Trump’s Kill and Cure Medicine for Afghanistan – HuffPost

On August 21, President Trump prescribed a new kill and cure medicine for winning the war in Afghanistan. Killing terrorists is the kill part of the medicine while negotiating with the Taliban at some surprise moment in the future is the cure part. The kill part is not new. Since 9/11, U.S. presidents have employed soaring rhetoric to sell the kill part. President Bush executed the kill part through the invasions of Afghanistan and Iraq. President Obama, the recipient of the 2009 Nobel Peace Prize, staged drone strikes in Afghanistan, Pakistan, Somalia, and Yemen to kill both alien and citizen terrorists.

The cure part is sort of new because previously (even before 9/11) the U.S. presidents publically vowed not to talk to the terrorists, though first secretly or sometimes openly, they all have negotiated with the leaders of terrorist organizations, including Yasser Arafat, Gerry Adams, Osama bin Laden, and Mullah Omar. Trump is simply making the cure part a bit less covert.

Killing terrorists is now a global practice of warfare that many nation-states endorse and act upon, ignoring the strictures of extra-judicial killings. Israel pioneered the state practice by killing Palestinian leaders in occupied territories, including the 2004 drone assassination of Sheikh Yassin, a quadriplegic leader of Hamas. Upon 9/11, the U.S. too adopted an open policy of killing terrorists. Recall, however, that the covert policy of killing foreign leaders has been for decades a part of the U.S. foreign policy.

The U.S. changed the kill rule of international law. When a minor state violates a rule of international law, it is considered a breach or crime; and, the violating state may be punished with economic sanctions or use of force. When a superpower violates a rule of international law, the rule itself loses legitimacy and may be abandoned if extensively violated. Such de-enactments of rules, though uncommon, are part of international lawmaking. Killing terrorists has been established as a recognized exception to the prohibition against extra-judicial killings.

One problem with the kill rule is the classification of terrorists subject to assassination. However, the classification is no longer confined to persons who personally commit acts of terrorism. A mastermind such as Osama bin Laden who finances terrorism is a legitimate target. So is an intellectual who incites resistance, as did Anwar Awlaki, a U.S. Citizen killed in a drone strike in Yemen. So is a spiritual leader, such as Sheikh Yassin. Afghan Taliban Chief Mullah Omar, though not killed, died under a hanging sword of U.S. bounty of $25 million placed on his head.

Theoretically, the kill part of the medicine may unleash fierce bombings of the Afghan Taliban who control significant territory of Afghanistan. Mega bombs may be routinized in all parts of Afghanistan. Likewise, drone warfare may escalate both in Afghanistan and Pakistan. This course of chemotherapy, however, is highly improbable, despite the anticipation of medicine.

It is unclear how Pakistan would react to increased drone strikes within Pakistan. Previous U.S. administrations would use drones or other strikes, including the killing of Osama bin Laden, with permission from and prior notice to the Pakistan armed forces. This covert strategy is unlikely to change, though the public rhetoric from both governments may turn mutually antagonistic.

If perchance the Trump administration pursues a unilateral kill policy in Pakistan, the Afghanistan war will break for the worse. Pakistan may shoot down U.S. drones, cutoff supply routes, or unleash groups willing to fight India in Kashmir. This development will generate a head-on collision between Pakistan and the U.S. It is highly doubtful that the U.S. and Pakistan will resort to such extremity, given the close relationship between U.S. and Pakistan militaries and intelligence communities.

In sum, the kill part of the medicine will remain a tool of propaganda, though a lot of civilians will be killed in showoff bombings and drone strikes. Afghanistan, one of the poorest countries in the world, will continue to suffer adversity, as it has in the past. The U.S. will fail to eliminate the Taliban, strengthen Afghan democracy, or bring prosperity to the people of Afghanistan. The kill part will be downright ineffective.

By contrast, the cure part carries some promise. Trump made two things clear: first, the U.S. is no longer interested in nation-building or promoting democracy in Afghanistan. This means that the people of Afghanistan may choose a form of government other than liberal democracy or democracy at all. It also means that the people of Afghanistan may choose a form of government consistent with the Shariah principles, much like the people of Saudi Arabia or the United Arab Emirates. This ideological flexibility may pave the way for the Taliban to take interest in negotiating an exit deal with the U.S.

The second thing that Trump made clear is the U.S. willingness to negotiate with the Taliban. Even though Trump indicated that the U.S. is open to talking to some elements of the Taliban, the pragmatics will dictate that the U.S. negotiate with the Taliban leadership. The cure part also means that Pakistan, commanding influence over the Afghan Taliban, will play a crucial role in shaping the future of Afghanistan. Pakistan furnishes the medium, the credibility, and the logistics for direct negotiation between the U.S. and the Afghan Taliban. To balance these services from Pakistan, Trump asks India to furnish resources for development in Afghanistan.

The U.S. can kill thousands of people in Afghanistan, as it has in the past sixteen years, but the kill medicine will not furnish a face-saving exit from this longest war in the U.S. history. The war will become ghastlier and the world less safe if the U.S. picks an unnecessary fight with Pakistan because Pakistan will divert its frustration against India, triggering yet another South Asian war. The way forward for the U.S. is no other but direct negotiation with the Taliban leadership without killing their leaders. Moreover, the time for negotiation is now and not at some unannounced surprise party in the future.

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Trump’s Kill and Cure Medicine for Afghanistan – HuffPost

Northwestern Medicine Caregivers Practice Having Difficult Conversations – Northwestern University NewsCenter

Margaret Chapman, MD, assistant professor of Medicine in the Division of Hospital Medicine, practices delivering bad news to a simulated patient.

Frontline caregivers practiced breaking bad news to simulated patients at an innovative new multi-site seminar broadcast from Feinbergs Simulation Lab earlier this month. The seminar uses active learning techniques to provide far more skill development than a simple lecture, according to course organizers.

The course was led from Feinberg by Gordon Wood, MD, 07 GME, assistant professor of Medicine in the Division of Hospital Medicine, and simultaneously broadcast to Lake Forest Hospital, KishHealth Foundation, Central DuPage Hospital and Marianjoy Rehabilitation Hospital. Participants included physicians, advanced practice providers, social workers and nurses.

A recent survey of 900 Northwestern Medicine healthcare providers found that education around improving communication skills was a key area for clinical caregivers. The course was not simply a way to make a patient momentarily more comfortable; rather, evidence shows strong associations between a healthcare providers communications skills and their patients outcomes. Yet, many caregivers have not received specialized training, even as recent studies have demonstrated the utility of small-group interventions.

A lot of people used to think youre either born a good communicator or youre not, Wood said. But, what were finding is that communication skills are teachable.

Watching a keynote and being lectured at isnt the solution, according to Wood, because communication is a learned skill, and the only way to improve is to put theory into practice. Therefore, the workshop was designed to feature ample time for deliberate practice using simulated patients, trained actors playing the role of patients.

Wood reviewed common disclosure systems, instructed participants how to deliver serious news clearly but compassionately and how to recognize when a patient needs time and space to process the news. Next, participants broke out into small groups to practice with the simulated patients. As Wood led the group at the Feinberg site, expert faculty facilitators and trained actors were at the other four Northwestern Medicine locations, providing the same experience to all participants.

It felt exactly like how it feels in a real patient scenario, rather than if we were just role playing with another participant in the course, said Margaret Chapman, MD, assistant professor of Medicine in the Division of Hospital Medicine as of September 1.

The authentic experience made it very simple to bring the lessons learned into a real-world setting, according to Chapman.

As a general internist, people often come to me with undifferentiated symptoms Im in the position to make a lot of first diagnoses, some of which are major problems, she said. The ability to practice with a patient in that high fidelity setting allowed us to take a critical eye to our personal communication skills, break down components of a difficult conversation and assemble what we knew and had just learned into a toolkit.

Nabil Issa, MD, associate professor of Surgery in the Division of Trauma and Critical Careand ofMedical Education, completed a prior session of the training and said it provided skills that hes been able to put into practice with his own patients, I lead difficult conversations and goals of care every time Im on service, whether in the surgical intensive care unit, acute care surgery or trauma, and this course provided me with totally new tools to rethink and improve my approach.

Multi-site training such as the difficult conversations course establishes a platform for simultaneous learning and sharing protocols across the Northwestern Medicine system, according to course organizers. The value of that collaboration wasnt lost on participants, said Chapman.

It was occurring at so many different sites with such a wide variety of professional backgrounds. It made for a well-rounded approach to the topic of communication, she said.

Physicians who went through similar training were found to use more empathy and ask more questions to understand the patients perspective, according to previous research. But the most telling measure of success, according to Wood, was a more informal study where people looked at video of patient interactions both pre-and post-training, without knowing which video was which. The subjects could sort a pre-training video from a post-training video over 90 percent of the time, illustrating the drastic improvement that can come from practicing on simulated patients.

The seminar was also supported by the Department of Innovations at Northwestern Medicine and Feinberg Information Technology.

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Northwestern Medicine Caregivers Practice Having Difficult Conversations – Northwestern University NewsCenter

Generic medicine law ‘may hurt patients’ – The Nation

THE UNIVERSITY Hospital Network has warned that some patients may suffer at the hands of the new Government Procurement and Supply Management Act, which requires them to use more generic medicines.

Taking effect today, the legislation requires medical-school hospitals to forego original drugs in favour of generic alternatives from the Government Pharmaceutical Organisation (GPO).

Also, they are legally required to ensure that at least 60 per cent of their medical supplies come from the GPO.

While quality generic medicines work well in most cases, some patients need original drugs, the University Hospital Network said in a statement yesterday.

The statement added that some patients could face grave consequences as soon as the new law became effective.

The University Hospital Network, which covers 19 institutes, said medical facilities would not buy original drugs for patients if their actions could be seen as defying the law.

We have raised our concerns in the hope that medical facilities will be allowed to consistently procure drugs, prosthetics and other medical supplies for patients so that there is no adverse impact on patients, the statement added.

Speaking on condition of anonymity, a medical lecturer said university hospitals had never before been required to buy drugs from the GPO.

This is the first time medical-school hospitals have been subject to such a stipulation. And there is a 60-per-cent buying percentage requirement too, he said.

Under the new Government Procurement and Supply Management Act, other state hospitals have to buy at least 80 per cent of their medical supplies from the GPO an increase over the 60-per-cent requirement.

The medical lecturer said he had been informed that the GPO did not even produce some generic drugs itself, but just repackaged the medicines under the GPO brand.

Patients will be definitely affected because some will need to use original drugs. When university hospitals cannot provide such drugs, [those patients who can afford to do so] will have to go to private hospitals, he said.

On August 8, several medical school executives submitted a petition to Finance Minister Apisak Tantivorawong asking him to review the procurement guidelines for medicines, prosthetics and other medical supplies.

Comptroller Generals Department director-general Suttirat Rattanachot has defended the new Government Procurement and Supply Management Act.

In an interview earlier this month, she said the law allowed state hospitals to draw up their own new regulations for procurement, as long as they were in line with the acts objectives and won approval from the Government Procurement and Supply Management Policy Board.

She added that the act did not even give priority to prices in the procurement process.

It is not necessary that buyers must go for the cheapest price. Quality is a factor for consideration, Suttirat said.

She added that the Finance Ministry had already prepared seven draft ministerial regulations to facilitate enforcement of the act.

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Generic medicine law ‘may hurt patients’ – The Nation

Tully Family Medicine opens in Athol – The Recorder

ATHOL Locals can now add routine medical appointments to their list of errands to do at North Quabbin Commons, as Tully Family Medicine has relocated to a new office on the east end of Athol.

One half of the 7,650-square-foot facility at 81 Reservoir Drive opened to the public Monday, with a walk-in clinic named Heywood Urgent Care expected to open in the other half in the fall. Office Manager Mary Paluk said at roughly 12:30 p.m. that scheduled appointments had been running smoothly.

So far, so good, she said, literally knocking on the wooden arm of a chair in the waiting area.

Tully Family Medicine now has eight examination rooms and is twice the size of its former location in Phillipston.

Paluk said Mondays are typically the busiest day of the week, and this Monday was no exception.

We had a full schedule. We hit the ground running, she said.

Paluk said Tully Family Medicine employs about 15 people and Heywood Urgent Care will employ 10 to 15. Both operations will be run by Heywood Medical Group, a nonprofit physician organization affiliated with Heywood Hospital. Heywood Medical Group is part of Heywood Healthcare, an independent community-owned health care system serving north central Massachusetts and southern New Hampshire.

Paluk said staff moved in equipment and supplies Friday.

Amanda MacFadgen, spokeswoman for Heywood Healthcare, said Tully Family Medicine will be led by Dr. Elizabeth Nottleson, with Deborah Plotkin, Carrie-Anne Case and Christopher Ambler as the facilitys nurse practitioners.

Win Brown, president and CEO of Heywood Healthcare, said the organization is committed to improving access to health services for the North Quabbin region.

In their new location in North Quabbin Commons, Tully Family Medicine has the ability to double their space and expand their care team, enabling more patients from infants to seniors to obtain convenient, quality primary care services right in their own community, he said.

Reach Domenic Poli at: or 413-772-0261, ext. 258. On Twitter: @DomenicPoli

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Tully Family Medicine opens in Athol – The Recorder

NMSU’s Burrell College of Osteopathic Medicine welcomes second class – El Paso Proud

LAS CRUCES, NM (KTSM) – It’s back to school time for thousands including students at the Burrell College of Osteopathic Medicine in Las Cruces.

The new school is looking to address a growing need in the Borderland. “There’s a need for doctors in Southern New Mexico and in El Paso,” said Muneer Assi, Chair of Internal Medicine.

Until last year, New Mexico only had one medical school, today, the second class of medical students at Burrell College of Osteopathic Medicine.

First year medical student Macken Yrun-Duffy is a Tuscon native and says Burrell is the perfect fit for him. “I love the southwest, I want to stay and help the community in the southwest,” said Yrun-Duffy. “Burrell has a partnership with hospitals in Tucson so I can do my rotations there 3rd and 4th year.”

For others, staying close to home was important. “I have the convenience of seeing my family and getting their support which is really important to me,” said Irene Martinez, a UTEP graduate and El Paso native.

There are currently 162 students, and they’re hoping they stay close.

“We’re here to get more physicians to stay in the area because this is an area of need and the more physicians that we can train in the area, that are from the area, maybe they’ll stay in the area,” Dr. Assi said.

Hopefully, with the new medical school the students, faculty and staff can give the area’s doctor shortage a cure.

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Medicine | Define Medicine at

a specialized dictionary covering terms used in the health professions by doctors, nurses, and others involved in allied health care services. A dictionary with authoritative spellings and definitions is a particularly crucial resource in medicine, where a misspelling or misunderstanding can have unfortunate consequences for people under care. Print dictionaries in this field may be sorted alphabetically or may be categorized according to medical specializations or by the various systems in the body, as the immune system and the respiratory system. The online Medical Dictionary on allows alphabetical browsing in the combined electronic versions of more than one authoritative medical reference, insuring access to correct spellings, as well as immediate, direct access to a known search term typed into the search box on the site:

A medical dictionary reveals that large numbers of medical terms are formed from the same Latin and Greek parts combined and recombined.

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Medicine | Define Medicine at

medicine | science |

Alternative Title: medical practice

Medicine, the practice concerned with the maintenance of health and the prevention, alleviation, or cure of disease.

The World Health Organization at its 1978 international conference held in the Soviet Union produced the Alma-Ata Health Declaration, which was designed to serve governments as a basis for planning health care that would reach people at all levels of society. The declaration reaffirmed that health, which is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. In its widest form the practice of medicine, that is to say the promotion and care of health, is concerned with this ideal.

It is generally the goal of most countries to have their health services organized in such a way to ensure that individuals, families, and communities obtain the maximum benefit from current knowledge and technology available for the promotion, maintenance, and restoration of health. In order to play their part in this process, governments and other agencies are faced with numerous tasks, including the following: (1) They must obtain as much information as is possible on the size, extent, and urgency of their needs; without accurate information, planning can be misdirected. (2) These needs must then be revised against the resources likely to be available in terms of money, manpower, and materials; developing countries may well require external aid to supplement their own resources. (3) Based on their assessments, countries then need to determine realistic objectives and draw up plans. (4) Finally, a process of evaluation needs to be built into the program; the lack of reliable information and accurate assessment can lead to confusion, waste, and inefficiency.

Health services of any nature reflect a number of interrelated characteristics, among which the most obvious, but not necessarily the most important from a national point of view, is the curative function; that is to say, caring for those already ill. Others include special services that deal with particular groups (such as children or pregnant women) and with specific needs such as nutrition or immunization; preventive services, the protection of the health both of individuals and of communities; health education; and, as mentioned above, the collection and analysis of information.

In the curative domain there are various forms of medical practice. They may be thought of generally as forming a pyramidal structure, with three tiers representing increasing degrees of specialization and technical sophistication but catering to diminishing numbers of patients as they are filtered out of the system at a lower level. Only those patients who require special attention either for diagnosis or treatment should reach the second (advisory) or third (specialized treatment) tiers where the cost per item of service becomes increasingly higher. The first level represents primary health care, or first contact care, at which patients have their initial contact with the health-care system.

Primary health care is an integral part of a countrys health maintenance system, of which it forms the largest and most important part. As described in the declaration of Alma-Ata, primary health care should be based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development. Primary health care in the developed countries is usually the province of a medically qualified physician; in the developing countries first contact care is often provided by nonmedically qualified personnel.

The vast majority of patients can be fully dealt with at the primary level. Those who cannot are referred to the second tier (secondary health care, or the referral services) for the opinion of a consultant with specialized knowledge or for X-ray examinations and special tests. Secondary health care often requires the technology offered by a local or regional hospital. Increasingly, however, the radiological and laboratory services provided by hospitals are available directly to the family doctor, thus improving his service to patients and increasing its range. The third tier of health care, employing specialist services, is offered by institutions such as teaching hospitals and units devoted to the care of particular groupswomen, children, patients with mental disorders, and so on. The dramatic differences in the cost of treatment at the various levels is a matter of particular importance in developing countries, where the cost of treatment for patients at the primary health-care level is usually only a small fraction of that at the third level; medical costs at any level in such countries, however, are usually borne by the government.

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Ideally, provision of health care at all levels will be available to all patients; such health care may be said to be universal. The well-off, both in relatively wealthy industrialized countries and in the poorer developing world, may be able to get medical attention from sources they prefer and can pay for in the private sector. The vast majority of people in most countries, however, are dependent in various ways upon health services provided by the state, to which they may contribute comparatively little or, in the case of poor countries, nothing at all.

The costs to national economics of providing health care are considerable and have been growing at a rapidly increasing rate, especially in countries such as the United States, Germany, and Sweden; the rise in Britain has been less rapid. This trend has been the cause of major concerns in both developed and developing countries. Some of this concern is based upon the lack of any consistent evidence to show that more spending on health care produces better health. There is a movement in developing countries to replace the type of organization of health-care services that evolved during European colonial times with some less expensive, and for them, more appropriate, health-care system.

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In the industrialized world the growing cost of health services has caused both private and public health-care delivery systems to question current policies and to seek more economical methods of achieving their goals. Despite expenditures, health services are not always used effectively by those who need them, and results can vary widely from community to community. In Britain, for example, between 1951 and 1971 the death rate fell by 24 percent in the wealthier sections of the population but by only half that in the most underprivileged sections of society. The achievement of good health is reliant upon more than just the quality of health care. Health entails such factors as good education, safe working conditions, a favourable environment, amenities in the home, well-integrated social services, and reasonable standards of living.

The developing countries differ from one another culturally, socially, and economically, but what they have in common is a low average income per person, with large percentages of their populations living at or below the poverty level. Although most have a small elite class, living mainly in the cities, the largest part of their populations live in rural areas. Urban regions in developing and some developed countries in the mid- and late 20th century have developed pockets of slums, which are growing because of an influx of rural peoples. For lack of even the simplest measures, vast numbers of urban and rural poor die each year of preventable and curable diseases, often associated with poor hygiene and sanitation, impure water supplies, malnutrition, vitamin deficiencies, and chronic preventable infections. The effect of these and other deprivations is reflected by the finding that in the 1980s the life expectancy at birth for men and women was about one-third less in Africa than it was in Europe; similarly, infant mortality in Africa was about eight times greater than in Europe. The extension of primary health-care services is therefore a high priority in the developing countries.

The developing countries themselves, lacking the proper resources, have often been unable to generate or implement the plans necessary to provide required services at the village or urban poor level. It has, however, become clear that the system of health care that is appropriate for one country is often unsuitable for another. Research has established that effective health care is related to the special circumstances of the individual country, its people, culture, ideology, and economic and natural resources.

The rising costs of providing health care have influenced a trend, especially among the developing nations, to promote services that employ less highly trained primary health-care personnel who can be distributed more widely in order to reach the largest possible proportion of the community. The principal medical problems to be dealt with in the developing world include undernutrition, infection, gastrointestinal disorders, and respiratory complaints, which themselves may be the result of poverty, ignorance, and poor hygiene. For the most part, these are easy to identify and to treat. Furthermore, preventive measures are usually simple and cheap. Neither treatment nor prevention requires extensive professional training: in most cases they can be dealt with adequately by the primary health worker, a term that includes all nonprofessional health personnel.

Those concerned with providing health care in the developed countries face a different set of problems. The diseases so prevalent in the Third World have, for the most part, been eliminated or are readily treatable. Many of the adverse environmental conditions and public health hazards have been conquered. Social services of varying degrees of adequacy have been provided. Public funds can be called upon to support the cost of medical care, and there are a variety of private insurance plans available to the consumer. Nevertheless, the funds that a government can devote to health care are limited and the cost of modern medicine continues to increase, thus putting adequate medical services beyond the reach of many. Adding to the expense of modern medical practices is the increasing demand for greater funding of health education and preventive measures specifically directed toward the poor.

In many parts of the world, particularly in developing countries, people get their primary health care, or first-contact care, where available at all, from nonmedically qualified personnel; these cadres of medical auxiliaries are being trained in increasing numbers to meet overwhelming needs among rapidly growing populations. Even among the comparatively wealthy countries of the world, containing in all a much smaller percentage of the worlds population, escalation in the costs of health services and in the cost of training a physician has precipitated some movement toward reappraisal of the role of the medical doctor in the delivery of first-contact care.

In advanced industrial countries, however, it is usually a trained physician who is called upon to provide the first-contact care. The patient seeking first-contact care can go either to a general practitioner or turn directly to a specialist. Which is the wisest choice has become a subject of some controversy. The general practitioner, however, is becoming rather rare in some developed countries. In countries where he does still exist, he is being increasingly observed as an obsolescent figure, because medicine covers an immense, rapidly changing, and complex field of which no physician can possibly master more than a small fraction. The very concept of the general practitioner, it is thus argued, may be absurd.

The obvious alternative to general practice is the direct access of a patient to a specialist. If a patient has problems with vision, he goes to an eye specialist, and if he has a pain in his chest (which he fears is due to his heart), he goes to a heart specialist. One objection to this plan is that the patient often cannot know which organ is responsible for his symptoms, and the most careful physician, after doing many investigations, may remain uncertain as to the cause. Breathlessnessa common symptommay be due to heart disease, to lung disease, to anemia, or to emotional upset. Another common symptom is general malaisefeeling run-down or always tired; others are headache, chronic low backache, rheumatism, abdominal discomfort, poor appetite, and constipation. Some patients may also be overtly anxious or depressed. Among the most subtle medical skills is the ability to assess people with such symptoms and to distinguish between symptoms that are caused predominantly by emotional upset and those that are predominantly of bodily origin. A specialist may be capable of such a general assessment, but, often, with emphasis on his own subject, he fails at this point. The generalist with his broader training is often the better choice for a first diagnosis, with referral to a specialist as the next option.

It is often felt that there are also practical advantages for the patient in having his own doctor, who knows about his background, who has seen him through various illnesses, and who has often looked after his family as well. This personal physician, often a generalist, is in the best position to decide when the patient should be referred to a consultant.

The advantages of general practice and specialization are combined when the physician of first contact is a pediatrician. Although he sees only children and thus acquires a special knowledge of childhood maladies, he remains a generalist who looks at the whole patient. Another combination of general practice and specialization is represented by group practice, the members of which partially or fully specialize. One or more may be general practitioners, and one may be a surgeon, a second an obstetrician, a third a pediatrician, and a fourth an internist. In isolated communities group practice may be a satisfactory compromise, but in urban regions, where nearly everyone can be sent quickly to a hospital, the specialist surgeon working in a fully equipped hospital can usually provide better treatment than a general practitioner surgeon in a small clinic hospital.

Before 1948, general practitioners in Britain settled where they could make a living. Patients fell into two main groups: weekly wage earners, who were compulsorily insured, were on a doctors panel and were given free medical attention (for which the doctor was paid quarterly by the government); most of the remainder paid the doctor a fee for service at the time of the illness. In 1948 the National Health Service began operation. Under its provisions, everyone is entitled to free medical attention with a general practitioner with whom he is registered. Though general practitioners in the National Health Service are not debarred from also having private patients, these must be people who are not registered with them under the National Health Service. Any physician is free to work as a general practitioner entirely independent of the National Health Service, though there are few who do so. Almost the entire population is registered with a National Health Service general practitioner, and the vast majority automatically sees this physician, or one of his partners, when they require medical attention. A few people, mostly wealthy, while registered with a National Health Service general practitioner, regularly see another physician privately; and a few may occasionally seek a private consultation because they are dissatisfied with their National Health Service physician.

A general practitioner under the National Health Service remains an independent contractor, paid by a capitation fee; that is, according to the number of people registered with him. He may work entirely from his own office, and he provides and pays his own receptionist, secretary, and other ancillary staff. Most general practitioners have one or more partners and work more and more in premises built for the purpose. Some of these structures are erected by the physicians themselves, but many are provided by the local authority, the physicians paying rent for using them. Health centres, in which groups of general practitioners work have become common.

In Britain only a small minority of general practitioners can admit patients to a hospital and look after them personally. Most of this minority are in country districts, where, before the days of the National Health Service, there were cottage hospitals run by general practitioners; many of these hospitals continued to function in a similar manner. All general practitioners use such hospital facilities as X-ray departments and laboratories, and many general practitioners work in hospitals in emergency rooms (casualty departments) or as clinical assistants to consultants, or specialists.

General practitioners are spread more evenly over the country than formerly, when there were many in the richer areas and few in the industrial towns. The maximum allowed list of National Health Service patients per doctor is 3,500; the average is about 2,500. Patients have free choice of the physician with whom they register, with the proviso that they cannot be accepted by one who already has a full list and that a physician can refuse to accept them (though such refusals are rare). In remote rural places there may be only one physician within a reasonable distance.

Until the mid-20th century it was not unusual for the doctor in Britain to visit patients in their own homes. A general practitioner might make 15 or 20 such house calls in a day, as well as seeing patients in his office or surgery, often in the evenings. This enabled him to become a family doctor in fact as well as in name. In modern practice, however, a home visit is quite exceptional and is paid only to the severely disabled or seriously ill when other recourses are ruled out. All patients are normally required to go to the doctor.

It has also become unusual for a personal doctor to be available during weekends or holidays. His place may be taken by one of his partners in a group practice, a provision that is reasonably satisfactory. General practitioners, however, may now use one of several commercial deputizing services that employs young doctors to be on call. Although some of these young doctors may be well experienced, patients do not generally appreciate this kind of arrangement.

Whereas in Britain the doctor of first contact is regularly a general practitioner, in the United States the nature of first-contact care is less consistent. General practice in the United States has been in a state of decline in the second half of the 20th century, especially in metropolitan areas. The general practitioner, however, is being replaced to some degree by the growing field of family practice. In 1969 family practice was recognized as a medical specialty after the American Academy of General Practice (now the American Academy of Family Physicians) and the American Medical Association created the American Board of General (now Family) Practice. Since that time the field has become one of the larger medical specialties in the United States. The family physicians were the first group of medical specialists in the United States for whom recertification was required.

There is no national health service, as such, in the United States. Most physicians in the country have traditionally been in some form of private practice, whether seeing patients in their own offices, clinics, medical centres, or another type of facility and regardless of the patients income. Doctors are usually compensated by such state and federally supported agencies as Medicaid (for treating the poor) and Medicare (for treating the elderly); not all doctors, however, accept poor patients. There are also some state-supported clinics and hospitals where the poor and elderly may receive free or low-cost treatment, and some doctors devote a small percentage of their time to treatment of the indigent. Veterans may receive free treatment at Veterans Administration hospitals, and the federal government through its Indian Health Service provides medical services to American Indians and Alaskan natives, sometimes using trained auxiliaries for first-contact care.

In the rural United States first-contact care is likely to come from a generalist. The middle- and upper-income groups living in urban areas, however, have access to a larger number of primary medical care options. Children are often taken to pediatricians, who may oversee the childs health needs until adulthood. Adults frequently make their initial contact with an internist, whose field is mainly that of medical (as opposed to surgical) illnesses; the internist often becomes the family physician. Other adults choose to go directly to physicians with narrower specialties, including dermatologists, allergists, gynecologists, orthopedists, and ophthalmologists.

Patients in the United States may also choose to be treated by doctors of osteopathy. These doctors are fully qualified, but they make up only a small percentage of the countrys physicians. They may also branch off into specialties, but general practice is much more common in their group than among M.D.s.

It used to be more common in the United States for physicians providing primary care to work independently, providing their own equipment and paying their own ancillary staff. In smaller cities they mostly had full hospital privileges, but in larger cities these privileges were more likely to be restricted. Physicians, often sharing the same specialties, are increasingly entering into group associations, where the expenses of office space, staff, and equipment may be shared; such associations may work out of suites of offices, clinics, or medical centres. The increasing competition and risks of private practice have caused many physicians to join Health Maintenance Organizations (HMOs), which provide comprehensive medical care and hospital care on a prepaid basis. The cost savings to patients are considerable, but they must use only the HMO doctors and facilities. HMOs stress preventive medicine and out-patient treatment as opposed to hospitalization as a means of reducing costs, a policy that has caused an increased number of empty hospital beds in the United States.

While the number of doctors per 100,000 population in the United States has been steadily increasing, there has been a trend among physicians toward the use of trained medical personnel to handle some of the basic services normally performed by the doctor. So-called physician extender services are commonly divided into nurse practitioners and physicians assistants, both of whom provide similar ancillary services for the general practitioner or specialist. Such personnel do not replace the doctor. Almost all American physicians have systems for taking each others calls when they become unavailable. House calls in the United States, as in Britain, have become exceedingly rare.

In Russia general practitioners are prevalent in the thinly populated rural areas. Pediatricians deal with children up to about age 15. Internists look after the medical ills of adults, and occupational physicians deal with the workers, sharing care with internists.

Teams of physicians with experience in varying specialties work from polyclinics or outpatient units, where many types of diseases are treated. Small towns usually have one polyclinic to serve all purposes. Large cities commonly have separate polyclinics for children and adults, as well as clinics with specializations such as womens health care, mental illnesses, and sexually transmitted diseases. Polyclinics usually have X-ray apparatus and facilities for examination of tissue specimens, facilities associated with the departments of the district hospital. Beginning in the late 1970s was a trend toward the development of more large, multipurpose treatment centres, first-aid hospitals, and specialized medicine and health care centres.

Home visits have traditionally been common, and much of the physicians time is spent in performing routine checkups for preventive purposes. Some patients in sparsely populated rural areas may be seen first by feldshers (auxiliary health workers), nurses, or midwives who work under the supervision of a polyclinic or hospital physician. The feldsher was once a lower-grade physician in the army or peasant communities, but feldshers are now regarded as paramedical workers.

In Japan, with less rigid legal restriction of the sale of pharmaceuticals than in the West, there was formerly a strong tradition of self-medication and self-treatment. This was modified in 1961 by the institution of health insurance programs that covered a large proportion of the population; there was then a great increase in visits to the outpatient clinics of hospitals and to private clinics and individual physicians.

When Japan shifted from traditional Chinese medicine with the adoption of Western medical practices in the 1870s, Germany became the chief model. As a result of German influence and of their own traditions, Japanese physicians tended to prefer professorial status and scholarly research opportunities at the universities or positions in the national or prefectural hospitals to private practice. There were some pioneering physicians, however, who brought medical care to the ordinary people.

Physicians in Japan have tended to cluster in the urban areas. The Medical Service Law of 1963 was amended to empower the Ministry of Health and Welfare to control the planning and distribution of future public and nonprofit medical facilities, partly to redress the urban-rural imbalance. Meanwhile, mobile services were expanded.

The influx of patients into hospitals and private clinics after the passage of the national health insurance acts of 1961 had, as one effect, a severe reduction in the amount of time available for any one patient. Perhaps in reaction to this situation, there has been a modest resurgence in the popularity of traditional Chinese medicine, with its leisurely interview, its dependence on herbal and other natural medicines, and its other traditional diagnostic and therapeutic practices. The rapid aging of the Japanese population as a result of the sharply decreasing death rate and birth rate has created an urgent need for expanded health care services for the elderly. There has also been an increasing need for centres to treat health problems resulting from environmental causes.

On the continent of Europe there are great differences both within single countries and between countries in the kinds of first-contact medical care. General practice, while declining in Europe as elsewhere, is still rather common even in some large cities, as well as in remote country areas.

In The Netherlands, departments of general practice are administered by general practitioners in all the medical schoolsan exceptional state of affairsand general practice flourishes. In the larger cities of Denmark, general practice on an individual basis is usual and popular, because the physician works only during office hours. In addition, there is a duty doctor service for nights and weekends. In the cities of Sweden, primary care is given by specialists. In the remote regions of northern Sweden, district doctors act as general practitioners to patients spread over huge areas; the district doctors delegate much of their home visiting to nurses.

In France there are still general practitioners, but their number is declining. Many medical practitioners advertise themselves directly to the public as specialists in internal medicine, ophthalmologists, gynecologists, and other kinds of specialists. Even when patients have a general practitioner, they may still go directly to a specialist. Attempts to stem the decline in general practice are being made by the development of group practice and of small rural hospitals equipped to deal with less serious illnesses, where general practitioners can look after their patients.

Although Israel has a high ratio of physicians to population, there is a shortage of general practitioners, and only in rural areas is general practice common. In the towns many people go directly to pediatricians, gynecologists, and other specialists, but there has been a reaction against this direct access to the specialist. More general practitioners have been trained, and the Israel Medical Association has recommended that no patient should be referred to a specialist except by the family physician or on instructions given by the family nurse. At Tel Aviv University there is a department of family medicine. In some newly developing areas, where the doctor shortage is greatest, there are medical centres at which all patients are initially interviewed by a nurse. The nurse may deal with many minor ailments, thus freeing the physician to treat the more seriously ill.

Nearly half the medical doctors in Australia are general practitionersa far higher proportion than in most other advanced countriesthough, as elsewhere, their numbers are declining. They tend to do far more for their patients than in Britain, many performing such operations as removal of the appendix, gallbladder, or uterus, operations that elsewhere would be carried out by a specialist surgeon. Group practices are common.

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medicine | science |

Medicine bawl –

Aside from drug abuse among the youth, the motorbiking Duterte Harley may just have to open up another front in his war: The lucrative market in counterfeit drugs.

One report in the Wall Street Journal estimated the value of fake medicine sold here at more than P8 billion a yearand growing fast.

According to TechTrace, the Swiss company in the information business for fighting illicit trade and counterfeiting, fake drugs already became one of the fastest growing and most lucrative income sources for organized crime worldwide.

One literature on counterfeit medicine warned: It may be contaminated or contain the wrong or no active ingredient. They could have the right active ingredient but at the wrong dose. Counterfeit drugs are illegal and may be harmful to your health.

Therethe thing with fake medicine was, first and foremost, it could kill people. TechTrace estimated more than a million deaths a year worldwide.

Here the proliferation of fake medicines already turned into police matter under Duterte Harley, and you know how the police handled things under him.

That was perhaps why the Food and Drugs Administration, or FDA, under its young director general handpicked by Duterte Harley, its first non-doctor boss named Nela Charade Puno, tapped the PNP to launch a massive campaign against counterfeit goods i.e. medicines, food items and cosmetics.

The FDA has established that the fake drugs came mainly from China and India. In short, smuggled! Uh-oh, the Bureau of Customs again!

But it also discovered that, aside from over-the-counter sales, the marketing was done by legitimate outfits hiding behind the secrecy of internet sales.

To stop the trend, the FDA needed an ocean of money, which it did not have, more so because its mother unit, the Department of Health, even cut its budget.

By the way, the DOH also cut the budgets of some 50 government hospitals, and still Health Secretary Paulyn Ubial reportedly was confident on her confirmation by the Commission on Appointments.

The CA of course rejected Judy Taguiwalo as head of DSWD for no apparent reason, although Rep. Ronaldo Zamora, who headed the House of Representatives group in the CA, said that Taguiwalo was not fit for the job.

In what way? Well, according to Zamora, she would not even question the massive funding in the DSWD for the doleout program, conditional cash transfer, or CCT.

And all the while I thought that Congress should have asked the question, since it was the job of Congress to allot or not to allot the billions for CCT.

Theredespite being clean and all, Taguiwalo was not fit for the job, because she did not do the job that Congress was supposed to do.

Still her boss, Duterte Harley, went all out for Customs Commissioner Nicanor Faeldon, despite the latters admission that the 3 oclock habit remained in the BOC under his watch.

Anyway, under Duterte Harley, the FDA refused to bawl over its lack of funding to stop the proliferation of counterfeit medicine, even when the DOH cut its budget for law enforcement.

It is up to you to determine whether or not the DOH cut the budget to protect syndicates in the fake drug racket.

In the past year or so, however, the FDA regulatory reinforcement unit (REU) already seized millions of pesos worth of the counterfeit products even including fake ball pens.

Now the FDA, which last week celebrated its 54th anniversary, had this Regulatory and Advocacy Fair, showing how the agency cut red tapes in its systems.

That should be good news to the P190-billion a year local pharmaceutical industry, particularly the small companies, mostly owned by Filipinos, which must get FDA approval for their products.

It was bad news to the facilitators in and out of FDA, who reportedly already launched a demolition job against the agency, particularly its head Puno, similar to the recent smear campaign by a big foreign company against her, because she stood her ground regarding the FDA ban on its product.

As for Duterte Harley, the FDA campaign against fake drugs seemed to be the kind of war that he would love.

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Medicine bawl –

Drugmaker Hikma’s US unit raises medicine prices – Financial Times – CNBC

Michael Fein | Bloomberg | Getty Images

An employee works in a lab at Momenta Pharmaceuticals in Cambridge, Massachusetts.

Hikma Pharmaceuticals Plc’s U.S. subsidiary has raised the price of a common diarrhea drug by more than 400 percent and is charging more for five other medicines as well, the Financial Times reported on Sunday.

West-Ward Pharmaceuticals, the U.S. division of London-listed Hikma, increased the prices at the start of August by between 75 percent and 430 percent, for a mean of 237 percent, according to figures seen by the Financial Times.

In the United States, generic drugmakers such as Hikma are able to dictate prices of their products that have a monopoly or face little competition, the FT said.

Among the six drugs, West-Ward is either the only U.S. supplier or one of two manufacturers.

The average wholesale price of a 60 ml bottle of liquid Atropine-Diphenoxylate, a common diarrhea drug also known as Lomotil, went from about $16 a bottle to $84, the FT reported.

Brian Hoffmann, president of U.S. generics at West-Ward, said the prices of 94 percent of the group’s copycat medicine portfolio had either fallen or stayed the same in 2017, and that they had fallen overall this year.

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Drugmaker Hikma’s US unit raises medicine prices – Financial Times – CNBC

Stanford Medicine magazine reports on the future of vision – Stanford Medical Center Report

Many of the strategies being explored at the Stanford University School of Medicine to protect, improve and restore vision sound seriously sci-fi. Among them: cornea transplants conducted with magnetic fields instead of scalpels, virtual reality workouts to repair damaged retinas, and bionic vision.

The new issue of Stanford Medicine magazine, a theme issue on eyes and vision, includes details about these projects and others pushing the boundaries of biology and technology to help people see.

Studies show that when it comes to their health, the thing people most worry about, after death, is losing their vision, said Jeffrey Goldberg, MD, professor and chair of ophthalmology, in the reports lead article. Peoples productivity and their activities of daily life hinge critically on vision, more than on any other sense.

The lead article explains the basic workings of the eye and describes an array of ophthalmological research, including Goldbergs work to repair damaged corneas by injecting healthy cells into the eye and using magnets to pull the cells into position. A patient in a small early study entered the trial legally blind, with 20/200 vision, and left it with 20/40 vision close to normal. A larger study is planned to begin soon.

The fear of vision loss, even for people in lesser stages of disease, can be quite dramatic. So anything we can do to stabilize, better diagnose and hopefully one day restore vision in some of these diseases, I think, will have an enormous global impact, Goldberg said. This type of work is an example of Stanford Medicines focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill.

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Stanford Medicine magazine reports on the future of vision – Stanford Medical Center Report

Tully Family Medicine opens in Athol – The Recorder

ATHOL Locals can now add routine medical appointments to their list of errands to do at North Quabbin Commons, as Tully Family Medicine has relocated to a new office on the east end of Athol.

One half of the 7,650-square-foot facility at 81 Reservoir Drive opened to the public Monday, with a walk-in clinic named Heywood Urgent Care expected to open in the other half in the fall. Office Manager Mary Paluk said at roughly 12:30 p.m. that scheduled appointments had been running smoothly.

So far, so good, she said, literally knocking on the wooden arm of a chair in the waiting area.

Tully Family Medicine now has eight examination rooms and is twice the size of its former location in Phillipston.

Paluk said Mondays are typically the busiest day of the week, and this Monday was no exception.

We had a full schedule. We hit the ground running, she said.

Paluk said Tully Family Medicine employs about 15 people and Heywood Urgent Care will employ 10 to 15. Both operations will be run by Heywood Medical Group, a nonprofit physician organization affiliated with Heywood Hospital. Heywood Medical Group is part of Heywood Healthcare, an independent community-owned health care system serving north central Massachusetts and southern New Hampshire.

Paluk said staff moved in equipment and supplies Friday.

Amanda MacFadgen, spokeswoman for Heywood Healthcare, said Tully Family Medicine will be led by Dr. Elizabeth Nottleson, with Deborah Plotkin, Carrie-Anne Case and Christopher Ambler as the facilitys nurse practitioners.

Win Brown, president and CEO of Heywood Healthcare, said the organization is committed to improving access to health services for the North Quabbin region.

In their new location in North Quabbin Commons, Tully Family Medicine has the ability to double their space and expand their care team, enabling more patients from infants to seniors to obtain convenient, quality primary care services right in their own community, he said.

Reach Domenic Poli at: or 413-772-0261, ext. 258. On Twitter: @DomenicPoli

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Tully Family Medicine opens in Athol – The Recorder

Gwinnett Medical Center unveils Sports Medicine and Concussion … –

Gwinnett Medical Center unveiled Georgias first sports injury treatment center and concussion classroom on wheels Wednesday.

This is the first vehicle of its kind in the state of Georgia and one of the first in the United States, said Kristin Crea, director of GMCs Sports Medicine department.

The Sports Medicine and Concussion Care-A-Van is a mobile care unit equipped with a full-service athletic training room. Basically, it allows GMCs Sports Medicine department to take its injury treatment and prevention services on the road.

When we travel around and talk to different directors, most athletic directors and coaches dont have access to injury prevention, Crea said. This really allows us to reach and have better access to these places that dont have this kind of care.

That includes care for concussions. GMCs Sports Medicine department includes a Concussion Institute directed by Dr. Saadiq El-Amid. Since the institute opened in August 2013, its treated more than 8,500 concussions.

Concussions are happening at epidemic levels, Crea said.

But El-Amid said the real scary cases are concussions that never receive treatment or get attention too late.

I cant tell you how many people ignore concussions, he said. If you ignore a concussion and continue to play a sport, you could hit your head again. That could lead to other issues.

Some patients accidentally ignore concussions because they dont think they could have sustained one unless they were hit on the head while playing a sport. But El-Amid said concussions are more common than that. In fact, any motion that jerks or whiplashes the head could move the brain and cause a concussion.

I personally sustained a concussion once because I tried to ride every roller coaster ride at Six Flags in 24 hours, El-Amid said.

Misinformation and ignorance about concussions thrives, particularly in areas where residents dont have contact with medical personnel or literature. Crea said she hopes the Care-A-Van can fix that gap. She and El-Amid plan to drive it all over the state, including to rural areas that wouldnt normally receive a lot of information about sports injuries or concussions.

The beauty of the Care-A-Van is its mobile, Crea said. So we can go wherever we need to different sports facilities, high schools, day cares, corporations, programs, schools and churches. We can go whereever we see fit.

Both Crea and El-Amid hope to use the Care-A-Van as a sort of moving billboard for concussion awareness and treatment.

I would love to be able to see this thing sitting in front of the mall on the weekends, El-Amid said. Its not only to teach those around, but also to let them have a name and an institution to get in touch with if they think they have a concussion.

The Care-A-Van can also help if nearby residents are already concerned they might have a concussion or could sustain one in the future. The van comes equipped with several laptops and tablets that allow physicians to give Immediate Post-Concussion Assessment and Cognitive Tests and baseline tests.

An ImPACT assesment is an online test that measures congnitive ability. A patient can take an ImPACT test after sustaining a head injury to figure out whether the brain is concussed.

The Care-A-Van can administer these tests. But they arent helpful unless the person has a baseline score to compare with the ImPACT score. And few concussion patients have thought far enough ahead to take a baseline ImPACT score test before they were injured.

El-Amin said he hopes the Care-A-Van can change that.

Lets say we administer a baseline test to a kid in rural south Georgia. Then, the kid goes off to Alabama and sustains a concussion, El-Amin said. Then, when they want to ImPACT test him, hell be able to tell doctors, Hey, my family got impact tested by this mobile center a few years ago.

He said the Care-A-Van would be able to share the kids baseline score so his doctors could figure out the severity of his injury.

Right now, El-Amin said GMC plans to take its new mobile center all over Georgia, educating residents in as widespread an area as possible. But he doesnt want Gwinnett to monopolize the states mobile education space forever.

I would love to see other hospitals follow us, El-Amin said.

Its all about preventing potentially serious injuries.

Were in a position right now to really, really make a difference, El-Amin said.

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Gwinnett Medical Center unveils Sports Medicine and Concussion … –

Top UCSD researchers pitch yoga, massage and integrative medicine for healing – The San Diego Union-Tribune

She wielded a kitchen knife, not a scalpel, but Serena Silberman was doing her part Saturday to heal the human body, one chop of parsley, peach and pomegranate at a time.

Food can be medicine, said Silberman, an instructor at the University of California San Diego Integrative Medicine Natural Healing Cooking Program, as she prepped a meal for more than 200 people at the Sanford Consortium for Regenerative Medicine in La Jolla.

Her feast was to commemorate the debut of UC San Diegos Centers for Integrative Health, an initiative throughout the university and health network to unify current research, education and clinical programs ranging from nutrition and acupuncture to meditation and yoga.

Saturdays all-day conference rang in the new collaborative health effort at UC San Diego by discussing how western science can be better wedded to traditional folk cures and alternative medicine to offer better outcomes for patients.

Charlie Neuman/U-T

At the Sanford Consortium, UC San Diego on Saturday launched the new Centers for Integrative Health. At the beginning of the event attendees participate in meditation.

At the Sanford Consortium, UC San Diego on Saturday launched the new Centers for Integrative Health. At the beginning of the event attendees participate in meditation. (Charlie Neuman/U-T)

To Silberman, that means parsley. Rich in antioxidants, the green leaves naturally contain the anti-inflammatory luteolin; Vitamin A to boost the white blood cells that attack infection; and folate, which can help protect patients from heart attack, stroke and hardened arteries.

And then theres her generous dusting of turmeric, the orange-colored herb from the ginger family that doubles as a curry spice and dye. Researchers are studying whether it might heal heart disease and diabetes with very few side effects.

Indian cooks have only been doing it for 5,000 years, so they might know something, said Silberman, punctuating her point with the chop-chop-chop of peaches.

None of this is new to UC San Diego. The Center for Integrative Medicine, for example, was established seven years ago and now treats more than 10,000 patients annually, but organizers hope future consultations will seamlessly involve the Centers for Mindfulness, Integrative Research, Integrative Nutrition and Integrative Education into a one-stop experience.

That means 26 practitioners in 10 clinics within eight departments throughout the health system will be integrated.

Dr. Dan Slater, a physician and UC San Diego professor of family medicine and public health, presented to a packed Sanford Consortium audience a case study he thinks might guide future patient care.

Charlie Neuman/U-T

Attendees to the launch of UC San Diego’s Centers for Integrative Health get acupuncture and massages while listening to therapeutic harp music by Carolyn Worster.

Attendees to the launch of UC San Diego’s Centers for Integrative Health get acupuncture and massages while listening to therapeutic harp music by Carolyn Worster. (Charlie Neuman/U-T)

A 61-year-old woman was suffering from symptoms suggesting ulcerative colitis, a painful inflammatory bowel disease. The wait had grown to six months in her small town for a colonoscopy that peeked at the lining of her intestine and took a sample of the tissue, a procedure Slater noted was not cheap and was not necessarily convenient.

So he and his team of integrative health specialists prescribed a diet high in fiber, fruits and vegetables and low in fats and sweets. A little more turmeric and a few dollops of probiotics good bacteria to boost the digestive system and within three months she was feeling better. By the time her colonoscopy rolled around, her condition was either in remission or cured.

To Slater, that highlights what the Centers for Integrative Health might do best researching many pathways to a cure but letting the body do most of the work by exploring everything from aromatherapy to zen.


Top UCSD researchers pitch yoga, massage and integrative medicine for healing – The San Diego Union-Tribune

Justin Sports Medicine helps Cowboys at CNR – 6 On Your Side

Fire Weather Warningissued August 20 at 4:22AM MDT expiring August 20 at 9:00PM MDT in effect for: Bannock, Bingham, Blaine, Bonneville, Butte, Caribou, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, Power, Teton

Fire Weather Watchissued August 19 at 8:50PM MDT expiring August 20 at 9:00PM MDT in effect for: Bannock, Bingham, Blaine, Bonneville, Butte, Caribou, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, Power, Teton

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Justin Sports Medicine helps Cowboys at CNR – 6 On Your Side

Is it too easy to get pain medicine? –

After everything thats been reported about the opioid epidemic in our nation, I didnt expect a painkiller to be offered so easily.

But after a brief visit to the emergency room, I wondered if my experience is part of the reason America is awash in opioids, in the words of Thomas Frieden, former director of the U.S. Centers for Disease Control and Prevention.

I was in the hospital after a prolonged stomach flu. For seven days, I either couldnt keep down or get into my system much of anything, and 9 pounds fell off me. Normally, Id jump up and down at that statement, but I was too miserable.

Before I got to the ER, Id been to my primary care doctor, twice. My doctor thought Id been knocked down to the point I needed a jump start, in the form of intravenous fluids.

So, as I tried to get comfortable on a really uncomfortable slab of mattress, I told the ER doctor my symptoms. I mentioned stomach pain throughout, and that my primary care doctor thought it was muscle soreness from so much retching. The ER doctor listened patiently, poked my innards, felt the pulse in my ankle and listened to my heart.

He agreed that IV fluids were the ticket and ordered a CT scan to rule out any ugly possibilities, like appendicitis or diverticulitis.

Then he asked something about my comfort level. I didnt really grasp what he was saying, so he rephrased it: Do you want anything for the pain?

I said no right off the bat, then asked what was available. As we talked, I told him I didnt want any kind of opioid, and I swear he almost looked embarrassed when I said that. He said there were lesser pain relievers that could be administered through the IV.

My mother, who was in the room with me, said its no wonder so many people have problems with prescription painkillers. Look at how easy it would have been for me to get some.

As I recounted the story, one co-worker made the valid point that doctors want to alleviate the pain and suffering they see. Thats their purpose. Plus, she said, the doctor probably could tell that I didnt look like an addict.

If this epidemic has taught us anything, isnt it that those who get addicted to pain medicine dont fit any kind of profile?

They dont look like strung-out junkies; they look like the rest of us: hard-working moms and dads, honor students and Eagle Scouts, bus drivers, day-care workers and executives. Then, an accident or injury comes along and theyre given highly addictive narcotics to cope with the pain. Some develop an ungodly form of addiction to the highs the medicine produces in the brain and cant turn off the need for it.

But if you still think that only those with tattoos and stringy hair become hooked to the point they lose sight of everything else that matters, I encourage you to attend any of the upcoming town-hall meetings sponsored by a coalition formed to tackle the problem in our region. The Community Collaborative for Youth and Families is holding sessions in each locality in Planning District 16 through October.

The group also will show the documentary, Chasing the Dragon: The Life of an Opiate Addict, which is an eye-opening look at the drug problem in our nation. It was filmed in Virginiaincluding at the Rappahannock Regional Jailso dont think for a second that this is a problem limited to the nations urban areas.

The meetings are from 6:30 to 8:30 p.m. at these locations:

Aug. 21: King George Middle School

Sept. 13: Caroline County Community Center

Sept. 26: Brooke Point High School, Stafford

Oct. 2: James Monroe High School

Oct. 16: Rubicon Caf, Salem Fields Community Church, Spotsylvania

The conversation about opioid drugs needs to include a lot of different people, including health-care providers on the front lines. Certainly, they want to make people feel better, but they cant put people into positions that might cause more pain in the long run.

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Is it too easy to get pain medicine? –

WRCF, Inova Sports Medicine Host Third Annual High School Coaches Clinic –

The Washington Redskins Charitable Foundation on Friday hosted the third annual High School Coaches Clinic for 100 high school coaches from the Washington, D.C., region.

In the midst of the preseason, the Washington Redskins are still in their building phase coaches continue to scout the roster, take notes during games and practice and preach unity that will become vital for the year ahead.

Its a comforting notion for DuVal High School football head coach Carlos Lockwood, who was one of roughly 100 coaches to take in the teams third annual High School Coaches Clinic presented by Inova Sports Medicine at the Inova Sports Performance Center at Redskins Park on Friday.

For me, I like stuff like this because its always about building, being a sponge, Lockwood said. Even for me being a head coach, I can always learn and when you hear the same things from the guys at the higher level, it just always hits home.

The clinic, which was hosted by the Washington Redskins Charitable Foundation, allowed local high school coaches to watch the Redskins complete Fridays walkthrough practice prior to a speakers panel that included many special guests and lunch in the team dining room.

Redskins President Bruce Allen kicked things off with a brief introduction followed by head coach Jay Gruden, who chatted about what he looks for in athletes effort and consistent work habits were primary themes before lending the stage to special teams coordinator Ben Kotwica, offensive coordinator Matt Cavanaugh and defensive coordinator Greg Manusky.

Together, the three of them addressed a wide range of topics, including what they learned from their high school coaches to balancing the stresses of their jobs with their families. The high school coaches, who came from Virginia, Maryland and Washington, D.C., took notes and photos, returning home with bullet points to teach their student-athletes.

Later, EXOS Performance Director of Pro Sports,Brent Callaway, ran through a PowerPoint with slides dedicated to movement, nutrition, mindset and recovery, valuable tenets the company has dedicated their time to prepare athletes to perform at their best.

Before breaking for lunch, Super Bowl MVP and current Senior Vice President of Player Personnel Doug Williams shared a few stories about his time as a high school head coach (he had an undefeated team at Northeast High School in Zachary, La.) and the challenges and joys of the position. The former quarterback was a hit, providing insight and humor for 15 minutes and encouraging those in front of him to be ambassadors for their communities.

Dougs iconic, Lockwood said. Just to hear him speak about his childhood and what was going on back home and how meaningful it was for that team he had to go undefeated. Some of those guys never played collegiately or in the pros, but thats what brings back that community is high school football.

Also in attendance was Dunbar High Schools head football coach Matthew Vaughn, in charge of the program that Redskins tight end Vernon Davis called his growing up. Watching practice and roaming the halls where Davis walks, Vaughn was grateful to be among a community of high school coaches and see Davis up close again.

Hes made a tremendous impact on the community as well as the school, Vaughn said. We use Vernon as the standard of where the kids want to be and what they want to do. Hes a great role model for the kids and he does a lot for the community. Im proud to be here to watch him today and the kids, we always talk about Vernon and the things that hes done, and the way he went about his business and the way he still goes about his business and the way he represents the school, community and the Redskins.

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WRCF, Inova Sports Medicine Host Third Annual High School Coaches Clinic –

WSU’s Elson S. Floyd College of Medicine welcomes inaugural class – The Spokesman-Review

Fri., Aug. 18, 2017, 7:13 p.m.

More than a dozen Washington State University deans, faculty and guests helped welcome the Elson S. Floyd College of Medicines inaugural class at a ceremony Friday, where the 60 doctors-to-be donned white coats embroidered with the crimson cougar.

But the spirit of the event was best captured by Carmento Floyd, the widow of the former WSU President for whom the medical school is named.

You are and will be the most important class, because you were first, she said, moments after graciously receiving a symbolic white coat through tears. We expect greatness from you, and you must expect greatness from yourselves. Her remarks were met with a long standing ovation.

The event, which nearly filled the ground floor of the Martin Woldson Theater at The Fox, was much more than a celebration for future physicians. It was a recognition of the advocacy, persistence and vision from Floyd and others that led to WSU receiving approval to start the school in 2015.

This is a moment Ive been waiting for for a long time, Dean John Tomkowiak said.

The incoming class of 60 students are all from Washington, something touted repeatedly by college administrators.

We dont even have an out-of-state tuition rate, WSU President Kirk Schultz said.

The hope is for the college to make a dent in the areas of Washington considered medically underserved a list that includes some portion of nearly every county east of the Cascades. And not only rural areas; the list, according to the Washington Department of Health, includes all of Yakima and Franklin counties.

We see a lot of things out there about the need for more physicians in our state, and this is a tangible step toward that goal, Schultz said.

He added that the university is lucky to be in a state where theres bipartisan support for investing in higher education.

At a time when many states are cutting funds from state universities, Washington taxpayers are funding about $66,000 of the $100,000 it takes to educate a single medical student for a year, Tomkowiak told students at an orientation ceremony Wednesday.

The state, those 7.1 million stakeholders, are putting in $2 for every $1 that you are, he said.

Its a commitment the students have taken to heart. Following orientation on Wednesday, many members of the class said they wanted to attend WSU in part because of its focused on providing care to underserved parts of their home state.

We wanted to be able to give back to the people of our state, said Christie Kirkpatrick, whos from Longview, Washington. Its really cool to be around people who all care about the same things.

Following speeches Friday afternoon, each students walked across the stage to be cloaked in their own white coat. A display overhead broadcast an individual oath for each student about their commitment to becoming a doctor and the reasons for choosing the profession.

It is a privilege to be trained in eastern Washington, where I plan to serve, wrote student Christina Eglin. Advocating for patients, treating others with compassion and giving back to a home community were common themes.

One student, Sye Jabbouri, wrote about the care shown to his Assyrian Iraqi family by strangers as they fled war at home, and said he wanted to bring that same care to his patients.

Washington poet laureate Tod Marshall read a poem he wrote for the occasion, which focused on the symbolism of a white coat as a honor to be earned.

Today is beautiful plumage and honor. Tomorrow, your gentle actions, the music of your listening will bear out the honor of a coats threads, he recited.

Published: Aug. 18, 2017, 7:13 p.m.

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WSU’s Elson S. Floyd College of Medicine welcomes inaugural class – The Spokesman-Review

Danbury dentist accredited in dental sleep medicine – Danbury News Times

Photo: H John Voorhees III / Hearst Connecticut Media

Dentist Leila Chahine, of Dental Wellness and Health in Danbury, holds a Mandibular Advancement Device. Tuesday, August 15, 2017, in Danbury, Conn.

Dentist Leila Chahine, of Dental Wellness and Health in Danbury, holds a Mandibular Advancement Device. Tuesday, August 15, 2017, in Danbury, Conn.

Danbury dentist accredited in dental sleep medicine

Dental Wellness & Health, the office of Leila Chahine, recently received accreditation from the American Academy of Dental Sleep Medicine, or AADSM, in recognition of the offices excellence in treating patients with sleep apnea, snoring and other breathing-related sleep disorders.

The office is one of only three in Connecticut and 71 in the nation to receive the accreditation.

If a patients sleep ability is not healthy, the rest of his or her body cannot attain the most favorable health, either, Chahine said. I see my job as evaluating the whole patient and trying to create the best dental situation possible to foster optimal health. Our team is proud to be recognized for the highest level of care we provide to our patients.

Dental Wellness & Health, at 16 Hospital Ave., offers general dentistry services as well as the sleep disorder treatments. To combat sleep apnea and other sleep disorders, and to offer an alternative to CPAP machines, Chahine custom fits patients with a mouth piece or oral sleep appliance that repositions the lower jaw to allow for stable air flow during sleep.

Sleep is my passion, Chahine said.

To become accredited, facilities must meet quality measures outlined in the AADSMs Standards for Accreditation of Dental Sleep Medicine Facilities, which detail expectations for the proficiency of a facilitys dental director and staff. The standards also detail expectations in: documentation and billing of patients; professionalism of consumer care; follow-up service; and safety.

The accreditation lasts for three years. The program was developed to define excellence in dental sleep medicine, said Harold Smith, president of the AADSM. Patients and referring physicians can have peace-of-mind when working with an accredited facility, knowing that the facility has proven, recognized excellence in every aspect of care.

Smith said dentists and physicians can work together to diagnose and treat sleep disorders.

Chahine, who is from Lebanon, hopes the accreditation will increase understanding and acceptance of dental sleep medicine as it pertains to overall health and quality of life. Before, there was no way to tell the difference between a dentist with experience in dental sleep medicine and a novice, she said. Sleep apnea is a serious condition. Ive been specializing in this for 20 years. The accreditation is way for patients to ensure they are getting the best care.

Chahine, a past president of the Greater Danbury Dental Society, formerly served as the education chairman of the AADSM.

The AADSM is a non-profit national professional society dedicated to the practice of dental sleep medicine. It has more than 3,000 member dentists.

To reach Dental Wellness & Health, call 203-744-1814.

The writer may be reached at; 203-731-3338

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Danbury dentist accredited in dental sleep medicine – Danbury News Times