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By M. Kan. Fresno Pacific University. 2018.

It makes little difference to the citizen whether statements such as the list of national targets for physical activity in England cheap 5mg vasotec with mastercard enrique iglesias heart attack, issued by the Faculty of Public Health Medicine in February 1993 buy 5mg vasotec overnight delivery heart attack urine, emanate from the Left or the Right, as in either case the citizen is threatened by the tyranny of the majority, if he chooses not to fulfil his quota of exercise. Any prescriptive system to make man free, or healthy, ends by enslaving him, or by taking health away from him. Those who conform, whether out of greed, cowardice, stupidity or genuine enthusiasm. Fascism and communism are histori- cal forms of totalitarianism which are unlikely to re-emerge in the same form in Western democracies, and even less so under the same name. The brave new world of the year 2000 is being heralded in the name of medical science, genetics, and the promise of longevity. The criminalisation of motherhood was dis- cussed by Ernest Drucker, professor of epidemiology and social medicine at Montefiore Medical Center in the Bronx, where about a quarter of all women who give birth use drugs, 46 such as cocaine. About half of the newborn babies who test positive for drugs are removed from their mothers and placed in foster care. Drucker illustrated this practice in a case of a poor Puerto-Rican woman, whose baby was taken away from her after birth. She had a complication of pregnancy known as placenta praevia and the baby died shortly after birth. Annas asked: Does it make any sense to decree that the pregnant woman must, in effect, live for her foetus? That she commits a crime if she does not eat only healthy foods; smokes cigarettes or drinks alcohol; takes drugs (legal or illegal); has intercourse with her husband? Favouring the foetus radically devalues the pregnant woman, and treats 158 Coercive medicine her like an inert incubator, or as a culture medium for the foetus. Women have always been unequal citizens, at least in medical eyes, but this has been obscured by the rhetoric of equality. Women have been barred from employment that was con- sidered harmful to a foetus, even if they were not pregnant. In 1978, American Cyanamid banned all women of childbear- ing age (defined as 16 to 50) from their plant in West Virginia, unless they could prove that they had been sterilised. Free sterilisation was offered and five women accepted it rather 48 than being dismissed. A Nevada woman who drank some beer the day 49 before she went into labour lost custody of her child. The New England Journal of Medicine reported 21 such cases in women who were, as a rule, single, poor, and coloured; Acceptance of forced caesarean sections, hospital deten- tions, and intra-uterine transfusions may trigger demands for court-ordered pre-natal screening, foetal surgery, and restrictions on the diet, work, athletic activity and sexual 50 activity of pregnant women. The woman did not consent, so she was brought to court, where her doctor claimed that there was a 99 per cent probability that the child would die and a 50 per cent probability that the mother would die, if a caesarian section was not performed. She won an appeal to the Georgia Supreme Court and, shortly after- wards, delivered a healthy baby without surgical inter- 52 vention. While some women may be forced to keep their pregnancy against their will others may be prevented from becoming pregnant. It usually takes some 15-20 years before American fashions in public health are adopted in Britain. Yet a High Court in London, in October 1992, ordered an emergency caesarean section on a 30-year-old woman, who refused the operation on religious grounds. In 1992, in Erlangen, Germany, an 18-year-old woman was killed in a car accident and since she was carrying a four-month-old 160 Coercive medicine foetus it was decided to keep the brain-dead woman on a life-support machine until the baby could be delivered. Police powers may even extend to forcing women to undergo a gynaecological examination if there is a suspicion that they have had an illegal abortion abroad. According to a study carried out in 1991 by the Max Planck Institute for Foreign and International Law in Freiburg, there were about ten such cases a year, especially in women returning to Ger- 58 many from the Netherlands. As early as 1963, Erwin Goffman noted that: Only one completely unblushing male in America is a young, married, white, urban, northern, heterosexual Protestant father of college education, fully employed, of good complexion, weight and height and a recent record 60 of sports. Medical screening of healthy humans is the latest addition to collecting information on private citizens. It is the apparent benevolence of the purposes of health screening - to prevent disease and to prolong life - which makes it particularly dangerous, as its more sinister aspects go unnoticed. Epidemiologists, physicians, and other policy makers often treat an estimate of the likelihood of something happening 62 to an individual as an important fact about him. This new statistical or actuarial concept of risk only became part of health promotion rhetoric in the 1970s. This develop- 162 Coercive medicine ment is in line with the neopuritanical tendency towards nor- malisation.

Wales best 5mg vasotec pulse pressure guidelines, Australia vasotec 5mg overnight delivery arrhythmia in 5 year old, and recently co-authored Selling Sickness: How the World’s Biggest Pharmaceutical bowel syndrome (see pp. David Henry is a professor of cholesterol and osteoporosis, being Three decades ago, Ivan Illich clinical pharmacology at the University of Newcastle, argued polemically that the medical Newcastle, New South Wales, Australia, and co- framed as diseases. The Essay section contains opinion pieces on topics Lynn Payer described widening the * To whom correspondence should be addressed. Considered by health professionals, industry leaders, some as a serious academics, or policymakers—are psychiatric illness, now underwritten by the marketing premenstrual departments of large drug companies dysphoric disorder rather than by organizations with is regarded a primary interest in public health. As a recent Reuters Business Insight there are often report on so-called lifestyle drugs— different motives designed to be read by pharmaceutical for the different industry leaders—pointed out, “The individuals who coming years will bear greater witness get caught up in to the corporate sponsored creation disease-mongering of disease” [10]. In the years will also bear witness to a much pharmaceutical more vigorous effort from within civil industry and in the society to understand and to challenge public relations that corporate process. For their conception of the phenomenon is who suffer severe forms of the problem, part, the motives of health professionals warranted—requiring researchers to who will benefit greatly from treatment and health advocacy groups may well be explore the uncertainty surrounding and may be helped enormously by the the welfare of patients, rather than any the definition of the problem, how and publicity and marketing given to both direct self-interested financial benefit, why different stakeholders understand the treatment and the disorder. For but we believe that too often marketers it differently, and the deeper social and example, industry-funded awareness are able to crudely manipulate those economic contexts. But in other cases, the actors in disease mongering will be a within social democracies worldwide, same marketing/awareness-raising key step towards a better understanding and the consequent commercialisation campaign will be viewed very differently of this phenomenon. Before embarking on to grow the potential markets for their to help sell a re-branded version research agendas to investigate disease products. As threats to independence from doing More conventional health-science part of such an examination, a series of so [15]. By way of contrast, many methodologies may prove to be case studies would inevitably emerge, consumer/advocacy groups around valuable ways of investigating the warranting deeper study and research the world now rely on such funding potential influences of a disease- and serving as a way to popularize [16], raising questions about their marketing campaign on outcomes such awareness of the process of disease credibility, particularly as they are often as public perceptions of a particular mongering. An open debate within the drugs linked to that disease, and study of the launch of a new or recently the health consumer movement about even health status of those diagnosed expanded disease or condition. A global collaboration could, for its involvement in disease mongering, Multisite controlled studies of drug example, study the way female sexual would be welcome. The success profile scholars with an interest in the of sildenafil depended on corporate- area of medicine and the media, Lisa A challenge to the funded disease-awareness campaigns Schwartz and Steven Woloshin, present excesses of disease promoting erectile dysfunction [13], a timely and relevant case study on the and similarly the commercial success “selling” of restless legs syndrome [6]. While also investigating the extent to which challenging since almost everyone is activists and scholars have begun the media stories on medicine either report exposed to disease mongering in some process of observing these activities, it appropriately on the nature and extent form. Similarly, rigorous studies of is our view that the magnitude of public of illness or tend to simply regurgitate publicly funded “counter-detailing”— and private resources spent on these the promotional messages of disease- where noncommercially oriented products, the potential harm that can mongering campaigns (http:⁄⁄www. Around the world, there are tentative the influence of the pharmaceutical First, academic investigation of the steps to identify, understand, and industry in Britain, the Royal College of prevalence of this problem would be combat the threat to human health General Practitioners outlined serious highly desirable. Researchers could, from the corporate-sponsored selling concerns about the process [17]. These small steps are being subsequent report recommended that common (high-burden) diseases/ taken by several players within the industry-funded disease-awareness conditions, and investigate how and health field, and we trust this theme campaigns should no longer be “veiled why the definitions of those diseases/ issue may support and augment these advertising” of branded drugs [18]. Such retrospective At a consumer level, Health Action pharmaceutical companies have investigations could include analysis of International (http:⁄⁄www. Yet in the debate those decisions, the conflicts of concerned about what it has described about research and development for interest of panel members and their as the blurring of boundaries between treatments for neglected diseases in the respective professional bodies, and ordinary life and medical illness in developing world, there are strong signs the sponsorship of these processes. Unlike driven by motivations other than profit happening in a random, ad hoc way many patient advocacy groups, Health [19]. Tiefer L (2006) Female sexual dysfunction: A case study of disease mongering and activist understand more of the implications private) insurers. Parry V (2003) The art of branding a within industry, just as other parts of to promote a renovation in the way condition. Coe J (2003) Healthcare: The lifestyle drugs outlook to 2008, unlocking new value in well- disease mongering from within. Lexchin J (2006) Bigger and better: How Pfizer better understand the phenomenon of assembled, free of commercial conflicts redefined erectile dysfunction. Australia, for example, it has been who would ultimately generate more Available: http:⁄⁄haiweb. Health Action International (1999) The ties subsidy for inappropriate prescriptions Until a rigorous research agenda is that bind: Weighing the risks and benefits of several high-profile drugs to people initiated, and the social renovations of pharmaceutical industry sponsorship.

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Also purchase 10mg vasotec with visa arteria umbilical, it is important to highlight which stakeholders are involved in activities with key roles to play in disease prevention and control (e cheap 5mg vasotec fast delivery blood pressure normal child. How: The management plan should describe the specific disease management practices required. The logistics and practicalities of their implementation should be explicit or sources of this information should be provided. When: The timing of disease management activities should be described, both in terms of when to be implemented and their duration. For example, specific disease management activities may be required to coincide with seasonal use of the wetland by domestic livestock or migratory wild animals, or in response to ‘seasonal’ diseases. Similarly it should be explicit when to cease or reduce other activities which might have a negative impact on disease prevention or control. For example, during periods where there is a high risk of disease outbreak, anthropogenic stressors should be reduced or restricted to less sensitive areas of a site. Staff awareness and training The outbreaks are seasonal in nature (in response to factors including hot weather) hence a training presentation is provided to all grounds staff (i. Training includes information about the disease, recognising disease signs in the field, principles of disease control and the annual action plan. All appropriate staff with a role to play in the prevention and/or control of outbreaks are, therefore, aware of the actions to be taken and their responsibility for their Figure 3-6. Summary of management actions During the next eight weeks (or whatever period is considered appropriate i. Prevent environmental conditions that can lead to an outbreak Keep water levels stable. Environmental factors Maintain water pump in ‘South Lake’ (area of high risk and previous disease outbreak). Keep high volume of water moving through the ‘South Lake’ (replace in-flow pipe with one of larger diameter). The pipe bringing water from the canal to the ‘Swan Lake’ to be continued to be kept clear, including regular clearing of grids at either end. Care to be taken when strimming/cutting vegetation to prevent organic matter entering water bodies. Carcase and maggot removal Vegetation at water’s edge will be strimmed/cut to allow easier searches for sick and dead animals. Active searches for carcases of all species (including fish) to begin immediately, with extra searches in priority areas. Searches to be done early in the morning to reduce effects of the disturbance on visitors. All grounds staff and volunteers to be extremely vigilant – looking for any birds showing early stages of paralysis, obviously sick birds and carcases. Double bagging to collect carcases (a single bag can be knotted, inverted and knotted again to create double bag). Recording: details of species, ring number and location of sick and dead birds to be recorded. Bags containing carcases, maggots and substrate containing maggots to be put into freezer to kill maggots. Consideration given to scaring techniques in case birds need to be scared from specific sites. If the need arises, one half of isolation area to be set up to as a hospital unit for sick birds. The aim is to consider possible emergency disease scenarios and to integrate rapid cost effective response actions that allow outbreaks to be controlled and prevented in the future. Contingency plans should be considered, ‘bought into’ and agreed upon by all major stakeholders, and have appropriate resources and legislative backing where necessary. Regular simulation exercises will also serve to highlight any modifications required in contingency plans where aspects are subject to change such as incorporating new staff, new emerging disease threats and legislation and regulations [►Section 3. Plans should include clear objectives and guidelines and be written in language that is understandable to all relevant stakeholders. Above all, plans should provide sufficient information to allow the relevant authorities and managers to make informed decisions on appropriate policies and measures used to control a disease outbreak. It is advisable to develop contingency plans for specific high-risk/high priority diseases which incorporate generic standard operating procedures that may be common to several different specific plans. These should be supported by additional financial and resource plans and supportive legislation to ensure enforcement of contingency plans when needed.

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The committee recog- nizes the need for a safe generic vasotec 5mg on-line arrhythmia medicine, effective cheap vasotec 10mg online heart attack one direction song, and affordable hepatitis C vaccine and offers the following recommendation: Recommendation 4-7. Studies to develop a vaccine to prevent chronic hepatitis C virus infection should continue. Comprehensive viral hepatitis services should have fve core components: outreach and awareness, prevention of new infec- tions, identifcation of infected people, social and peer support, and medical management of infected people. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The committee offers recommendations to address major defciencies for each group and health-care venue. As treatments for chronic hepatitis B and C improve, it becomes critical to identify chronically infected people. There- fore, it is important that the general population have access to screening and testing services so that people who are at risk for viral hepatitis can be identifed. Federally funded health-insurance programs— such as Medicare, Medicaid, and the Federal Employees Health Ben- efts Program—should incorporate guidelines for risk-factor screening for hepatitis B and hepatitis C as a required core component of pre- ventive care so that at-risk people receive serologic testing for hepatitis B virus and hepatitis C virus and chronically infected patients receive appropriate medical management. Thus, there is a growing urgency for culturally appropriate programs to provide hepatitis B screening and related services to this high-risk population. There is a pervasive lack of knowledge about hepatitis B among Asians and Pacifc Islanders, and this is probably also the case for other foreign-born people in the United States. The committee be- lieves that the needs of foreign-born people are best met with the approach outlined in Recommendations 3-1 and 3-2. The community-based approach as outlined in Recommendation 3-2 would be strengthened by additional resources to provide screening, testing, and vaccination services. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The Centers for Disease Control and Prevention, in conjunction with other federal agencies and state agencies, should provide resources for the expansion of community-based programs that provide hepatitis B screening, testing, and vaccination services that target foreign-born populations. Federal, state, and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus pre- vention programs. At a minimum, the programs should include access to sterile needle syringes and drug-preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus. Although illicit-drug use is associated with many serious acute and chronic medical conditions, health-care use among drug users is lower than among persons who do not use illicit drugs. Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepatitis C. The services should include testing to detect infection, counseling to reduce alcohol use and secondary transmission, hepatitis B vaccination, and referral for or provision of medical management. Preventing the transition from non-injection-drug use Copyright © National Academy of Sciences. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The com- mittee therefore offers the following research recommendation: Recommendation 5-5. Innovative, effective, multicomponent hepatitis C virus prevention strategies for injection-drug users and non-injection- drug users should be developed and evaluated to achieve greater con- trol of hepatitis C virus transmission. In particular, • Hepatitis C prevention programs for persons who smoke or sniff heroin, cocaine, and other drugs should be developed and tested. However, most programs are understaffed and underfunded and cannot offer adequate case-management services. The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepa- titis B prevention program coordinators to expand and enhance the capacity to identify chronically infected pregnant women and provide case-management services, including referral for appropriate medical management. The National Institutes of Health should sup- port a study of the effectiveness and safety of peripartum antiviral therapy to reduce and possibly eliminate perinatal hepatitis B virus transmission from women at high risk for perinatal transmission. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Screening of all incarcerated people for risk factors can identify those who need blood tests for infection and, if appropriate, treatment. The Centers for Disease Control and Preven- tion and the Department of Justice should create an initiative to foster partnerships between health departments and corrections systems to ensure the availability of comprehensive viral hepatitis services for incarcerated people. Community Health Centers The Health Resources and Services Administration administers grant programs across the country to deliver primary care to uninsured and underinsured people in community health centers, migrant health centers, homeless programs, and public-housing primary-care programs.

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