Methyl chloride and the U.S. cigarette

Various brands and types of cigarettes were purchased at retail locations in southern California. Volatile gas samples were analyzed using multicolumn/multidetector gas chromatography. Results showed methyl chloride (CH(3)Cl) levels as much as four orders of magnitude higher than typical urban levels, about 30-500 ppmv (1.5-5.3 mg/cigarette), compared with about 500 pptv in urban air. The concentration of CH(3)Cl correlated well with the levels of both CO (r (2) = 0.63) and CO(2) (r (2) = 0.77), showing the link between CH(3)Cl and combustion. In some brands, CH(3)Cl levels were well above the U.S. Environmental Protection Agency's maximum exposure limit of 200 ppmv. Light branded cigarettes tended to have higher CH(3)Cl levels than the heavier and filtered brands, possibly showing the dependence of cigarette packing on CH(3)Cl production. In addition, CH(3)Cl emitted from cigarette smoke may prove to be an important anthropogenic source of CH(3)Cl in the United States, at about 5%.

Automated determination of seven phenolic compounds in mainstream tobacco smoke

Exposure to hydroxyl-substituted arenes, commonly referred to as phenols or phenolic compounds, can have serious health consequences. Select phenols present in tobacco smoke are cardiovascular toxins, act as tumor co-promoters and show genotoxic activity. To examine the mainstream smoke levels of these compounds, we developed and applied a method for quantitative analysis of seven phenols (phenol, o-cresol, m-cresol, p-cresol, catechol, resorcinol, and hydroquinone) in mainstream smoke. Total mainstream smoke particulate matter was collected on a Cambridge filter pad and spiked with an isotopically labeled internal standard solution. This pad underwent an automated phenol derivatization procedure to increase analyte volatility and enhance detection. Following the derivatization step, phenols from the particulate matter were sampled using solid-phase microextraction with subsequent gas chromatography/mass spectrometric detection. Sensitivity, selectivity, accuracy, and reproducibility were more than adequate for routine detection of phenols in mainstream smoke. Detection limits ranged from 0.04-0.57 microg, with a quantification range of 0.1-710 microg. Higher sensitivity and sample throughput were achieved compared with previously described methods. Mainstream smoke from 28 brands of domestic commercial cigarettes was evaluated to assess typical levels, and reference cigarettes containing single tobacco blends were examined to ascertain the phenolic profile from different types of tobaccos. As expected under machine smoking conditions using the Federal Trade Commission parameters, full-flavored cigarettes deliver more phenols than the light varieties, followed by the ultra light varieties. Differences were seen in relative levels of phenolic compounds in the mainstream smoke from unfiltered cigarettes made with a single type of tobacco.

IFTC v. Evanston: antitrust enforcement of hospital mergers receives a shot in the arm

This article examines the Federal Trade Commission's Evanston decision and assesses its future impact on hospital merger analysis. In finding that a consummated merger of two Chicago-area hospitals violated the antitrust laws, the FTC analyzed the merger using a unilateral effects theory of anticompetitive harm. This theory entails examining the competitive impact on third-party payors as a result of the loss of competition between the merging hospitals, rather than the traditional market share and market structure data relied upon in earlier court decisions. After a detailed discussion of the Evanston decision and the history of hospital merger litigation leading up to it, the authors argue that while the Evanston decision indicates that the government will use unilateral effects analysis in challenging future hospital mergers, this analysis is fraught with litigation challenges. The government's next case will not have the benefit of a strong evidentiary record as in Evanston, thereby making it more difficult for the government to prove its unilateral effects theory.

Working through the frustrations of clinical integration

Everybody--hospitals, physicians, payers and even government regulators--agree that if all of a patient's providers coordinate her care, the whole process would be simpler, safer and more effective. But federal laws, the cost of information technology, physician reluctance to team with hospitals and other factors keep getting in the way. Could those obstadcles to clinical integration finally be melting away?

Antitrust agony. In wake of the latest federal action, four hospital mergers are being proposed. The players wait to see if their deals pass muster

Four potential mergers could face some tough scrutiny from federal regulators in the wake of a recent case in Illinois. The Evanston Northwestern Healthcare case, in which the FTC forced the system to separately negotiate managed-care contracts for the acquired hospital, "make it more likely" the FTC will investigate, says Chul Pak, left, a former FTC lawyer who worked on that case.

Finding victory in legal defeat. FTC says ENH can keep Highland Park (Ill.) Hospital, but industry wary of what anti-competitive decision might mean

Seven years after Evanston Northwestern Healthcare acquired Highland Park Hospital, the Federal Trade Commission has finally issued a ruling saying the deal was anti-competitive. While ENH can keep the hospital, the feds say it must negotiate separately with payers for services at Highland Park. FTC litigator Tom Brock, left, says the case turned on exorbitant price hikes the system extracted from managed-care plans.