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Medicine

By O. Narkam. Southeastern University. 2019.

Only a widespread agreement on the procedures through which the autonomy of postindustrial man can be equitably guaranteed will lead to the recognition of the necessary limits to human action order generic top avana on line. Common to all ethics is the assumption that the human act is performed within the human condition purchase top avana 80mg visa. In our industrialized epoch discount top avana 80mg on-line, however, not only the object but also the very nature of human action is new. Traditionally the categorical imperative could circumscribe and validate action as being truly human. The loss of a normative "human condition" introduces a newness not only into the human act but also into the human attitude towards the framework in which a person acts. If this action is to remain human after the framework has been deprived of its sacred character, it needs a recognized ethical foundation within a new imperative. This imperative can be summed up only as follows: "Act so that the effect of your action is compatible with the permanence of genuine human life. Is it possible, without restoring the category of the sacred, to attain the ethics that alone would enable mankind to accept the rigorous discipline of this new imperative? If not, rationalizations could be created for any atrocity: "Why should background radiation not be raised? But only the awe of the sacred, with its unqualified veto, has so far proved independent of the computations of mundane self-interest and the solace of uncertainty about remote consequences. This could be reinvoked as an imperative that genuine human life deserves respect both now and in the future. Recourse to faith provides an escape for those who believe, but it cannot be the foundation for an ethical imperative, because faith is either there or not there; if it is absent, the faithful cannot blame the infidel. Recent history has shown that the taboos of traditional cultures are irrelevant in combatting an overextension of industrial production. The taboos were tied to the values of a particular society and its mode of production, and it is precisely those that were irrevocably lost in the process of industrialization. It is not necessary, probably not feasible, and certainly not desirable to base the limitation of industrial societies on a shared system of substantive beliefs aiming at the common good and enforced by the power of the police. It is possible to find the needed basis for ethical human action without depending on the shared recognition of any ecological dogmatism now in vogue. This alternative to a new ecological religion or ideology is based on an agreement about basic values and on procedural rules. It can be demonstrated that beyond a certain point in the expansion of industrial production in any major field of value, marginal utilities cease to be equitably distributed and over-all effectiveness begins, simultaneously, to decline. If the industrial mode of production expands beyond a certain stage and continues to impinge on the autonomous mode, increased personal suffering and social dissolution set in. In the interim between the point of optimal synergy between industrial and autonomous production and the point of maximum tolerable industrial hegemony political and juridical procedures become necessary to reverse industrial expansion. If these procedures are conducted in a spirit of enlightened self-interest and a desire for survival, and with equitable distribution of social outputs and equitable access to social control, the outcome ought to be a recognition of the carrying capacity of the environment and of the optimal industrial complement to autonomous action needed for the effective pursuit of personal goals. Political procedures oriented to the value of survival in distributive and participatory equity are the only possible rational answer to increasing total management in the name of ecology. The recovery of personal autonomy will thus be the result of political action reinforcing an ethical awakening. They will recognize that only the disciplined limitation of power can provide equitably shared satisfaction. The recovery of autonomous action will depend, not on new specific goals people share, but on their use of legal and political procedures that permit individuals and groups to resolve conflicts arising from their pursuit of different goals. Better mobility will depend, not on some new kind of transportation system, but on conditions that make personal mobility under personal control more valuable. Better learning opportunities will depend, not on more information about the world better distributed, but on the limitation of capital-intensive production for the sake of interesting working conditions. Better health care will depend, not on some new therapeutic standard, but on the level of willingness and competence to engage in self-care. The Right to Health Increasing and irreparable damage accompanies present industrial expansion in all sectors. Most of the remedies now proposed by the social engineers and economists to reduce iatrogenesis include a further increase of medical controls. These so-called remedies generate second-order iatrogenic ills on each of the three critical levels: they render clinical, social, and cultural iatrogenesis self-reinforcing. The most profound iatrogenic effects of the medical technostructure are a result of those nontechnical functions which support the increasing institutionalization of values. The technical and the nontechnical consequences of institutional medicine coalesce and generate a new kind of suffering: anesthetized, impotent, and solitary survival in a world turned into a hospital ward. The intensity with which it is experienced will depend on the independence, vitality, and relatedness of each individual. Either the natural boundaries of human endeavor are estimated, recognized, and translated into politically determined limits, or compulsory survival in a planned and engineered hell is accepted as the alternative to extinction. Until recently the choice between the politics of voluntary poverty and the hell of the systems engineer did not fit into the language of scientists or politicians. Our increasing confrontation with medical nemesis now lends new significance to the alternative: either society must choose the same stringent limits on the kind of goods produced within which all its members may find a guarantee for equal freedom, or society must accept unprecedented hierarchical controls3 to provide for each member what welfare bureaucracies diagnose as his or her needs. In several nations the public is now ready for a review of its health-care system. Although there is a serious danger that the forthcoming debate will reinforce the present frustrating medicalization of life, the debate could still become fruitful if attention were focused on medical nemesis, if the recovery of personal responsibility for health care were made the central issue, and if limitations on professional monopolies were made the major goal of legislation. Instead of limiting the resources of doctors and of the institutions that employ them, such legislation would tax medical technology and professional activity until those means that can be handled by laymen were truly available to anyone wanting access to them. Instead of multiplying the specialists who can grant any one of a variety of sick- roles to people made ill by their work and their life, the new legislation would guarantee the right of people to drop out and to organize for a less destructive way of life in which they have more control of their environment. Instead of restricting access to addictive, dangerous, or useless drugs and procedures, such legislation would shift the full burden of their responsible use onto the sick person and his next of kin. Instead of strengthening the licensing power of specialized peers and government agencies, new legislation would give the public a voice in the election of healers to tax-supported health jobs. Instead of submitting their performance to professional review organizations, new legislation would have them evaluated by the community they serve. It is not the result of instinct, but of an autonomous yet culturally shaped reaction to socially created reality. Health embraces the future as well, and therefore includes anguish and the inner resources to live with it. Health designates a process by which each person is responsible, but only in part responsible to others. A man is responsible for what he has done, and responsible to another person or group. Health is a task, and as such is not comparable to the physiological balance of beasts. Knowledge encompassing desirable activities, competent performance, the commitment to enhance health in others these are all learned from the example of peers or elders. These personal activities are shaped and conditioned by the culture in which the individual grows up: patterns of work and leisure, of celebration and sleep, of production and preparation of food and drink, of family relations and politics. Long-tested health patterns that fit a geographic area and a certain technical situation depend to a large extent on long-lasting political autonomy.

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Traditional medicine has historically played a prominent role in the national health care system and remains well integrated with allopathic care top avana 80mg with amex. Both systems of medicine receive government support purchase generic top avana from india, and the Chinese Constitution was amended in 1982 to state that "both modern medicine and traditional 69 Chinese medicine must be developed order top avana in india. Principles of human rights should be applied to all aspects of traditional healing. Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. Indigenous individuals also have the right to access, without any discrimination, to all social and health services. Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right. In conjunction with indigenous peoples, States shall take effective measures to recognize 72 and protect the exercise of these rights. These range from an absence of regulation to highly structured regulation similar to that applied to pharmaceuticals. There is ongoing debate whether marketing exclusivity should be granted in return for data 75 submission. Data-based exclusivity prevents generic drug manufacturers from making use of data submitted in an initial application by an originator pharmaceutical manufacturer for a 76 fixed period of time. In effect, this may extend the exclusivity period for an originator drug 77 beyond the patent term or beyond a finding that a patent is invalid. In applying for regulatory approval of a generic equivalent to an approved on-patent medicine, access to or reliance on the original application for regulatory approval is essential. While generics manufacturers can independently generate new clinical data, this is extremely costly and time-consuming. Also, re-generating clinical test data may be regarded as unethical in that it exposes human subjects to a clinical trial that would add no scientific value, and provides a placebo to some patients in place of a medicine with proven efficacy. Dietary supplement labels may only make health claims, nutrient content claims, and 80 structure/function claims. Health claims describe a relationship between a dietary supplement ingredient and reduced risk of a disease condition, nutrient content claims describe the relative amount of a dietary substance in a product, and structure/function claims describe how supplements may affect the organs or systems of the body without mention of any specific disease. In practice, structure/function claims may promise vaguely worded health benefits that can be similar to claims to treat illness. Examples include calcium builds strong bones and fiber maintains bowel regularity. Claims must be followed by the disclosure that This statement has not been evaluated by the Food and Drug Administration. Manufacturers that want to legally make a claim to treat illness may only do so if their claims are supported by adequate scientific evidence. However, since 2006 dietary supplement manufacturers have been required to report 85 any serious adverse effects within 15 days of knowledge of the event. These rules set requirements for domestically marketed herbs that include meeting specifications for identity, purity, strength, 89 and composition. Complementary and Alternative Medicine in the United States, 258-260 (National Academies Press 2005). Although a botanical preparation, this medicine is now approved as a pharmaceutical medicine and prescribed by physicians. Fulyzaq is derived from the red sap of the Croton lechleri plant, which is a traditional herbal medicine known as sangre de grado ( dragon s blood ). It is used extensively within the indigenous cultures of the Amazon River to treat diarrhea, among 91 other conditions. Under the mutual recognition procedure, 93 approval by a single national regulatory body is accepted by other countries. Marketing authorization applications for herbal medicines must fall within one of three categories: 1) full dossier with product-specific safety and efficacy data, 2) well-established use with sufficient safety and efficacy data, or 3) traditional use with sufficient safety data 94 and plausible efficacy (simplified registration procedure). Because product-specific safety and efficacy data is rarely available, most herbal medicines are approved for well- established or traditional use. A bibliographic application is permitted, which must 95 provide a detailed scientific bibliography addressing non-clinical and clinical characteristics. If published literature does not meet minimum 98 requirements, it can be combined with additional non-clinical tests as a mixed application. The requirement for proof of efficacy is replaced by a plausibility requirement. Without this simplified procedure, most traditional herbal medicines would be unable to fulfill the well-established use requirement for detailed references to published scientific literature on product safety and efficacy. Traditional medicines from China, India and Brazil, for example, may fail to satisfy this condition. Other nations, such as China, have similar requirements for a history of domestic use, which may have a protectionist element. In other words, these regulations may promote the sale of local goods while preventing the sale of goods produced in other nations. Generally, traditional Chinese medicines are regulated as drugs and must adhere to many of the regulations for pharmaceutical medicines. This applies to all Chinese herbal medicines regardless of their dosage form (oral tablet, injection, etc. Only traditional medicines registered as drugs are permitted to make therapeutic claims. Without preexisting approval, the new approval process is extensive and similar to the approval process of pharmaceuticals. Approval requires submission of pre-clinical and clinical study data, and approved medicines are then subject to up to five years of additional post-market surveillance. For example, traditional medicines are also required to adhere to information in the pharmacopoeia and in 105 relevant monographs. If herbal products are used as ingredients in food and do not make specific health 107 claims, then there is no registration requirement as a drug. Traditional medicines in food which claim health effects (these are general health claims, but not specific therapeutic claims) undergo special 108 regulation as health foods. Health foods must have raw materials and final products that comply with food hygiene requirements and that do not cause human harm, animal or human studies to demonstrate a health effect, and a formulation and dosage based on 109 scientific evidence. Traditional medicines that would qualify as health foods, but that are not indigenous to China, have separate regulations as novel health foods. Modern regulations on traditional medicine began with the Drugs and Cosmetics Act of 1940, which contained a separate chapter and rules for Ayurveda, Siddha 110 and Unani drugs.

By adding the residual volume to the vital capacity purchase top avana overnight, total lung capacity can then be calculated generic top avana 80mg visa. Typically top avana 80 mg with amex, labs using the gas dilution technique utilize either the closed circuit helium (He) method or an open circuit nitrogen (N2) method. The starting volume of gas containing the helium is known and the amount of helium in the lungs at the start is zero. Since helium is inert, it does not diffuse across the alveolar- capillary membrane, and the gas equilibrates throughout the entire system. After the patient breathes normally for up to 10 minutes, equilibration usually occurs, and the amount of helium in the system is again measured. The open circuit nitrogen method is based on a similar principle of the helium technique, except here the expired concentration of nitrogen normally present in the lungs is now measured. In this technique, the patient is given 100% oxygen to breath in order to wash out the air (mostly made up of nitrogen) from the lungs. The concentration of nitrogen is continuously monitored in the expired gas, and when the exhaled concentration of nitrogen is essentially zero, the test ends. Body Plethysmography Body plethysmography is another technique used to measure lung volumes. This method incorporates the physiologic principle of Boyle s law which states that the product of the pressure times the volume of a gas is constant if the temperature is unchanged, or P1V1=P2V2. This causes the chest volume to expand which in turn causes a decrease in the box volume and a corresponding increase in box pressure. The pressure change in the box is recorded and thereby allows for a calculation of the change in box volume, which is equal to the change in lung volume. Lung volumes measured by body plethysmography, may be higher than volumes measured by using gas dilution method. This is primarily due to the measurement of both communicating and non-communicating compartments of the lungs with plethysmography, as opposed to just measuring the communicating compartments alone using the gas dilution techniques. It is therefore a more accurate test in patients with severe airway obstruction (where there is trapped air from airways that collapse at low lung volumes) as well as those with bullous lung disease or emphysema. Diffusing Capacity Diffusing capacity is a measurement of the ability of gases like oxygen to transfer from the alveoli into the pulmonary capillary blood. A low diffusing capacity is rarely a cause for hypoxia (low oxygen levels) at rest but can be a cause during physical exertion. Diffusing capacity is a non-invasive test which involves the inhalation of a gas mixture containing a small amount of carbon monoxide because this gas is normally not present in the lungs or blood, and is very soluble in blood. This small amount will not be harmful to the patient and does not last long in the body so it will not be present later that day if a fire fighter has carbon monoxide level taken at a fire or in an emergency room. During the diffusing capacity test, a known amount of carbon monoxide is breathed in and then whatever is not subsequently breathed out should represent the amount that diffused through the lung and into the pulmonary capillary system. In this technique, the patient exhales completely, and then inhales a gas mixture deeply, that contains 0. The patient then holds their breath for 10 seconds, during which time the carbon monoxide leaves the air spaces and enters the blood. The amount of gas diffused from the lung into the pulmonary capillary system is related to the surface area of the lung, the capillary blood volume, and the thickness of the alveolar-capillary membrane. Any condition which alters any one of these factors can cause a reduction in diffusion. In emphysema, the walls between the alveoli break down, creating fewer alveoli, and this loss of surface area is associated with reduced diffusion. Pulmonary embolism (blood clots) or pulmonary hypertension results in the obliteration and/or obstruction of pulmonary arteries. In these patients, the measurement of gas transfer for carbon monoxide is usually reduced. Interstitial lung diseases affect the meshwork of lung tissue (alveolar septa) other than the air spaces (alveoli), and can result in thickening of the alveolar-capillary membrane making it harder for gas to diffuse. Pulmonary diseases that essentially just affect the airways, such as asthma or chronic bronchitis, do not demonstrate a reduced diffusion capacity. Increased diffusion capacity is rarely important but may occur if the patient is bleeding into their lung. Diffusion capacity is a valuable tool in the diagnosis and monitoring of pulmonary diseases. It should be noted however that there are some patients with interstitial lung disease who are found to have diffusion abnormalities before lung volume abnormalities are present. It is low in some patients with obesity due to compression of the lung and its circulation. Low hemoglobin concentration (as in anemia) also leads to a reduced diffusion capacity as there is less blood to diffuse onto; a correction for anemic patients is sometimes used. Likewise, diffusing capacity can be elevated in a condition called polycythemia (increased number of red blood cells). It can also be low in patients with carbon monoxide intoxication (acute or chronic exposures even from tobacco smoke). People with asthma will respond to bronchoprovocation with a greater degree of airway obstruction than will normal subjects. Methacholine is a commonly used provocative agent that is a nonspecific stimulus of bronchoconstriction, though cold air and exercise testing are also sometimes used. Following testing, a bronchodilator is administered and lung function returns to normal and symptoms resolve. The lower the dose that is required, the more hyperreactive the individual s airways are. Cough variant asthma, in which the patient has asthma though only coughs as the main presentation, can also be diagnosed by this method. It also has been used to follow subjects with exertional asthma, occupational asthma, document the severity of asthma and to assess the response to treatment. Presence of increased airway responsiveness is a significant predictor of subsequent accelerated decline in pulmonary function. It is important to understand that provocative testing is only of use in patients with normal lung function when the diagnosis of asthma is in question. Medications may influence this test and therefore should be carefully discussed with the physician before provocative challenge testing is ordered. Corticosteroids, leukotriene antagonists (such as Singulair) and antihistamines may interfere with the accuracy of provocative testing. However, if you have a history of using these medications you should bring them with you, tell the person administering the test about them and be prepared to use them on your way home if necessary. Exercise testing allows for the correlation of exercise-induced symptoms with objective data. Exercise tests can quantitate the degree of functional impairment and help determine whether the limiting factor is pulmonary, cardiac, pulmonary vascular, or due to decreased conditioning. This would include any individual who has severe physical or emotional impairments where testing is deemed unsafe.

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