Do hospitals' freebies undermine breast-feeding? (AP)

CHICAGO � Jessica Ewald brought more than a new baby boy home when she gave birth earlier this year. Like many new moms, she got a hospital goody bag, with supplies including free infant formula and formula coupons.

"We gave it away the moment we came home because I said I'm not having that in our house," Ewald said.

Ewald, 32, of Oakbrook Terrace, Ill., is the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals. Ewald was taught early on that "breast is best," and even though as a teen she rolled her eyes when her mom asked pregnant women about nursing, Ewald knew she'd choose breast over bottle when her own time came.

Borrowing a line from a blogger, Ewald says hospitals sending newborns home with formula "is like giving somebody divorce papers at their wedding." It can really undermine a woman's determination to breast-feed, she said.

The head of the federal Centers for Disease Control and Prevention shares her concern.

"Hospitals need to greatly improve practices to support mothers who want to breast-feed," Dr. Thomas Frieden said last month in releasing a CDC report card on breast-feeding. It showed that less than 5 percent of U.S. infants are born in "baby-friendly" hospitals that fully support breast-feeding, and that 1 in 4 infants receive formula within hours of birth.

Routinely offering new moms free formula is among practices the CDC would like to end. In some cases, hospitals agree to give out those freebies in exchange for getting free supplies for special-needs infants, Frieden said.

Exactly how many U.S. hospitals hand out formula is unclear. The American Hospital Association and the International Formula Council, a trade group for formula makers, do not keep statistics and formula companies contacted for this story declined to comment.

A nationwide study of more than 3,000 U.S. hospitals and maternity centers published last year in the Journal of Human Lactation found that 91 percent sent new moms home with free formula in 2006-07. A smaller 2010 study of 1,239 hospitals suggests that the practice has decreased, although most � 72 percent � still offered formula. That study is being released Monday in October's Pediatrics.

"I don't think hospitals are the right place to market anything and I don't think hospitals should be marketing a product that is nutritionally inferior to breast milk," said study author Anne Merewood, an associate pediatrics professor at Boston University medical school and editor of the Journal of Human Lactation.

"People do think if a doctor gives something it must be good for you," Merewood said.

Some women and activists, though, say the move to end formula freebies is part of a breast-feeding movement that has gone too far, overstating the benefits and guilt-tripping new moms who have difficulty nursing or just choose not to. And even some breast-feeding moms don't have a problem with the free formula.

"I think it's fine to offer freebies to any mom, especially those who are undecided or have already made up their mind not to breast-feed. We are always free to refuse," said the Rev. Camille Lebron Powell, an associate Presbyterian pastor in Little Rock, Ark.

Breast milk contains antibodies that strengthen babies' immune systems and help them fight infections. Research has shown that breast-fed babies have reduced chances of becoming obese or developing diabetes in childhood, and sudden infant death syndrome is less common in breast-fed infants.

The American Academy of Pediatrics and other medical groups recommend that infants receive only breast milk for their first six months. The new CDC report shows that only 15 percent of new mothers achieve that goal, and only 44 percent of new moms breast-feed at all for six months.

Lebron Powell doesn't dispute the benefits and chose to breast-feed her children, aged 9 months and 4 years old. But she says those who choose to use formula shouldn't be demonized.

"Breast-feeding is free. It's good for the baby and it's good for the mom. But it's hard and if you work and the employer doesn't support your pumping needs, you are in trouble," she said.

Hospitals have been offering formula freebies for decades, but they have a new incentive to abandon the practice.

The Joint Commission hospital accrediting group last year added "exclusive breast milk feeding" during newborns' hospital stays as a measure that hospitals can be evaluated on. While formula giveaways won't be evaluated, the commission mentions monitoring that practice when it educates hospitals on how to improve their performance, said Celeste Milton, an associate project director at the commission.

The goal is to discourage hospitals from giving infants formula when it's not medically necessary, said commission spokeswoman Elizabeth Zhani.

Central DuPage Hospital in Winfield, Ill., the suburban Chicago hospital where Ewald had her baby last March, boasts that 93 percent of its new mothers are breast-feeding when they're sent home. It also supplies lactation consultants to new moms � a service Ewald said she appreciated. But Ewald said she got a mixed message about breast-feeding, because nurses there wanted to give her baby formula to help him gain weight, and because of those free samples in her goody bag.

Hospital spokeswoman Amy Jo Steinbruecker said the gift bags contain "literature and samples of common items newborns may need, including a small sample of formula," and are meant to support healthy parenting and baby care.

But she said the hospital is examining the formula freebies as it seeks to be designated "baby-friendly."

The World Health Organization and the United Nations Children's Fund established that designation to encourage breast-feeding, with 10 criteria hospitals must meet. These include allowing new moms and infants to remain together throughout the hospital stay and not giving newborns any pacifiers or formula.

Jennifer Smoter, a spokeswoman for Abbott Nutrition, makers of Similac formula, declined to disclose how many hospitals Abbott provides with formula samples and would not comment on the practice. Representatives of Mead Johnson, makers of Enfamil formula, did not respond to several email and telephone requests for comment.

Haley Stevens, a scientific affairs specialist for the International Formula Council trade group, said not offering new moms formula samples "is really irresponsible."

New moms should have formula available, along with information on how to use it so they don't water it down or make other mistakes that could endanger their babies' health, Stevens said.

"We agree breast-feeding is the best, when you can do it," she said. "There's no question. But if one size doesn't fit all, it's good to have a backup."

___

Online:

CDC breast-feeding report: http://www.cdc.gov/breastfeeding/data/reportcard.htm

American Academy of Pediatrics: http://www.aap.org

___

AP Medical Writer Lindsey Tanner can be reached at www.twitter.com/LindseyTanner

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Japan finds radiation in rice, more tests planned (AP)

TOKYO � Japan is ordering more tests on rice growing near a crippled nuclear plant after finding elevated levels of radiation, government officials said Saturday.

A sample of unharvested rice contained 500 becquerels of cesium per kilogram, they said. Radioactive cesium was spewed from the Fukushima Dai-ichi nuclear power plant after it was damaged by a massive earthquake and tsunami on March 11.

Under Japanese regulations, rice with up to 500 becquerels of cesium per kilogram is considered safe for consumption.

Officials have tested rice from more than 400 spots in Fukushima prefecture. The highest level of cesium previously found was 136 becquerels per kilogram, prefectural official Kazuhiko Kanno said.

News of the elevated radiation level in rice from Nihonmatsu city, 55 kilometers (35 miles) west of the nuclear plant, set off alarm in the Japanese media.

The government has been testing vegetables and fish for radiation since the disaster, in which backup generators and cooling systems failed at the plant and the cores of three reactors melted.

Some nations have stopped importing some food products from Japan. Japanese consumers are nervous about radiation, but campaigns to buy from Fukushima have drawn support around the nation.

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AP IMPACT: Hospital drug shortages deadly, costly (AP)

TRENTON, N.J. � A drug for dangerously high blood pressure, normally priced at $25.90 per dose, offered to hospitals for $1,200. Fifteen deaths in 15 months blamed on shortages of life-saving medications.

A growing crisis in the availability of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy from secondary suppliers at huge markups because they can't get the medications any other way.

An Associated Press review of industry reports and interviews with nearly two dozen experts found the shortages � mainly of injected generic drugs that ordinarily are cheap � have delayed surgeries and cancer treatments, left patients in unnecessary pain and caused 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 with those drugs.

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.

At a hearing Friday before the health subcommittee of the House Energy and Commerce Committee, hospital officials and other experts testified that the worsening shortages are preventing them from giving many patients the best care and are driving up costs.

"Considering the nation's budget crisis and our skyrocketing health care bill, these markups are nothing more than profiteering at the expense of patients and providers who are struggling to afford vital medicines," said Mike Alkire, chief operating officer of Premier Healthcare Alliance, a group that helps U.S. hospitals and other health providers improve their patient care and finances.

The shortages could cost hospitals at least $415 million a year, he said, citing data from health care providers across the nation. 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.

The scarcity of mainstay cancer drugs is not only hurting patients but is halting or disrupting clinical studies of potential new treatments, said Dr. Robert S. DiPaola, director of the Cancer Institute of New Jersey.

"The drug shortages of today can have a ripple effect on the availability of new drugs and treatment combinations tomorrow," he told the committee.

On Monday, the Food and Drug Administration is holding a meeting 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 include theft of prescription drugs from warehouses or during shipment, as well as the "gray market" vendors who buy scarce drugs from small regional wholesalers, pharmacies or other sources and then sell them to hospitals at many times the normal price. These sellers may not be licensed, authorized distributors.

In addition, many companies have stopped making generic injected drugs because the profit margins are slim. Producing them is far more expensive than stamping out pills, and it takes 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 drug in short supply, they're discouraged by the lengthy, expensive process of setting up new manufacturing lines and getting FDA approval.

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. The active ingredient might have degraded and the drug might not work well or could even harm the patient, he said.

Cohen attributes at least 15 recent deaths to drug shortages, either because the right drug wasn't available or because of dosing errors or other problems in administering or preparing alternative medications. But many deaths and injuries go unreported, he said.

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 those 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. The figure 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 beta blocker for dangerously high blood pressure, normally priced at $25.90 per dose, for $1,200.

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 the agency'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. Another 99 have been prevented so far this year, Howard K. Koh, assistant secretary for health in the Department of Health and Human Services, told the committee.

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.

The pitches hospitals get from 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.

Another 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 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 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?tabid14434

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

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AP IMPACT: Hospitals face drug price-gouging (AP)

TRENTON, N.J. � 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?tabid14434

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

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Widely used hospital drugs are in short supply (AP)

Drugs used frequently to treat hospital patients, many of them critically ill, increasingly are difficult or impossible to find. Shortages causing the most disruption in care include:

_Sodium phosphate injection � electrolyte (controls heart, nerve, muscle function)

_Magnesium sulfate injection � electrolyte (controls heart, nerve, muscle function)

_Levofloxacin injection � antibiotic

_Foscarnet injection � antiviral drug

_Paclitaxel injection � chemotherapy

_Doxil injection � chemotherapy

_Prochlorperazine injection � for nausea

_Ondansetron injection � for nausea

___

Source: University of Utah Drug Information Service

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Scores got sick, 1 died trying to kill bedbugs (AP)

ATLANTA � Worried about bedbugs? Maybe you should be more concerned about the insecticides used to get rid of them.

A government study counted one death and 80 illnesses linked to bedbug insecticides over three years. Many were do-it-yourselfers who misused the chemicals or used the wrong product. And most of the cases were in New York City.

The study released Thursday by the Centers for Disease Control and Prevention is the first to look at the issue.

The CDC was able to only get data from seven states, including New York, where bedbugs have become a highly publicized problem and where health officials have also been extra vigilant about unusual chemical poisonings.

Investigators said they didn't know what to expect, but were relieved to see a relatively small number of cases.

"At this point, it's not a major public health problem," said Dr. Geoff Calvert, a CDC investigator who co-authored the study.

Bedbugs are wingless, reddish-brown insects that bite people and animals to draw blood for their meals. Though their bites can cause itching, they have not been known to spread disease.

"There's nothing inherently dangerous about bedbugs," said Dr. Susi Vassallo, an emergency medicine doctor who works at New York City's Bellevue Hospital Center and occasionally deals with patients talking about bedbugs.

Vassallo, who is also a toxicologist, said most of the insecticides used against bedbugs are not a health risk but should still be applied by a trained exterminator.

The CDC looked at reports from California, Florida, Michigan, North Carolina, New York, Texas and Washington, the only states that tracked such illnesses. The study counted 111 cases in the years 2003 through 2010. Most occurred in the last few years, when bedbug reports rose across the country. More than half were in New York City.

Most were people with headaches or dizziness, breathing problems or nausea and vomiting.

The one death in 2010 was a 65-year-old woman from Rocky Mount, N.C., who had a history of heart trouble and other ailments. She and her husband used nine cans of insecticide fogger one day, then the same amount two days later, without opening doors and windows to air out their home afterward. She also covered her body and hair with another bedbug product, and covered her hair with a plastic cap.

CDC officials said it's not clear that the insecticides were a definite cause of illness in each of the cases, and it's possible some were coincidental.

About 90 percent of the cases were linked to pyrethroids or pyrethrins, common insecticides sometimes used against bedbugs. But in some cases, an incorrect and more dangerous product was used. That happened in Ohio last year, when an uncertified exterminator used malathion � which should never be used indoors � to rid an apartment of bedbugs. A couple and their 6-year-old child got sick.

The report was released through a CDC publication, Morbidity and Mortality Weekly Report.

___

Online:

CDC report: http://www.cdc.gov/mmwr

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