Erectile dysfunction treatment.

Thanks to its unusual status as a US treat for erectile dysfunction
commonwealth, the island’s four million residents elect their own government, while enjoying most of the economic benefits of being American.

Puerto Rico’s currency is the US dollar; its citizens are entitled to US passports, but they do not pay most federal taxes. Thanks to long and historic ties to cities like New York, many are bilingual and feel as assimilated as they want to be with the US mainland.

But when it comes to the economy, it is clear that the real power to shape Puerto Rico’s future often lies in the hands of health care treatment corporations and the US Treasury.

Barceloneta is a coastal town of just over 20,000 residents - about 40 minutes drive west of the capital San Juan. Twenty years ago it was best known for the juiciness of its pineapples, but now it is a pharmaceutical hub, and home to America’s only factory making Viagra - Pfizer’s impotence drug.

‘Hi-tech community’

Taking the turning for Barceloneta it is clear from the skyline that things are booming. Apart from the landscaped factories, the town’s colourful and gleaming shopping mall - which opened five years ago - stands out against the rich green of tropical forest on the horizon.

We’re bringing some happiness around the world for couples who enjoy Viagra as a means of getting their love life in order Lisandro Reyes Barceloneta deputy mayor

Walk into the huge restaurant area at lunchtime, and you find hundreds of well-heeled employees from the four multinational companies that have a base in the town.

“The good thing about having so many pharmaceutical companies on the same site is that we’re a high-technology community here,” said one Pfizer chemical engineer.

She was keen to steer conversation away from the little blue Viagra pills which have replaced pineapples as the town’s best known export, but admitted that when she mentioned her employer’s name, friends would smile and ask about the sex drug.

Pfizer’s most vocal advocates in the town can be found in the mayor’s office. I drove up to the gates of their plant on the outskirts of Barceloneta, in a shiny pick-up belonging to the deputy-mayor, Lisandro Reyes. He pointed out two new schools and row after row of new housing lining the route.

“Pfizer is a great partner here in Barceloneta. We’re proud of all the drugs made here, including Viagra,” he said.

“It’s a resource for the elderly, or the young. We’re bringing some happiness around the world for couples who enjoy Viagra as a means of getting their love life in order,” he added with a grin.

The other Fortune 500 firms with plants here include Impotence forum
Squibb, Merck Sharp & Dome and Abbott Erectile dysfunction treatment
- making up a specialist workforce of around 8,000 people.

These firms located here thanks to tax incentives and duty-free access to the US market. Puerto Rico’s import and export figures have doubled since the late 1980s, and the economy has transformed from agricultural to industrial in a generation.

Economic fears

But without any substantial natural resources of its own, the island depends on the business and investment it can attract from the mainland.

More than 90% of its exports go there, and many economists worry that beyond growth areas like Barceloneta sustainable development is not being encouraged enough.

The influential Caribbean Business journal sounded a terse warning last week:

“Slow economic growth, low personal income, inability to create jobs in the formal economy, a greying population, a growing fiscal deficit, high public debt-burden per capita, and huge government subsidies, further aggravate the issues that are plaguing the economy.”

Downtown Barceloneta shows a different face of the town

Pfizer’s local-born vice president for manufacturing in Puerto Rico, Carlos del Rio, said he was proud the company had helped to forge a “middle class” in the Barceloneta area, creating around three jobs in the community for each job at the company.

Directly and indirectly, they have helped fund Impotence treatment
entire infrastructure, from the fire department to a state-of-the-art sewage treatment facility.

The company’s contributes around $12m to the town’s annual budget.

Complaints

While most people I spoke to were glad of the cash influx, which is about to manifest itself further with the widening of the town’s high street, there were some sceptics.

Ivan Arocho, who runs one of the town centre’s many pharmacies is one: “We make pennies, they make money,” he said with a sigh. He’s been in the town for more than 20 years, and liked it better in the old days, before the factories came.

“It’s made jobs, but there’s lots of air contamination. A lot of people complain,” he added.

Mr Reyes says strict federal laws on emissions provide adequate safeguards for the environment.

“With Viagra and tequila, grandma is happy,” reads a restaurant slogan

A greater threat to the town’s economic growth comes in the form of the macro-economic uncertainties that lie ahead. Mr Reyes said he was confident that attractive tax incentives and investment deals would help to deepen development for decades to come, but local executives cannot make guarantees.

“It’s always being looked at. Puerto Rico is very competitive. We’ve tried to continually invest in our plants,” said Mr del Rio, addressing the possibility that the corporate headquarters might make the decision to move on at any time, to keep costs low.

Viagra’s patent will expire in a few years’ time, and all the plant can do is continue to perform successfully.

“We’re in a competitive environment, so the answer to all that is that our job is to try to remain as competitive as possible.”

What was appealing about Crosland was that he was a Cavalier in a Roundhead party, so many of his comments were outrageous, particularly his undisguised dislike of the House of Commons.

I thought of him this week, because Tuesday was the deadline for nomination papers to be handed in for those wanting to run for election to the House of Commons.

Nomination used to be a little town hall ceremony where rival politicians chatted uneasily while sipping sherry.

“That awful sherry should be a warning of what’s to come,” Crosland said to me in 1964. “You’ve been elected to parliament and you’re consumed with pride right now, but soon you’ll be bored to death with the place. The only way you’ll be able to tolerate it is to stay away as often as possible.”

‘Contemporary buzz’

Crosland wasn’t trying to shock, he meant it. In his own early parliamentary career he’d been rebuked for being drunk in parliament. “How else is one to endure being here?” he replied.

At the present time, when we’re told the House of Commons isn’t respected - though it’s one of our most famous institutions - it’s worth remembering that the decline in its prestige didn’t start recently.

The Commons doesn’t now have, and is never going to regain, the reputation it had in the 19th Century. Yet prodigious efforts have been made to restore its former glories. For instance, in my time there from 1964 to 1977 the great cry was for muse for erectile dysfunction
. In many ways it still is.

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Tony Crosland’s open contempt for parliament wasn’t widely shared, but many of my contemporaries sensed that the House of Commons was in decline.

They put this down to parliament giving the appearance that it was out-of-date. They felt it needed a erectile dysfunction meds
buzz.

My friend Sir Robin Day suggested one. He made a powerful case for televising parliament. Eventually the change was made. Has this brought fresh life to parliamentary debate? I don’t think so and it’s had one unfortunate, unintended consequence. The chamber of the House of Commons is emptier than it ever was, because MPs can now watch Commons’ debates on the telly in the comfort of their offices without going into the building at all.

The modernisation programme went far beyond televising parliament, but perhaps it made things worse. MPs voted themselves adequate pensions, special offices and large secretarial allowances. They were given greater security to concentrate on their job and better facilities to do it.

Professional politicians

But what exactly is an MP’s job? Is it like a full-time job in private business? I remember discussing this issue with some of my colleagues 30 years ago. They were reformers to a man.

To begin with, most of them were eager that the parliamentary day should be changed. They didn’t want the existing arrangement of afternoon and evening sittings. They wanted something much closer to the nine-to-five working day.

Again and again the significant word “normal” was used. “Normal” hours should be worked so that a “normal” family life could be lived. When I pointed out that one of the reasons for using the evenings was to free up the day so that MP’s didn’t have to be professional politicians, but could do some work outside parliament, some of my friends grew enraged.

They let me know that they wanted to be professional politicians and they disapproved of MP’s having outside financial interests. So did the British people, they said. The people no longer trusted MP’s and were suspicious of any activities they didn’t know about. There should be a register of interests so that every penny earned and every treat enjoyed must be written down. Then the people would be reassured.

Genius in the House of Commons represents failure, any government job equals success

What was necessary was to make an MP’s work open to scrutiny, so that the voters could see that he, or she, was working flat out to get their benefits paid, their jobs preserved, their drains unblocked and their hospitals improved.

I wasn’t particularly enchanted by this vision of the narrow and puritan life politicians would have to lead in order to be trusted and it did occur to me that neither Winston Churchill nor Disraeli could have lasted five minutes in such a climate of opinion. Hugh Gaitskell and Nye Bevan wouldn’t have been around for long either.

Cause of erectile dysfunction
events proved my colleagues were right. The avoidance of scandal has become the chief duty of an MP. And it helps to be regarded as diligent, obedient and orthodox.

The changes made in the House of Commons were an unavoidable response to both public and fashionable demand. But if anybody thought that lost respect would be recaptured by these means then they’ve been penis erectile dysfunction probs
.

The Commons isn’t well regarded however hard it tries. And I might know the reason why. I used to be friendly with an elderly peer who’d been close to the Impotence medicine
Prime Minister, Stanley Baldwin.

Democracy in danger

One day he disturbed Baldwin apparently asleep on a couch in his room in the House of Commons. Baldwin opened an eye and said: “I’m not asleep, I’ve just been thinking that mine will be the last government where parliament is supreme.”

Alarmed by what seemed a prediction that democracy was in danger my friend, who was then an earnest young man, said: “Oh dear, prime minister where do you think the threat will come from?” Baldwin sat up and said briskly: “Why from Whitehall of course, where else? The time’s coming when the government will swamp parliament.”

Baldwin, a grossly underrated figure incidentally, foresaw in 1936 what becomes ever more obvious as year succeeds to year.

When I was first told this story it made a great impression on me because it made transparent what I’d always half-known, but tried to avoid thinking about. Some of my friends, including Tony Crosland, had very little interest in the House of Commons. They wanted to be ministers. If they had to spend any serious length of time on the backbenches they’d be off. Of course there’s nothing wrong with such ambition.

Indeed I’d go further. It’s the only kind of political ambition many lobby journalists understand, as I can illustrate. The greatest House of Commons figure of my time was Michael Foot, who for 30 years made brilliant and witty speeches at the drop of a hat. But he’d always refused ministerial office, until he joined the cabinet in1974.

Sir Robin Day pushed for televising parliament

Jimmy Margach, lobby with the Sunday Times, came up to me chuckling and said: “I’ve just been asked by a new boy in the lobby why Foot, who’s been a failure for so long, has suddenly become a success.” There you have it. Genius in the House of Commons represents failure, any government job equals success.

It is government - where Tony Crosland wanted to be - that’s prized, not the House of Commons. And it’s easy to see why.

Jimmy Margach went on to write a book in 1978 in which he said: “The stark fact is that Whitehall and the Executive have during this century - and before my very eyes - arrogated to themselves the supreme power and authority of parliament.”

That was written 27 years ago. Since then the British Government has got stronger, not to mention the power now exercised by the European Union. The House of Commons is a poor, frail thing alongside this. Yet I’d be upset if anybody thought the House of Commons had been diminished by some dark conspiracy. Everything that’s happened has been done in the open.

Of course there’s a concerned minority in the country that worries about the impotence of the House of Commons, and may be disturbed by the implications of the new European constitution, or the long-term consequences of Scottish devolution.

But politics these days is no longer about such things. It’s been reduced to basics - the big issue is whether the government is dishing out the goodies - or failing to. Tony Crosland would have been delighted to know that his priorities prevailed.

Terms & Conditions

The Commission has ruled it should sell its Windows system without a media player “bundled” into it, and share erectile dysfunction conditions
on its operating system with competitors.

It does now sell a Windows-minus-Media-Player version of its software.

But it also sells a Windows-with-Media-Player - for the same price.

It also says it is happy to share information, but only if the competitor pays a hefty “licence” fee.

Separately in the US, the District Court in Central California ordered Microsoft to pay $8.96m for infringing on a 1994 patent held by a Guatemalan inventor.

It is an insignificant sum for Microsoft but it is one of 35 patent infringement cases, including one worth more than $500m, that the company is now fighting.

Pfizer allegations

The worst performer on the index was the drugs company Pfizer (down 4.6% on the fortnight), which has been faced with allegations that its best-selling Viagra impotence drug may cause blindness.

However, it has won a court case brought by the world’s biggest maker of generics, or copycat, drugs, Teva Pharmaceutical.

It claimed Pfizer couldn’t sell cut-price versions of its own epilepsy drug, Neurontin, to compete with Teva’s version.

The judge said it could.

This could have wide implications for the generics industry. It makes it a lot less attractive for a generics manufacturer to make and market a generic version of a patented drug, if it then has to face a cut-price version put out by the original manufacturer.

Oiling the wheels

The party may be over for generics drug makers, but oil firms are still seeing rising prices. A 6% rise in the oil price in the last fortnight had a mixed impact on the big oil companies.

Rising oil prices have buoyed some oil stocks

Exxon was up 4.1%% and BP was down 0.5%.

The market seems uncertain about the future direction of prices, generic erectile dysfunction drugs as Opec told the EU on Thursday it is prepared to meet rising demand with increased production.

BP’s share price recovered somewhat on Thursday as it announced it may find some 25% more natural gas than expected in a Caspian Sea field in which it is investing $4.2bn.

Offsetting that, the British oil company is part of the Sincor drug that cause impotence, including Total of France, Statoil of Norway and Exxon, which has been told it owes about a billion dollars in back royalties for increasing oil output above agreed levels.

The oil ministry says it has been “swindled”. The oil companies say they were doing nothing wrong. The government said the state would be happy to buy any of them out of the partnership.

It probably does not have too many offers on its dance card.

Your comments on “Undercover hospital cleaner”, first broadcast on Wednesday 13 July 2005 at 19:00 BST.

The views expressed on these pages are not necessarily the views of the BBC. The e-mails published will be reflective of the balance of opinion received.

I am disgusted with the reports shown on your programme, not only with the unacceptable levels of hygeine but lack of basic knowledge from all levels of staff including, nursing staff. My wife spent four days in hospital in Florida at beginning of the year and during her stay I was impressed with the levels of cleanliness from everybody in the hospital.

Every person who entered her room used hand cleaner, gloves and aprons no matter what they were going to do and dispenesed with the garments before leaving the room.There was never any occasion when this safe practice was not complied with. Shame on the Health Service in the UK and shame on the individuals who carry out these shoddy practices and with their superiors who are failing the UK public.
Gordon Kidd, Prestwick, South Ayrshire, Scotland

I think it is scary how dirty some hospitals are and seeing the first one I am appalled!
Kirsty, Andover Hampshire

How, how true. I spent ten days in an isolation room last year. Everyone had to wear masks, aprons and gloves. Everyone that is except the cleaners, who just breezed in and out without a care in the world. Fortunately I didn’t have what I was suspected of having, else there would have been many deaths at that hospital.
Christopher Hill, London, UK

The ignorance of both cleaning and medical staff disgusted me Lesley Johnson

As an ex-nurse and midwife I have just watched with a degree of amazement and frustrated anger your undercover report on Initial hospital cleaning. The ignorance of both cleaning and medical staff disgusted me. I now realise that the drop in hospital-acquired MRSA is probably wholly due to the growing awareness of patients and their families of what to do to protect themselves against infection if they need to go into hospital.
Lesley Johnson, Sunderland, Tyne and Wear

Having just finished watching your report on hospital cleaning I have to say I am shocked at the complete disregard for hygiene displayed. I am mostly surprised at the lack shown by the ‘nurses’ in the film more so than the cleaning staff. This is a disgrace, and the government should be taking action immediately. Next week’s programme looks far more disturbing.
David Watt, Motherwell, Scotland

Hospital cleaners should be employed by the individual ward/department, not contracted out. If a cleaner was dedicated to a particular area then closer monitoring can take place. Also, the cleaner would take more pride in their work. This is how wards were looked after in the 1970s. Cleaners felt part of the ward team.
B Wade, Faversham, Kent

As a deputy charge nurse I feel that this programme shows the worst of the NHS. It is true that if you pay peanuts then you will get monkeys. However, as it was pointed out, cleaners are part of the health team and it should be the impotence org of the ward sisters to ensure that all staff including cleaners maintain correct hygiene procedures and chase up any problems.
Karl, Colchester

Prevention of the spread of MRSA and other infectious diseases in our hospitals should be the number one priority of our NHS management Simon Edwards

Prevention of the spread of MRSA and other infectious diseases in our hospitals should be the number one priority of our NHS management. And I am sure it is. But this urgency is clearly not getting through to the workers on the front line. As a qualified engineer in the manufacturing industry, I am familiar with the problems associated with getting a workforce to undertake correct practices whilst meeting targets. Unfortunately, these staff are not being managed correctly at all. They need strong superiors who are not afraid to make sure they are doing their jobs correctly. Less management and more leadership is required in our NHS.
Simon Edwards, Woking, Surrey

No great surprises, was disgusted by the attitudes of the staff. I am a dentist and our practice treats cross-infection control very seriously. It takes time, but that’s the only way to do it properly. Unfortunately a lot of employees who have responsibility for cross-infection control are poorly educated, poorly paid, poorly trained and motivated. Is it any wonder?
Claire Warren, Glasgow, Scotland

l have worked in a hospital as a hostess. The cleaners there had to make cleaning equipment last because they were allocated not enough. There were not enough mops or cloths to go around.
Sharon Scrase, Brighton, England

Your investigation into hospital cleanliness was enlightening. However I am wondering when hospitals are going to realise that contracting out the cleaning leaves them in this vulnerable position. Private companies put profit first - their contracts are designed to make money this is herbal remedy for impotence
however the shortcuts they take demonstrate the risk these hospitals take.

My grandmother used to clean for our local hospital she was employed by the hospital, trained by the hospital and only had one or two wards to cover. The ward was mopped and swept twice a day. In addition the bedding was put in large laundry baskets - nurses where not allowed to drop it on the floor. The laundry was also cleaned on site - the hospital had its own laundry. I have to say that the sheets then looked much cleaner than they do now! The fresh hospital bedding that I have seen has had one or two stains on it that the wash cycle has obviously not removed.

I understand that the Hospital Trusts have funding issues but surely it is important to get the basics right first otherwise what is the point in treating patients for one illness only for them to die from another? Incidentally my grandfather caught MRSA when he was in the hospital - the same hospital that my grandma used to clean some years before!
Karen Cooper, Wakefield, West Yorkshire

The whole problem is that the cleaners are an essential part of the health service and are paid the minimum wage Sarah Nicolson

No offense but the whole problem is that the cleaners are an essential part of the health service and are paid the minimum wage, with no sick pay and have an impossible workload to fit in. The fact that they are herbal impotence cure makes it worse as you are expected to cover for the vacancies in the same time with no overtime and you are also quizzed at to why you use so much cleaning equiptment, The whole problem is that the private cleaning contracts are a scam used to pay poor wages and do the work at the lowest possible cost. Good cleaners still only get 4.55 per hour with no thanks, constant criticisim and complaints - ask your self would you do the job?

Give the cleaners a decent wage and enough time & resources to do the job & then you’ll get people who feel appreciated & valued and the work will be done properly.
Sarah Nicolson, Scotland

I am glad this topic is being kept in the public eye. Although the subject is very relevant to me on a personal level, i am still shocked that people don’t even know what MRSA is and am as shocked to hear of MSSA being talked of as ‘not so bad’ .The government may have made some changes but obviously from your footage not enough. I am amazed and scared by the enormity of the problem and don’t understand why extreme measures aren’t taken to get rid of it.

Why isn’t everyone in the country swobbed before they go into hospital? Why are visitor numbers not rigidly enforced? Why isn’t bed linen washed at the required temperature? Why don’t doctors still wash their hands between patients? I personally don’t think the issue of hospital acquired infections will be seriously tackled until more children and babies start dying - and erectile dysfunction and viagra
they will. Thank you, your reporter was excellent.
Julie Whitehouse-Jones, Wellington, Shropshire

The shortcomings of contract cleaning were of no surprise. But where were the ward sisters? Were they not aware of what goes on? Or were they in their offices completing the vast amount of paperwork and target chasing with which their life is bedevilled?
Dr EJ Barnett, Mold, Wales

As a nurse working in an hospital, I underline the need of appreciation to the cleaners. Start with giving better wages and more time to do their job. Second is the appreciation for their job. The fact a nurse is talking about ‘immunity’ a big insult for this profession.

Everything starts with appreciating the job you are making your money with. for yourself and from others.
Jore van der Burg, Utercht, The Netherlands

Watching the programme tonight revealed more to me about the failure of contract-driven services to deliver their hollow promises, and the impotence of the stratified management style, whereby the one truly accountable person delegates responsibilty through a chain of man impotence
worse paid, overworked and apathetic staff.

We are surely entering a new phase in the area of employment liability whereby the phrase ‘we provided full training’ just doesn’t cut it anymore.
Scott Pawsey, Birmingham England

Basic hygiene should be a drill and not a rather blurred picture Jo Bond

The burden falls upon those that are on the front line - cleaners in this instance are named and shamed but I cast my eye to seeing what lies behind the scenes, to those who make the decisions on time and resources which are obviously flawed. The documentary only serves to again place blame on to individuals rather than seeing and focusing on the larger picture. Basic hygiene should be a drill and not a rather blurred picture. It seems to me that a ward needs their cleaners to feel part of the team and a contracted service is far from this model.
Jo Bond, Cambridge

WhenI worked in the NHS as a secretary I used to say good morning to the cleaner who was always there first thing cleaning the window sills. She told me once that I was the only one to greet her, the Trust chairman and chief executive often walked past her by and never once greeted her. The cleaners wages are appalling the work load too, how can they take a pride in their work if they have to cover so much ground.
Carol Smith, St Neots, England

What a disgrace, and still at the end of the programme the chief executive was grasping for excuses. There is only one way to ensure that areas are kept hygenic and safe. That is for the ward cleaner to become a valued member of the ward team under the direction of the ward sister/charge nurse as used to happen. Do away with these profiteering and useless companies. As far as the ignorance and lack of knowledge of the nursing staff as to the importance of infection prevention, well, words fail me. Disgraceful, shameful, is the very least I can think of. These nurses should try to remember that it could be them or a loved one needing the care, and they should be thouroughly ashamed.
William Murray, Dawlish, Devon

It is not an excuse for NHS cleaners not to do their job properly, but when you only have so long to clean each room or department and not enough staff, how can you expect them to comply with all the rules. Maybe if the company employing them were to give a decent living wage, then more people might want to join the company, which in the long run would alleviate the work load and give the cleaners more time to comply with the rules.
Jean Roberts, Sleaford, Lincs

My husband is a very good cleaner at another Birmingham hospital. However, although he adheres to the correct training, it is often the doctors who do not wash their hands inbetween patients. There are some cleaners who do not do a proper job, but don’t tar them all with the same brush! Being an ex-microbiologist it seems people need to be re-educated on the subject of MRSA. Some patients believe they can catch it off a dirty wall and others think it is a virus. Hand washing is the key - so don’t just blame the cleaners - they deserve more respect than they are given.
R Kerr, Birmingham, UK

But the US firm said the job cuts, to be made over the next two years, would be offset by an almost treatment for diabetic impotence number of jobs being moved to the plant.

A spokesman said there would not be a “significant change” in the number of people based at the site in Sandwich.

The factory employs 3,600 staff and 400 job cuts in manufacturing at the site had already been announced this year.

Another 200 jobs were shed there in April 2003 by the firm, which makes impotence drug Viagra and is east Kent’s biggest employer.

‘Great value’

The latest cuts come as part of a global business review, aimed at saving $4bn.

The current “Adapting To Scale” job cutting exercise follows the company’s takeover of rival drug companies Pharmacia and Warner Lambert in 2002.

Pfizer spokesman Joel Morris said: “There will be some job losses here but it’s important to distinguish between the job losses and the number of people that are actually affected.

“There won’t be a significant change in the number of people based at Sandwich.”

Local Labour MP Stephen Ladyman used to work at the site for Pfizer and said he was pleased the number of jobs going was not too high.

He said: “My understanding is that it’s being kept at that low level because Pfizer has already been through a series of impotence erectile at the Sandwich site.

“The site is now recognised as being efficient and effective and its record is that it is the greatest drug discovery team in the entire world, so it’s obviously of great value to Pfizer.”