse them of going to the United Nations precisely to avoid talks.

Quartet envoy Tony Blair cautioned that the move at the U.N. must be followed by negotiations.

“You can pass whatever resolution you like at the United Nations, or at the Security Council, and it doesn’t actually deliver you a state,” Blair told BBC Radio. “And if you don’t have a negotiation, whatever you do at the U.N. is going to be deeply confrontational.”

Associated Press

U.S. stocks are falling as recession fears and global selling take them to new yearly lows.

Shares were on track for their fifth straight day of declines and their worst weekly losses since 2008.

Finance ministers from of the world’s leading economies pledged early Friday to take whatever steps are necessary to calm the markets. The statement did little to stem the selling.

Markets and Asia and Europe fell early Friday. Moody’s downgraded eight Greek banks over rising concerns about a possible Greek default. That would threaten banks that hold billions in Greek debt.

At 9:35 a.m. Eastern time, the S&P 500 was down 3 points, or 0.2 percent, at 1,127. The Dow was down 36, or 0.3 percent, at 10,698. The Nasdaq was down 2, or 0.1 percent, at 2,454.

Associated Press

U.S. stock futures dropped Friday as spreading recession fears power a global sell-off in all investments that carry risk.

Markets in Asia closed sharply lower. The broad STOXX 50 index of European shares was down 1 percent. U.S. markets have fallen for four straight sessions, driving the Standard & Poor’s 500 index down more than 7 percent this week.

Treasury yields remain near record lows as traders amass lower-risk bets. Demand for Treasurys drives their prices higher and their yields lower.

At 8:40 a.m. Eastern time, S&P 500 futures fell 14, or 1.3 percent, to 1,109. Dow Jones industrial average futures lost 120, or 1.1 percent, to 10,530. Nasdaq 100 futures slid 26, or 1.2 percent, to 2,149.

Finance ministers from 20 leading economies pledged late Thursday to take “all necessary actions to preserve the stability of the banking systems and financial markets” and make sure banks have the cash they need to stay afloat.

The announcement offered no new specifics, and did little to stem the selling. London’s FTSE 100 fell 1.2 percent, Germany’s Dax lost 2.1 and France’s CAC 40 dropped 1.8.

The Dow Jones industrial average has dropped 6.7 percent this week, its worst showing since the week ended Oct. 3, 2008. That’s the week Congress struggled to pass the $700 billion bank bailout known as the Troubled Asset Relief Program.

Fears about Europe’s debt crisis were stoked early Friday by news that Moody’s Investors Service had downgraded eight Greek banks by two notches. The rating agency said the banks hold too much Greek debt. It said Greece’s economic situation is worsening as government attempts to slash spending provoke violent protests.

The agency said the outlook for the banks’ long-term deposit and debt ratings was negative.

Greece appears increasingly likely to default on its debts. European officials have begun to speak openly of the possibility, and the fears have roiled international markets.

Greece will run out of money in the coming weeks if it fails to convince lenders it is meeting cost-cutting goals and deserves another round of bailout money.

A default by Greece would hurt banks in Greece, France and Germany that hold billions in Greek debt. Their holdings would lose value quickly, eroding the financial cushions banks keep to absorb unexpected losses.

A default would also increase investors’ concerns about defaults by other financially-troubled nations, such as Ireland, Portugal, Italy and Spain. If investors dumped bonds issued by those governments, their borrowing costs would spike. Investors fear a cascade of defaults akin to the global credit freeze after the 2008 bankruptcy of investment bank Lehman Brothers.

Europe’s economy is barely growing. A financial shock could tip Europe into recession, and would increase chances for a U.S. recession.

Companies that produce commodities lost value in premarket trading. Products such as silver, fossil fuels and industrial metals would lose value if economic growth slowed.

Silver lost 9.6 percent on Thursday. About half of demand for the metal comes from industrial users. Benchmark crude oil fell 6.3 percent, extending its 29-percent drop since April.

Traders sold precious metals to raise cash during Thursday’s plunge. Gold fell 3.7 percent on Thursday.

In premarket trading, Freeport-McMoRan Copper & Gold lost 4.8 percent. Cabot Oil & Gas Corp. fell 3.4, and Cliffs Natural Resources Inc. declined 3.2.

Traders dumped other investments that are more valuable in a growing economy, such as oil and raw materials. Benchmark crude fell 6.3 percent. It has dropped 29 percent since April as growth slowed.

The commodity sell-off continued on Friday. Crude oil fell 2.6 percent, gold 2.6 and silver 10.4.

Associated Press

SANAA, Yemen (AP) — Yemen’s President Ali Abdullah Saleh has called for a cease-fire after returning to the country, saying the only way out of the crisis is through negotiations.

The statement from Saleh’s office was the first message since his surprise return on Friday to the country from Saudi Arabia, where he has been for more than three months. Saleh was recovering from wounds sustained in a rocket attack on his compound in Sanaa.

In the message, Saleh is also urging political and military figures to a truce. He insists there is no way out of the crisis except through negotiations and talks to end the bloodshed.

Yemen’s turmoil escalated this week with fighting between Saleh loyalists and opponents, leaving nearly 100 killed.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP’s earlier story is below.

SANAA, Yemen (AP) — President Ali Abdullah Saleh returned Friday to the violence-torn Yemeni capital after more than three months of medical treatment in Saudi Arabia in a surprise move certain to further enflame battles between forces loyal to him and his opponents.

Saleh left Yemen for Saudi Arabia in early June after he was seriously injured in a rocket attack on his presidential compound in the capital Sanaa. His departure fueled hopes that he would be forced to step down, but instead he staunchly refused to resign, frustrating protesters who have been taking to the streets nearly daily since February demanding an end to his 33-year old rule.

Yemen slipped deeper into chaos during his absence, even as the United States and Saudi Arabia pushed him to hand over power. As time passed and Saleh recuperated, he was widely expected to stay in the kingdom.

The worst violence yet erupted this week with battles between Saleh loyalists and his armed opponents that have so far killed around 100 people, mostly protesters in Sanaa.

The elite Republican Guards, led by Saleh’s son Ahmed, have been engaged in street battles and exchanges of shelling over the city with army units that defected to the opposition and tribal fighters who support the protesters.

The fighting continued even after Saleh returned at dawn Friday. Heavy clashes and thuds of mortars were heard throughout the night in Sanaa and into morning hours. One person was killed overnight after mortars hit the square in central Sanaa where protesters demanding Saleh’s ouster have been camped out for months, a medical official said on condition of anonymity.

For the protest leaders, Saleh’s return bodes ill for the already explosive situation.

“His return means more divisions, more escalation and confrontations,” said Abdel-Hadi al-Azazi, a protest leader, told The Associated Press. “We are on a very critical escalation.”

By noon, thousands of Saleh supporters and rivals poured into the streets for parallel rallies in different parts of Sanaa as fighting subsided. The rallies revolved around Friday prayers and also included funeral ceremonies for those from each side killed in the clashes.

Reflecting Yemen’s widening rift. each side blamed the other for igniting the latest violence.

At the pro-Saleh rally along Boulevard 70 in southern Sanaa, sermon leaders accused the opposition of attempting a coup and warned against civil war. Saleh’s supporters carried his pictures along with those of the Saudi king in a tribute to the neighboring country where Saleh was recovering. Some chanted, “We love you, Ali.”

At the opposition rally on Boulevard 60, demonstrators carried pictures of those killed in the violence as speakers urged security forces to stop killing their own people.

The United States and Saudi Arabia have been trying to dissuade Saleh from returning home in hopes of working out a peaceful handover of power in the impoverished, deeply divided country where both have strong strategic interests.

Washington in particular wants a stable regime in Yemen to fight al-Qaida’s branch in the country, seen as the most active offshoot of the terror network after it plotted several attacks on American soil in recent years. Al-Qaida-linked Islamic militants have already taken advantage of Yemen’s turmoil, seizing control of several towns in the near-lawless south.

Saleh was severely burned and suffered other injuries when an explosion went off in a mosque where he was praying in his Sanaa presidential compound on June 3.

From the moment he was rushed to Saudi Arabia for treatment, he and his allies insisted his absence was temporary and that he would return to continue his rule. But even some Yemeni officials had recently predicted he would stay in Saudi Arabia — and the timing of his return Friday was a surprise.

Yemeni TV announced his return Friday morning, but did not show any footage of him. It aired old footage of Saleh at public events along with images of fireworks and patriotic songs, accompanied by a scroll from the Interior Ministry, urging citizens not to fire celebratory gunfire in the air in their joy over Saleh’s return because the shooting was dangerous.

“So long as you are well, we are all well. Yemen is well,” one song ran.

The TV report said Saleh was in good health. Officials in his office confirmed that he had returned on a private plane. The U.S. and Saudi Arabia have been trying to persuade Saleh to sign onto a deal proposed by Gulf Arab states, under which he would resign and hand power to his vice president to form a national unity government in return for immunity from any prosecution.

The mercurial Saleh has repeated promised to sign the agreement, then refused at the last minute.

The latest violence erupted after he recently delegated his vice president to restart negotiations with opponents on the deal. It was considered another stalling tactic by Saleh, and it was followed by a violent crackdown on protesters in Sanaa and other cities.

The fighting this week has been centered between the forces of Saleh’s son Ahmed and the military units of Maj. Gen. Ali Mohsen al-Ahmar, a longtime ally of the president who defected early on in the uprising and sided with the opposition. Many believe al-Ahmar is himself seeking power and he is distrusted by many in the protest movement who believe he would continue an authoritarian regime similar to Saleh’s.

Yemen’s turmoil began in February as the unrest spreading throughout the Arab world set off largely peaceful protests in this deeply unstable corner of the Arabian Peninsula. Saleh’s government responded with a heavy crackdown, with hundreds killed and thousands wounded so far.

Associated Press

SANAA, Yemen (AP) — President Ali Abdullah Saleh returned Friday to the violence-torn Yemeni capital after more than three months of medical treatment in Saudi Arabia in a surprise move certain to further enflame battles between forces loyal to him and his opponents.

Saleh left Yemen for Saudi Arabia in early June after he was seriously injured in a rocket attack on his presidential compound in the capital Sanaa. His departure fueled hopes that he would be forced to step down, but instead he staunchly refused to resign, frustrating protesters who have been taking to the streets nearly daily since February demanding an end to his 33-year old rule.

Yemen slipped deeper into chaos during his absence, even as the United States and Saudi Arabia pushed him to hand over power. The worst violence yet erupted this week with battles between Saleh loyalists and his armed opponents that have so far killed around 100 people, mostly protesters in Sanaa.

The elite Republican Guards, led by Saleh’s son Ahmed, have been engaged in street battles and exchanges of shelling over the city with army units that defected to the opposition and tribal fighters who support the protesters.

The fighting continued even after Saleh returned at dawn Friday. Heavy clashes and thuds of mortars were heard throughout the night in Sanaa and into morning hours. One person was killed overnight after mortars hit the square in central Sanaa where protesters demanding Sale’s ouster have been camped out for months, a medical official said on condition of anonymity.

For the protest leaders, Saleh’s return bodes ill for the already explosive situation.

“His return means more divisions, more escalation and confrontations,” said Abdel-Hadi al-Azizi, a protest leader, told The Associated Press. “We are on a very critical escalation.”

The anti-Saleh protesters have called for more rallies after Friday prayers, and a massive turnout is expected despite the latest bout of fighting.

The United States and Saudi Arabia have been trying to dissuade Saleh from returning home in hopes of working out a peaceful handover of power in the impoverished, deeply divided country where both have strong strategic interests.

Washington in particular wants a stable regime in Yemen to fight al-Qaida’s branch in the country, seen as the most active offshoot of the terror network after it plotted several attacks on American soil in recent years. Al-Qaida-linked Islamic militants have already taken advantage of Yemen’s turmoil, seizing control of several towns in the near-lawless south.

Saleh was severely burned and suffered other injuries when an explosion went off in a mosque where he was praying in his Sanaa presidential compound on June 3.

From the moment he was rushed to Saudi Arabia for treatment, he and his allies insisted his absence was temporary and that he would return to continue his rule. But even some Yemeni officials had recently predicted he would stay in Saudi Arabia — and the timing of his return Friday was a surprise.

Yemeni TV announced his return Friday morning, but did not show any footage of him. It aired old footage of Saleh at public events along with images of fireworks and patriotic songs, accompanied by a scroll from the Interior Ministry, urging citizens not to fire celebratory gunfire in the air in their joy over Saleh’s return because the shooting was dangerous.

“So long as you are well, we are all well. Yemen is well,” one song ran.

The TV report said Saleh was in good health. Officials in his office confirmed that he had returned on a private plane. The TV also said there would be a gathering of his Saleh’s supporters later in the day in Sanaa. It was unclear if Saleh would address that rally.

The U.S. and Saudi Arabia have been trying to persuade Saleh to sign onto a deal proposed by Gulf Arab states, under which he would resign and hand power to his vice president to form a national unity government in return for immunity from any prosecution.

The mercurial Saleh has repeated promised to sign the agreement, then refused at the last minute.

The latest violence erupted after he recently delegated his vice president to restart negotiations with opponents on the deal. It was considered another stalling tactic by Saleh, and it was followed by a violent crackdown on protesters in Sanaa and other cities.

The fighting this week has been centered between the forces of Saleh’s son Ahmed and the military units of Maj. Gen. Ali Mohsen al-Ahmar, a longtime ally of the president who defected early on in the uprising and sided with the opposition. Many believe al-Ahmar is himself seeking power and he is distrusted by many in the protest movement who believe he would continue an authoritarian regime similar to Saleh’s.

Yemen’s turmoil began in February as the unrest spreading throughout the Arab world set off largely peaceful protests in this deeply unstable corner of the Arabian Peninsula. Saleh’s government responded with a heavy crackdown, with hundreds killed and thousands wounded so far.

Associated Press

SANAA, Yemen (AP) — President Ali Abdullah Saleh made a surprise return to Yemen on Friday after more than three months of medical treatment in Saudi Arabia in a move certain to further enflame battles between forces loyal to him and his opponents that have turned the capital into a war zone.

Saleh immediately called for a cease-fire and said negotiations were the only way out of the crisis, his office said. The statement, however, suggested he does not intend to step down immediately and was likely to only anger protesters who have been demanding his ouster for months and the military units and armed tribal fighters that back the opposition.

“His return means more divisions, more escalation and confrontations,” said Abdel-Hadi al-Azazi, a protest leader, told The Associated Press. “We are on a very critical escalation.”

Saleh’s return to Yemen could further damage already crumbling efforts by the United States and Saudi Arabia to work out a peaceful handover of power. Washington is eager for some sort of post-Saleh stability in the strategically placed but deeply divided and impoverished nation in hopes of continuing an alliance against al-Qaida militants in Yemen — the terror network’s most active branch, blamed in several plots for attacks on U.S soil.

Both the U.S. and Saudi Arabia were believed to be trying to keep Saleh from leaving Saudi Arabia.

Saleh went to the kingdom for treatment after he was severely burned and wounded by a June 3 explosion at his presidential compound in the capital Sanaa. His departure fueled hopes that he would be forced to step down, but instead he staunchly refused to resign, frustrating protesters who have been taking to the streets nearly daily since February demanding an end to his 33-year old rule.

As time passed and Saleh recuperated, he was widely expected to stay in the kingdom — and the timing of his return Friday was a surprise.

The crackle of gunfire continued to be heard over Sanaa even after the president’s office issued the cease-fire call.

This week, the long deadlock that endured even during Saleh’s absence broke down into the worst violence in months as forces loyal to the president’s son attacked protesters in the streets and battled troops led by one of the regime’s top rivals, Maj. Gen. Ali Mohsen al-Ahmar, a former Saleh aide who joined the opposition early in the uprising.

Around 100 people have been killed the past week — mostly protesters as regime troops hit their gathering with shelling or barrages of sniper fire from rooftops. Residents have been forced to hunker down in their homes or flee the city as the two sides exchanged bombardment over Sanaa from strongholds in the surrounding hills.

The fighting continued even after Saleh returned at dawn Friday. Heavy clashes and thuds of mortars were heard throughout the night in Sanaa and into morning hours. One person was killed overnight after mortars hit the square in central Sanaa where protesters demanding Saleh’s ouster have been camped out for months, a medical official said on condition of anonymity.

By noon, thousands of Saleh supporters and opponents poured into the streets for parallel rallies in different parts of Sanaa during a lull in fighting. The rallies revolved around Friday prayers and also included funeral ceremonies for those from each side killed in the clashes.

Reflecting Yemen’s widening rift. each side blamed the other for igniting the latest violence.

At the pro-Saleh rally along Boulevard 70 in southern Sanaa, sermon leaders accused the opposition of attempting a coup and warned against civil war. Saleh’s supporters carried his pictures along with those of the Saudi king in a tribute to the neighboring country where Saleh was recovering. Some chanted, “We love you, Ali.”

At the opposition rally on Boulevard 60, demonstrators carried pictures of those killed in the violence as speakers urged security forces to stop killing their own people.

Yemeni TV announced his return Friday morning, but did not show any footage of him. It aired old footage of Saleh at public events along with images of fireworks and patriotic songs, accompanied by a scroll from the Interior Ministry, urging citizens not to fire celebratory gunfire in the air in their joy over Saleh’s return because the shooting was dangerous.

“So long as you are well, we are all well. Yemen is well,” one song ran.

The TV report said Saleh was in good health. Officials in his office confirmed that he had returned on a private plane. The U.S. and Saudi Arabia have been trying to persuade Saleh to sign onto a deal proposed by Gulf Arab states, under which he would resign and hand power to his vice president to form a national unity government in return for immunity from any prosecution.

The mercurial Saleh has repeated promised to sign the agreement, then refused at the last minute.

The latest violence erupted after he recently delegated his vice president to restart negotiations with opponents on the deal. It was considered another stalling tactic by Saleh, and it was followed by a violent crackdown on protesters in Sanaa and other cities.

Yemen’s turmoil began in February as the unrest spreading throughout the Arab world set off largely peaceful protests in this deeply unstable corner of the Arabian Peninsula. Saleh’s government responded with a heavy crackdown, with hundreds killed and thousands wounded so far.

Associated Press

Laugh if you want, but Carson Daly may have started the social TV movement way back in 1998 with MTV’s interactive call-in countdown show Total Request Live. Today, he hosts NBC’s fiercely social singing competition The Voice. (In between, he has hosted NBC’s late-late-night show Last Call with Carson Daly.) TRL and The Voice may feel miles apart on the music-show spectrum, but they’ve both contributed to the socialization of TV. We talked to Daly about his role in shaping TRL, adapting the Dutch formula for The Voice and the role of quality in social success…

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Peter Bishop never existed: True. Neither did what happened during the last three seasons of Fringe: False.

But where we last left off had many fans scratching their heads. After Peter (Joshua Jackson) built a bridge between the two universes in order to save billions of lives, he seemingly disappeared into thin air. The Observers noted that Peter had, in fact, never existed at all, a comment that caused just as much confusion as it did outrage among viewers.

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Supernatural returns for its seventh season Friday at 9/8c on The CW with two burning questions: What do you do when you become God? And what do you do when you’re the new God’s former best friends?

After ingesting all of the souls and their powers in Purgatory last season, Castiel (Misha Collins) declared himself the new God and demanded Sam and Dean Winchester (Jared Padalecki, Jensen Ackles) bow down before him … or die. Although the brothers have encountered and even defeated their share of demons, angels and other non-humans before, God is a different story.

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TRENTON, N.J. (AP) — A severe shortage of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy life-saving medications from secondary suppliers at huge markups because they can’t get them any other way.

An Associated Press review of industry reports and interviews with nearly two dozen experts found at least 15 deaths in the past 15 months blamed on the shortages, either because the right drug wasn’t available or because of dosing errors or other problems in administering or preparing alternative medications.

The shortages, mainly involving widely-used generic injected drugs that ordinarily are cheap, have been delaying surgeries and cancer treatments, leaving patients in unnecessary pain and forcing hospitals to give less effective treatments. That’s resulted in complications and longer hospital stays.

Just over half of the 549 U.S. hospitals responding to a survey this summer by the Institute for Safe Medication Practices, a patient safety group, said they had purchased one or more prescription drugs from so-called “gray market vendors”— companies other than their normal wholesalers. Most also said they’ve had to do so more often of late, and 7 percent reported side effects or other problems.

Hospital pharmacists “are really looking at this as a crisis. They are scrambling to find drugs,” said Joseph Hill of the American Society of Health-System Pharmacists.

A hearing on the issue was set for Friday before the health subcommittee of the House Energy and Commerce Committee. The Food and Drug Administration is holding a meeting Monday with medical and consumer groups, researchers and industry representatives to discuss the shortages and strategies to fight them.

The FDA says the primary cause of the shortages is production shutdowns because of manufacturing problems, such as contamination and metal particles that get into medicine.

Other reasons:

— Companies abandoning the injected generic drug market because the profit margins are slim. Producing these sterile medicines is far more complicated and expensive than stamping out pills, and it can take about three weeks to produce a batch. Making things worse, companies don’t have to notify customers or the FDA that they’ve stopped making a medicine. That means neither FDA nor competitors can try to fill the gap.

— Only a half-dozen companies make the vast majority of injected generics. Even if other companies wanted to begin making a generic drug in short supply, they’re discouraged by the lengthy, expensive process of setting up new manufacturing lines and getting FDA approval.

— Theft of prescription drugs from warehouses or during shipment.

— Secondary, “gray market” vendors who buy scarce drugs from small regional wholesalers, pharmacies or other sources and then market them to hospitals, often at many times the normal price. These sellers may not be licensed, authorized distributors.

Hospitals that buy scarce medicines from the “gray market” are taking a gamble.

The drugs may be stolen and hospitals can’t always tell whether a medicine was properly refrigerated — as required for many injectable drugs — or whether it’s past the expiration date, said Michael R. Cohen, a pharmacist and president of the institute. Either way, the active ingredient might have degraded and the drug might not work well or could harm the patient, he said.

Cohen attributes at least 15 recent deaths to drug shortages based on reports by medical personnel, but says many deaths and injuries go unreported.

In the worst known case, Alabama’s public health department this spring reported nine deaths and 10 patients harmed due to bacterial contamination of a hand-mixed batch of liquid nutrition given via feeding tubes because the sterile pre-mixed liquid wasn’t available.

So far this year, 210 drugs have been added to the list of drugs in short supply, one less than the total for all of last year, according to the University of Utah Drug Information Service, which tracks the shortages. That’s triple the roughly 70 a year from 2003 to 2006, when shortages began to climb steadily.

“The shortages aren’t resolving. They’re piling up on top of existing ones,” said Erin Fox, a pharmacist who manages the service. She said at least 55 drugs from shortages before this year are still unavailable or scarce.

The average price markup on drugs sold by secondary distributors was 650 percent, according to an Aug. 16 report by the Premier Healthcare Alliance, a group that helps U.S. hospitals and other health providers improve their patient care and finances. The report is based on an analysis of 636 unsolicited sales offers that were faxed and emailed to hospitals from secondary distributors in April and May.

Virtually every offer was for at least double the normal price, the survey found. The drugs with the highest markups were for critically ill patients needing anesthesia or other medicines for surgery or for emergency care, cancer, infectious diseases and pain management.

In an extreme case, one vendor was offering a generic drug for dangerously high blood pressure, normally priced at $25.90 per dose, for $1,200.

So far, hospitals have been absorbing the extra costs, but they’ll soon have to start passing them on to insurers and patients, according to the American Hospital Association.

Hospitals sometimes have to cave in to save patients, according to Cohen and several hospital pharmacy directors.

The FDA says it must uphold quality standards but also works hard to prevent shortages.

“When FDA detects a contaminant, whether it be shards of glass or metal particles or an infectious agent, we have to take action to protect the public,” said Dr. Peter Lurie, a senior adviser in the FDA commissioner’s office.

When the agency orders a production shutdown, it urges other manufacturers to boost their output and expedites any approvals needed, said Valerie Jensen, associate director of FDA’s drug shortage program. When raw materials used to make drugs are in short supply, the FDA tries to find new sources.

The agency averted 38 shortages last year, Jensen added.

Legislation pending in the House and Senate would increase penalties for drug thefts from warehouses and tractor-trailers. Another proposal, which has bipartisan support, would require drug manufacturers anticipating a shortage to immediately notify the FDA.

Sen. Amy Klobuchar, D.-Minn., the primary sponsor of the Senate version of the notification bill, said other solutions being considered include better tracking of medicine shipments, mandatory accreditation of distributors, stockpiling of key drugs and allowing routine imports of prescription drugs from countries such as Canada.

Distributors that supply about 90 percent of prescription drugs to hospitals buy direct from drug manufacturers and deliver only to customers with appropriate licenses, said John Parker, a spokesman for the Healthcare Distribution Management Association. He said HDMA members don’t participate in the “gray market” but would not comment further.

The pitches hospitals get from the secondary distributors generally say they have small batches of specific drugs that are hard or impossible to find. “Are you enjoying this crazy ‘roller coaster ride’ of pharmaceutical shortages? … I utilize over 60 vendors to locate and procure needed pharmaceuticals to assist when you have shortage needs,” one reads.

Several distributors who sent hospitals solicitations for scarce drugs didn’t return calls from the AP. One representative said he wasn’t authorized to discuss the issue.

One company, Novis Pharmaceuticals, defended the higher prices, saying secondary distributors have to charge far more because they don’t get the big rebates manufacturers give primary distributors. They also have high costs to locate and transport batches of scarce drugs, although the company, which mainly distributes blood plasma, would not disclose its profit margin.

It’s illegal for companies to create a monopoly or collude to create a medicine shortage and raise prices, and there’s no evidence of that. There’s no federal law against price-gouging on prescription drugs, according to the FDA, but it does urge pharmacists to report cases to its Office of Criminal Investigation. An agency spokeswoman said she could not discuss whether any cases are being investigated.

The top three wholesalers say they try to alleviate problems by working with drug manufacturers, updating hospitals on shortages and rationing scarce supplies by giving their regular hospital customers a portion of their normal order. McKesson Corp. and Cardinal Health Inc. say they halt sales to any smaller distributors found to be diverting drugs or otherwise breaking rules. AmerisourceBergen Corp. does background checks on customers.

The hospital association and other groups urge hospitals not to buy from unaccredited vendors, to insist on documentation of the drug’s source if they must, and to report price gouging to state authorities. But only three states — Kentucky, Maine and Texas — have price-gouging laws that specifically cover medicines.

“Something has to be done here,” said pharmacist Michael O’Neal, head of drug procurement for Vanderbilt University Medical Center in Nashville, which has had to purchase medicines from secondary suppliers about 70 times the past two years.

“This is unethical,” he said. “We’re talking about people’s lives.”

____

Summary of state price-gouging laws: http://www.ncsl.org/default.aspx?tabid=14434

Institute for Safe Medication Practices consumer site: http://www.consumermedsafety.org/

Associated Press

TRENTON, N.J. (AP) — A severe shortage of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy life-saving medications from secondary suppliers at huge markups because they can’t get them any other way.

An Associated Press review of industry reports and interviews with nearly two dozen experts found at least 15 deaths in the past 15 months blamed on the shortages, either because the right drug wasn’t available or because of dosing errors or other problems in administering or preparing alternative medications.

The shortages, mainly involving widely-used generic injected drugs that ordinarily are cheap, have been delaying surgeries and cancer treatments, leaving patients in unnecessary pain and forcing hospitals to give less effective treatments. That’s resulted in complications and longer hospital stays.

Just over half of the 549 U.S. hospitals responding to a survey this summer by the Institute for Safe Medication Practices, a patient safety group, said they had purchased one or more prescription drugs from so-called “gray market vendors”— companies other than their normal wholesalers. Most also said they’ve had to do so more often of late, and 7 percent reported side effects or other problems.

Hospital pharmacists “are really looking at this as a crisis. They are scrambling to find drugs,” said Joseph Hill of the American Society of Health-System Pharmacists.

A hearing on the issue was set for Friday before the health subcommittee of the House Energy and Commerce Committee. The Food and Drug Administration is holding a meeting Monday with medical and consumer groups, researchers and industry representatives to discuss the shortages and strategies to fight them.

The FDA says the primary cause of the shortages is production shutdowns because of manufacturing problems, such as contamination and metal particles that get into medicine.

Other reasons:

— Companies abandoning the injected generic drug market because the profit margins are slim. Producing these sterile medicines is far more complicated and expensive than stamping out pills, and it can take about three weeks to produce a batch. Making things worse, companies don’t have to notify customers or the FDA that they’ve stopped making a medicine. That means neither FDA nor competitors can try to fill the gap.

— Only a half-dozen companies make the vast majority of injected generics. Even if other companies wanted to begin making a generic drug in short supply, they’re discouraged by the lengthy, expensive process of setting up new manufacturing lines and getting FDA approval.

— Theft of prescription drugs from warehouses or during shipment.

— Secondary, “gray market” vendors who buy scarce drugs from small regional wholesalers, pharmacies or other sources and then market them to hospitals, often at many times the normal price. These sellers may not be licensed, authorized distributors.

Hospitals that buy scarce medicines from the “gray market” are taking a gamble.

The drugs may be stolen and hospitals can’t always tell whether a medicine was properly refrigerated — as required for many injectable drugs — or whether it’s past the expiration date, said Michael R. Cohen, a pharmacist and president of the institute. Either way, the active ingredient might have degraded and the drug might not work well or could harm the patient, he said.

Cohen attributes at least 15 recent deaths to drug shortages based on reports by medical personnel, but says many deaths and injuries go unreported.

In the worst known case, Alabama’s public health department this spring reported nine deaths and 10 patients harmed due to bacterial contamination of a hand-mixed batch of liquid nutrition given via feeding tubes because the sterile pre-mixed liquid wasn’t available.

So far this year, 210 drugs have been added to the list of drugs in short supply, one less than the total for all of last year, according to the University of Utah Drug Information Service, which tracks the shortages. That’s triple the roughly 70 a year from 2003 to 2006, when shortages began to climb steadily.

“The shortages aren’t resolving. They’re piling up on top of existing ones,” said Erin Fox, a pharmacist who manages the service. She said at least 55 drugs from shortages before this year are still unavailable or scarce.

The average price markup on drugs sold by secondary distributors was 650 percent, according to an Aug. 16 report by the Premier Healthcare Alliance, a group that helps U.S. hospitals and other health providers improve their patient care and finances. The report is based on an analysis of 636 unsolicited sales offers that were faxed and emailed to hospitals from secondary distributors in April and May.

Virtually every offer was for at least double the normal price, the survey found. The drugs with the highest markups were for critically ill patients needing anesthesia or other medicines for surgery or for emergency care, cancer, infectious diseases and pain management.

In an extreme case, one vendor was offering a generic drug for dangerously high blood pressure, normally priced at $25.90 per dose, for $1,200.

So far, hospitals have been absorbing the extra costs, but they’ll soon have to start passing them on to insurers and patients, according to the American Hospital Association.

Hospitals sometimes have to cave in to save patients, according to Cohen and several hospital pharmacy directors.

The FDA says it must uphold quality standards but also works hard to prevent shortages.

“When FDA detects a contaminant, whether it be shards of glass or metal particles or an infectious agent, we have to take action to protect the public,” said Dr. Peter Lurie, a senior adviser in the FDA commissioner’s office.

When the agency orders a production shutdown, it urges other manufacturers to boost their output and expedites any approvals needed, said Valerie Jensen, associate director of FDA’s drug shortage program. When raw materials used to make drugs are in short supply, the FDA tries to find new sources.

The agency averted 38 shortages last year, Jensen added.

Legislation pending in the House and Senate would increase penalties for drug thefts from warehouses and tractor-trailers. Another proposal, which has bipartisan support, would require drug manufacturers anticipating a shortage to immediately notify the FDA.

Sen. Amy Klobuchar, D.-Minn., the primary sponsor of the Senate version of the notification bill, said other solutions being considered include better tracking of medicine shipments, mandatory accreditation of distributors, stockpiling of key drugs and allowing routine imports of prescription drugs from countries such as Canada.

Distributors that supply about 90 percent of prescription drugs to hospitals buy direct from drug manufacturers and deliver only to customers with appropriate licenses, said John Parker, a spokesman for the Healthcare Distribution Management Association. He said HDMA members don’t participate in the “gray market” but would not comment further.

The pitches hospitals get from the secondary distributors generally say they have small batches of specific drugs that are hard or impossible to find. “Are you enjoying this crazy ‘roller coaster ride’ of pharmaceutical shortages? … I utilize over 60 vendors to locate and procure needed pharmaceuticals to assist when you have shortage needs,” one reads.

Several distributors who sent hospitals solicitations for scarce drugs didn’t return calls from the AP. One representative said he wasn’t authorized to discuss the issue.

One company, Novis Pharmaceuticals, defended the higher prices, saying secondary distributors have to charge far more because they don’t get the big rebates manufacturers give primary distributors. They also have high costs to locate and transport batches of scarce drugs, although the company, which mainly distributes blood plasma, would not disclose its profit margin.

It’s illegal for companies to create a monopoly or collude to create a medicine shortage and raise prices, and there’s no evidence of that. There’s no federal law against price-gouging on prescription drugs, according to the FDA, but it does urge pharmacists to report cases to its Office of Criminal Investigation. An agency spokeswoman said she could not discuss whether any cases are being investigated.

The top three wholesalers say they try to alleviate problems by working with drug manufacturers, updating hospitals on shortages and rationing scarce supplies by giving their regular hospital customers a portion of their normal order. McKesson Corp. and Cardinal Health Inc. say they halt sales to any smaller distributors found to be diverting drugs or otherwise breaking rules. AmerisourceBergen Corp. does background checks on customers.

The hospital association and other groups urge hospitals not to buy from unaccredited vendors, to insist on documentation of the drug’s source if they must, and to report price gouging to state authorities. But only three states — Kentucky, Maine and Texas — have price-gouging laws that specifically cover medicines.

“Something has to be done here,” said pharmacist Michael O’Neal, head of drug procurement for Vanderbilt University Medical Center in Nashville, which has had to purchase medicines from secondary suppliers about 70 times the past two years.

“This is unethical,” he said. “We’re talking about people’s lives.”

____

Summary of state price-gouging laws: http://www.ncsl.org/default.aspx?tabid=14434

Institute for Safe Medication Practices consumer site: http://www.consumermedsafety.org/

Associated Press