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Kaufman and colleagues have considered the relationship between minimum wage and suicide mortality in the buy azithromycin zithromax or doxycycline USA.1 Overall, they found that a dollar increase in the minimum wage was related to a meaningful 3.4% decrease in suicide mortality for those of lower educational attainment. Interestingly, this is the third paper in recent months to address the question of buy azithromycin zithromax or doxycycline how minimum wage affects suicide. Across these papers, there is a remarkable overall consistency of findings, and important subissues are highlighted in each individual paper.The first of these papers, by Gertner and colleagues, found a 1.9% reduction in suicide associated with a dollar increase in the minimum wage across the total population.2 However, this research was unable to delve into the subgroup effects that would have allowed for a difference in differences approach, or placebo tests, due to their data source. First, Dow and colleagues,3 and then Kaufman and colleagues1 built on this initial finding with analyses of buy azithromycin zithromax or doxycycline data that facilitated examination of subgroups. Both of these papers considered the group with a high school education or ….

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Latest Senior Health News FRIDAY, July 30, 2021 (HealthDay News) The Biden zithromax side effects rash administration has reversed a Trump policy that limited the size of like it fines that U.S. Nursing homes could be slapped with for violating safety standards. The Trump policy was adopted in 2017 and prevented zithromax side effects rash the U.S. Centers for Medicare and Medicaid Services (CMS) from hitting a nursing home with a fine for each day it didn't comply with federal standards. That reduced many penalties to a single fine, lowering total amounts from hundreds of thousands of dollars to a maximum of $22,000, The New York Times reported.

Many nursing homes cited for violations such as poor controls, not protecting residents from avoidable accidents, neglect, mistreatment and bedsores, are repeat offenders, according to Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy zithromax side effects rash. Larger fines are a deterrent and are more likely to indicate strong enforcement of the rules, Edelman told the Times. In early July, the Biden administration changed guidance on the CMS website, saying it had "determined that the agency should retain the discretion at this time to impose a per-day penalty where appropriate to address specific circumstances of prior noncompliance." The new policy means that regulators can impose either per-day or per-instance penalties, the Times reported. Deaths in zithromax side effects rash nursing homes account for nearly a third of the overall buy antibiotics death toll in the United States. While there's been a sharp drop in buy antibiotics deaths in nursing homes since treatments became available, inadequate staffing, shortages of protective equipment and poor control are still problems, according to advocates and some officials, the Times reported.

Federal data show that while 81% of nursing home residents are vaccinated, only 58% of workers are immunized, which increases the risk of outbreaks even among fully vaccinated residents. Fines levied on a per-day basis "only take precious resources away from an already underfunded industry, especially during an unprecedented time when nursing homes need every support to protect their residents," the main industry trade group, the American Health Care Association and National Center for Assisted Living, said in a statement, zithromax side effects rash the Times reported. More information Visit the Agency for Healthcare Research and Quality for more on nursing home safety. SOURCE. The New York Times Robert zithromax side effects rash Preidt Copyright © 2021 HealthDay.

All rights reserved. SLIDESHOW Exercise Tips for Seniors See SlideshowLatest Neurology News FRIDAY, July 30, 2021 (HealthDay News) Extremely premature babies have a much higher risk of cerebral palsy and other neurological conditions than full-term infants, a large Israeli study affirms. Cerebral palsy -- the name for a group of zithromax side effects rash lifelong conditions that affect movement and coordination -- is the most common cause of severe childhood physical disability and motor impairment. It can also affect sensation, perception, thinking, communication and behavior. "Extremely premature exposure to the environment outside of the uterus may alter musculoskeletal and nervous system development, and shift the trajectory of motor development for otherwise healthy children," study co-author Dr.

Eyal Sheiner said in zithromax side effects rash a news release from Ben-Gurion University of the Negev in Beer-Sheva, Israel. He is vice dean for academic promotion at the university and is also director of obstetrics and gynecology at Soroka University Medical Center in Beer-Sheva. For this study, Sheiner and his colleagues examined the outcomes of more than 220,500 deliveries over 23 years. They found that babies born before 25 weeks' gestation had four times the risk of developing long-term neurological issues and significantly higher rates of cerebral zithromax side effects rash palsy. Each additional week in the womb up to 37 weeks was linked to a decrease in the risk of long-term neurological problems, the researchers said.

The findings were recently published in the Journal of Clinical Medicine. "Neurological disorders that stem from premature births are devastating," said Doug Seserman, chief zithromax side effects rash executive officer of Americans for Ben-Gurion University, which supported the research. More information The March of Dimes has more on cerebral palsy. SOURCE. Ben-Gurion University of the Negev, news release, zithromax side effects rash July 29, 2021 Robert Preidt Copyright © 2021 HealthDay.

All rights reserved. QUESTION The abbreviated term ADHD denotes the condition commonly known as. See AnswerLatest Diabetes News FRIDAY, July 30, 2021 (HealthDay News) As many Americans know, today's health insurance plans often come zithromax side effects rash with high deductibles. Those out-of-pocket costs could cause harm. New research shows that 20% of people who have diabetes and high-deductible health plans regularly skip their medications.

Not keeping up with your diabetes medications comes with zithromax side effects rash the potential risk of an emergency room visit or a hospitalization. Compared to people without high-deductible health plans, people with high deductibles are also 28% more likely to not take their medicines on time due to cost, the new study found. "Taking prescribed medications is essential for maintaining good health for patients with diabetes," stressed study author Dr. Vikas Gampa, a primary care doctor at Massachusetts General Hospital and instructor in zithromax side effects rash medicine at Harvard Medical School. "Our results show that high-deductible health plans, particularly in this period of escalating prices for diabetes medication, are discouraging patients from getting the medications they need and thus they are placing patients with diabetes at risk." High-deductible health plans require patients to pay for all care until they reach the plan's deductible.

Insurance begins to cover medical costs after the patient pays the deductible, typically $1,300 for an individual or $2,600 for a family. These plans now comprise half zithromax side effects rash of all commercial health insurance plans. The researchers examined U.S. Federal survey zithromax side effects rash data on more than 7,000 adult patients with diabetes who were enrolled in a commercial health insurance plan. They looked for how often patients reported not taking their prescription medication because they could not afford it, comparing both the traditional and the high-deductible patients.

Roughly 25% of high-deductible plan enrollees who take insulin for diabetes could not afford their medication, compared to 19% of those with traditional plans, the study found. That's a 31% higher zithromax side effects rash rate. Researchers also found that diabetic patients who could not take their medications as prescribed were more likely to have one or more emergency department visits and potentially more hospitalizations per year than patients who did not skip medicines. "Putting up financial barriers to care in order to save plans money -- as high-deductible plans do -- not only takes a medical toll on patients, it is also short-sighted because doing so actually increases other health care costs such as covering emergency department visits," Gampa said in a Harvard news release. The findings were published online July 29 zithromax side effects rash in the Journal of General Internal Medicine.

"Patients with diabetes should recognize that a high-deductible plan will put them at risk for missing or delaying their medications, and doctors need to recognize that their patients with these plans may not be able to adhere to treatment plans," said study senior author Dr. Danny McCormick, an associate professor of medicine at Harvard Medical School and a primary care physician at the Cambridge Health Alliance. "Ultimately, policymakers need to enact reforms that discourage health plans from implementing financial barriers that block access to needed care, such as high-deductible plans," zithromax side effects rash McCormick said in the release. "Our results suggest that policymakers must enact reforms that control rapidly escalating prices for diabetic medications." More information The American Diabetes Association has more on diabetes. SOURCE.

Harvard Medical School, zithromax side effects rash news release, July 29, 2021 Cara Murez Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Type 2 Diabetes. Signs, Symptoms, Treatments See zithromax side effects rash SlideshowLatest Mental Health News FRIDAY, July 30, 2021 Opioid overdose-related visits to U.S. Emergency departments rose by nearly one-third during the buy antibiotics zithromax last year.

That's the key finding in a new analysis of data from 25 emergency departments in Alabama, Colorado, Connecticut, North Carolina, Massachusetts and Rhode Island. "buy antibiotics, and the disruptions in every part of our social and work lives, made zithromax side effects rash this situation even harder by increasing the risk of opioid misuse and relapse because people were separated from their social support and normal routines," said senior study author Molly Jeffery, a researcher at the Mayo Clinic in Rochester, Minn. The study revealed that opioid overdose-related emergency department visits rose 28.5% last year, compared to 2018 and 2019. The raw numbers in the study were 3,486 in 2020. 3,285 in zithromax side effects rash 2019.

And 3,020 in 2018. The researchers tied opioid overdoses to one in every 313 ER visits last year, compared with one in 400 in the previous two years. While ER visits related to opioid overdoses rose 10.5% last year, overall ER visits dropped 14%, according to findings published in the Annals of Emergency Medicine, and presented recently at the AcademyHealth annual zithromax side effects rash research meeting. Preliminary data recently released by the U.S. Centers for Disease Control and Prevention show more than 93,000 opioid overdose deaths in 2020 — up 29.4% from 2019 and the most ever recorded in a 12-month period in the United States.

"While institutions across the U.S zithromax side effects rash. Are keenly aware that opioid misuse is a major health concern, this shows that there is more work to be done, and it provides an opportunity for institutions and policymakers to expand evidence-based treatments and resources," Jeffrey said in a clinic news release. More than 70% of drug overdose deaths in 2019 involved opioids, according to the CDC, but trends were leveling off before the antibiotics zithromax. However, data reveal a significant reversal in that trend since the zithromax side effects rash start of the zithromax. Actual opioid overdose rates may be higher than the study suggests, because the number of people who overdose but don't go to the emergency department is likely on the rise, the researchers noted.

In response to the surge, Jeffrey said opioid addiction treatments such as buprenorphine and methadone, and the opioid overdose reversal drug naloxone need to be more accessible. She also noted that telehealth access for psychiatric care increased during the zithromax and has remained zithromax side effects rash high. "We think this may be an important way to increase the accessibility of care for many people with opioid misuse disorder or addiction," Jeffery said. More information The U.S. National Institute on Drug Abuse has more about the opioid crisis zithromax side effects rash.

SOURCE. Mayo Clinic, news release, July 28, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved zithromax side effects rash. SLIDESHOW Prescription Drug Abuse. Addiction, Health Risks, and Treatments See Slideshow.

Latest Senior Health News https://www.peak-inspiration.com/testimonial/capgemini-chelsea-slater/ FRIDAY, July 30, 2021 (HealthDay News) The Biden administration has reversed buy azithromycin zithromax or doxycycline a Trump policy that limited the size of fines that U.S. Nursing homes could be slapped with for violating safety standards. The Trump policy buy azithromycin zithromax or doxycycline was adopted in 2017 and prevented the U.S. Centers for Medicare and Medicaid Services (CMS) from hitting a nursing home with a fine for each day it didn't comply with federal standards. That reduced many penalties to a single fine, lowering total amounts from hundreds of thousands of dollars to a maximum of $22,000, The New York Times reported.

Many nursing homes cited for violations such as poor controls, not protecting residents from avoidable buy azithromycin zithromax or doxycycline accidents, neglect, mistreatment and bedsores, are repeat offenders, according to Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. Larger fines are a deterrent and are more likely to indicate strong enforcement of the rules, Edelman told the Times. In early July, the Biden administration changed guidance on the CMS website, saying it had "determined that the agency should retain the discretion at this time to impose a per-day penalty where appropriate to address specific circumstances of prior noncompliance." The new policy means that regulators can impose either per-day or per-instance penalties, the Times reported. Deaths in nursing homes account for nearly a third of the overall buy antibiotics death toll in the United States buy azithromycin zithromax or doxycycline. While there's been a sharp drop in buy antibiotics deaths in nursing homes since treatments became available, inadequate staffing, shortages of protective equipment and poor control are still problems, according to advocates and some officials, the Times reported.

Federal data show that while 81% of nursing home residents are vaccinated, only 58% of workers are immunized, which increases the risk of outbreaks even among fully vaccinated residents. Fines levied on a per-day basis "only take precious resources away from an already underfunded industry, especially during an unprecedented time when nursing homes need every support to protect their residents," the main industry trade group, the American Health Care Association and National Center for Assisted Living, said in a statement, the buy azithromycin zithromax or doxycycline Times reported. More information Visit the Agency for Healthcare Research and Quality for more on nursing home safety. SOURCE. The New York Times buy azithromycin zithromax or doxycycline Robert Preidt Copyright © 2021 HealthDay.

All rights reserved. SLIDESHOW Exercise Tips for Seniors See SlideshowLatest Neurology News FRIDAY, July 30, 2021 (HealthDay News) Extremely premature babies have a much higher risk of cerebral palsy and other neurological conditions than full-term infants, a large Israeli study affirms. Cerebral palsy -- the name for a buy azithromycin zithromax or doxycycline group of lifelong conditions that affect movement and coordination -- is the most common cause of severe childhood physical disability and motor impairment. It can also affect sensation, perception, thinking, communication and behavior. "Extremely premature exposure to the environment outside of the uterus may alter musculoskeletal and nervous system development, and shift the trajectory of motor development for otherwise healthy children," study co-author Dr.

Eyal Sheiner said in a news release from Ben-Gurion University of the Negev buy azithromycin zithromax or doxycycline in Beer-Sheva, Israel. He is vice dean for academic promotion at the university and is also director of obstetrics and gynecology at Soroka University Medical Center in Beer-Sheva. For this study, Sheiner and his colleagues examined the outcomes of more than 220,500 deliveries over 23 years. They found that buy azithromycin zithromax or doxycycline babies born before 25 weeks' gestation had four times the risk of developing long-term neurological issues and significantly higher rates of cerebral palsy. Each additional week in the womb up to 37 weeks was linked to a decrease in the risk of long-term neurological problems, the researchers said.

The findings were recently published in the Journal of Clinical Medicine. "Neurological disorders that stem from premature births are devastating," said Doug Seserman, chief executive buy azithromycin zithromax or doxycycline officer of Americans for Ben-Gurion University, which supported the research. More information The March of Dimes has more on cerebral palsy. SOURCE. Ben-Gurion University of the Negev, news release, July 29, 2021 Robert buy azithromycin zithromax or doxycycline Preidt Copyright © 2021 HealthDay.

All rights reserved. QUESTION The abbreviated term ADHD denotes the condition commonly known as. See AnswerLatest Diabetes News FRIDAY, July 30, 2021 (HealthDay buy azithromycin zithromax or doxycycline News) As many Americans know, today's health insurance plans often come with high deductibles. Those out-of-pocket costs could cause harm. New research shows that 20% of people who have diabetes and high-deductible health plans regularly skip their medications.

Not keeping up with your buy azithromycin zithromax or doxycycline diabetes medications comes with the potential risk of an emergency room visit or a hospitalization. Compared to people without high-deductible health plans, people with high deductibles are also 28% more likely to not take their medicines on time due to cost, the new study found. "Taking prescribed medications is essential for maintaining good health for patients with diabetes," stressed study author Dr. Vikas Gampa, a primary care doctor at Massachusetts General Hospital and instructor in buy azithromycin zithromax or doxycycline medicine at Harvard Medical School. "Our results show that high-deductible health plans, particularly in this period of escalating prices for diabetes medication, are discouraging patients from getting the medications they need and thus they are placing patients with diabetes at risk." High-deductible health plans require patients to pay for all care until they reach the plan's deductible.

Insurance begins to cover medical costs after the patient pays the deductible, typically $1,300 for an individual or $2,600 for a family. These plans buy azithromycin zithromax or doxycycline now comprise half of all commercial health insurance plans. The researchers examined U.S. Federal survey data on more than 7,000 adult patients with diabetes who were enrolled in a commercial health insurance plan buy azithromycin zithromax or doxycycline. They looked for how often patients reported not taking their prescription medication because they could not afford it, comparing both the traditional and the high-deductible patients.

Roughly 25% of high-deductible plan enrollees who take insulin for diabetes could not afford their medication, compared to 19% of those with traditional plans, the study found. That's a 31% higher rate buy azithromycin zithromax or doxycycline. Researchers also found that diabetic patients who could not take their medications as prescribed were more likely to have one or more emergency department visits and potentially more hospitalizations per year than patients who did not skip medicines. "Putting up financial barriers to care in order to save plans money -- as high-deductible plans do -- not only takes a medical toll on patients, it is also short-sighted because doing so actually increases other health care costs such as covering emergency department visits," Gampa said in a Harvard news release. The findings were published online July 29 in the Journal of buy azithromycin zithromax or doxycycline General Internal Medicine.

"Patients with diabetes should recognize that a high-deductible plan will put them at risk for missing or delaying their medications, and doctors need to recognize that their patients with these plans may not be able to adhere to treatment plans," said study senior author Dr. Danny McCormick, an associate professor of medicine at Harvard Medical School and a primary care physician at the Cambridge Health Alliance. "Ultimately, policymakers need to enact reforms that discourage health plans from implementing financial barriers that block access to needed care, buy azithromycin zithromax or doxycycline such as high-deductible plans," McCormick said in the release. "Our results suggest that policymakers must enact reforms that control rapidly escalating prices for diabetic medications." More information The American Diabetes Association has more on diabetes. SOURCE.

Harvard Medical School, news release, July 29, 2021 Cara Murez buy azithromycin zithromax or doxycycline Copyright © 2021 HealthDay. All rights reserved. SLIDESHOW Type 2 Diabetes. Signs, Symptoms, Treatments See SlideshowLatest Mental Health News FRIDAY, July 30, 2021 Opioid overdose-related visits to U.S buy azithromycin zithromax or doxycycline. Emergency departments rose by nearly one-third during the buy antibiotics zithromax last year.

That's the key finding in a new analysis of data from 25 emergency departments in Alabama, Colorado, Connecticut, North Carolina, Massachusetts and Rhode Island. "buy antibiotics, and the disruptions in every part of our social and work buy azithromycin zithromax or doxycycline lives, made this situation even harder by increasing the risk of opioid misuse and relapse because people were separated from their social support and normal routines," said senior study author Molly Jeffery, a researcher at the Mayo Clinic in Rochester, Minn. The study revealed that opioid overdose-related emergency department visits rose 28.5% last year, compared to 2018 and 2019. The raw numbers in the study were 3,486 in 2020. 3,285 in buy azithromycin zithromax or doxycycline 2019.

And 3,020 in 2018. The researchers tied opioid overdoses to one in every 313 ER visits last year, compared with one in 400 in the previous two years. While ER visits related to opioid overdoses rose 10.5% last year, overall ER visits buy azithromycin zithromax or doxycycline dropped 14%, according to findings published in the Annals of Emergency Medicine, and presented recently at the AcademyHealth annual research meeting. Preliminary data recently released by the U.S. Centers for Disease Control and Prevention show more than 93,000 opioid overdose deaths in 2020 — up 29.4% from 2019 and the most ever recorded in a 12-month period in the United States.

"While institutions buy azithromycin zithromax or doxycycline across the U.S. Are keenly aware that opioid misuse is a major health concern, this shows that there is more work to be done, and it provides an opportunity for institutions and policymakers to expand evidence-based treatments and resources," Jeffrey said in a clinic news release. More than 70% of drug overdose deaths in 2019 involved opioids, according to the CDC, but trends were leveling off before the antibiotics zithromax. However, data buy azithromycin zithromax or doxycycline reveal a significant reversal in that trend since the start of the zithromax. Actual opioid overdose rates may be higher than the study suggests, because the number of people who overdose but don't go to the emergency department is likely on the rise, the researchers noted.

In response to the surge, Jeffrey said opioid addiction treatments such as buprenorphine and methadone, and the opioid overdose reversal drug naloxone need to be more accessible. She also noted that telehealth access for buy azithromycin zithromax or doxycycline psychiatric care increased during the zithromax and has remained high. "We think this may be an important way to increase the accessibility of care for many people with opioid misuse disorder or addiction," Jeffery said. More information The U.S. National Institute on buy azithromycin zithromax or doxycycline Drug Abuse has more about the opioid crisis.

SOURCE. Mayo Clinic, news release, July 28, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights buy azithromycin zithromax or doxycycline reserved. SLIDESHOW Prescription Drug Abuse. Addiction, Health Risks, and Treatments See Slideshow.

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Grief management buy zithromax azithromycin in buy antibiotics buy zithromax 500mg online. Indian context. Indian J Psychiatry 2021;63:211Grief is a normal response to loss and bereavement. Human beings are aware of the concept of death and buy zithromax azithromycin permanence of loss leading to grief and bereavement.

It may be seen in some other species also. While there has been a neurobiological mechanism explaining grief, it primarily remains a sociocultural phenomenon affecting the brain and the body. The perception of death followed by the gradual buy zithromax azithromycin “sinking in” of its consequences leads to psychobiological reaction. Grief which is unmanaged can lead to serious health reactions like increased cardiovascular mortality (broken heart) and psychiatric disorders like depression and suicide.buy antibiotics as an epidemic has brought grief and bereavement to the doorstep of each and every person.

Constantly hearing, seeing about death, and losing friends and family has brought enormous strain to people's lives. Death rituals have a therapeutic function wherein buy zithromax azithromycin they allow a family and a group to mourn in a ritualistic way. This allows people to share grief and keep the deceased as focus of attention for a fixed time and then to move on with life. Sometimes, this process is hampered by what Kenneth Doka called “disenfranchised grief” in 1989 and defined it “as a process in which loss is felt as not being openly acknowledged, socially validated or publicly mourned.”[1] Externally imposed disenfranchised grief leads to grief remaining unresolved and unaddressed, and the person feels that his right to grieve has been denied.buy antibiotics has unexpectedly disturbed the process of death rituals as it leads to:Unexpected or sudden lossDepletion of emotional and coping resourcesLimitation in visiting and end of care supportNot able to perform last ritualsLack of social support due to buy antibiotics restrictions.[2]The mechanical and impersonal process has led to severe psychological trauma in the survivors, particularly in the early phase of the disease when the knowledge was less and health-care workers were burdened and under cover of personal protective equipment, communication was difficult.

Realizing this, the Indian Council of Medical Research has come out with buy zithromax azithromycin guidelines for health-care workers to deal with death and guide family members. However, persistence of grief reaction remains a problem, and due to lack of social support due to buy antibiotics, people are increasingly relying on professionals to take care of their grief reactions.In India, the sharing of grief is very important. People try to reach the grieving family. So, what should be the model of care for buy zithromax azithromycin these people?.

We should try to increase the sharing of grief and the handling of the person should be allowed to take placeThe physical support and the economical support have to be arranged, particularly where both parents have diedThere are some common modes like “condolence meetings” or “smaran sabha” which should be attended by both family members and colleagues.buy antibiotics has brought an unprecedented amount of grief, and it is our duty to manage grief with innovative solutions to prevent the emergence of prolonged grief reaction, depression, and suicide. References 1.Doka KJ, editor. Disenfranchised Grief buy zithromax azithromycin. New Directions, Challenges, and Strategies for Practice.

Champaign, IL. Research Press buy zithromax azithromycin. 2002. 2.Albuquerque S, Teixeira AM, Rocha JC.

buy antibiotics and buy zithromax azithromycin Disenfranchised Grief. Front Psychiatry 2021;12:638874. Correspondence Address:Om Prakash SinghDepartment of Psychiatry, WBMES, Kolkata, West Bengal. AMRI Hospitals, buy zithromax azithromycin Kolkata, West Bengal IndiaSource of Support.

None, Conflict of Interest. NoneDOI. 10.4103/indianjpsychiatry.indianjpsychiatry_489_21How to cite this article:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli buy zithromax azithromycin J. Mental health care in Karnataka.

Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry 2021;63:212-4How to cite this URL:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, buy zithromax azithromycin Thirthalli J. Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program.

Indian J Psychiatry [serial online] 2021 [cited 2021 buy zithromax azithromycin Jun 21];63:212-4. Available from. Https://www.indianjpsychiatry.org/text.asp?. 2021/63/3/212/318719Karnataka state has taken many strides forward with regard to the District Mental Health Program (DMHP) buy zithromax azithromycin and is one of the few states to have dedicated DMHP psychiatrists as team leaders in all the districts.

Moreover, some of the recent developments have moved beyond the Bellary model and augur well for the nation. This article attempts to provide a summary of such developments in the state and discusses the future directions. Core Services DMHP in Karnataka offers buy zithromax azithromycin (a) clinical services, including the outreach services (on a rotation basis), covering the primary health centers (PHCs), community health centers, and taluk hospitals. (b) training of all the medical officers and other health professionals such as nurses and pharmacists of the district.

(c) information, education, and communication (IEC) activities – posters, wall paintings in PHCs, IEC activities for schools, colleges, police personnel, judicial departments, elected representatives, faith healers, bus branding, radio talks, etc., In addition, sensitization of Anganwadi workers, accredited social health activists, auxiliary nurse midwives, police/prison staff, agriculture department/horticulture department/primary land development bank staff, village rehabilitation workers, staff of noncommunicable disease/revised National Tuberculosis Control Program, etc.. And (d) buy zithromax azithromycin targeted interventions are being focused on life skills education and counseling in schools, college counseling services, workplace stress management, and suicide prevention services. These initiatives have led to a phenomenal increase in patient footfalls to clinics [Figure 1] and >100,000 stakeholders are trained in various aspects of mental health (in the past 3 years).Figure 1. Chart showing the phenomenal increase in the number of footfalls covered over the past 3 yearsClick here to view Seamless Medication Availability The procurement has been streamlined.

The state-level buy zithromax azithromycin purchase is done by the Karnataka Drugs and Logistics Society, based on the indents collated from each of the districts, and then, sent to their respective district warehouses. Individual indenters (taluk hospitals, community health centers, and primary health centers) then need to procure them from the district warehouses. The amount spent for the purpose has gone up drastically to INR 3 crores (30 million rupees) in the past financial year (2017–2018). However, further streamlining is possible buy zithromax azithromycin in the sense that the delays can be further curtailed.

The Collaboration with the Karnataka State Wakf Board The WAKF board of Karnataka runs a “Darga” in south interior Karnataka. Thousands of persons with mental illnesses do come over here for religious cure. On a day of every week, the attendance crosses 10,000 footfalls. Recently, the authorities have agreed to come up with an allopathic PHC inside buy zithromax azithromycin the campus of the Darga.

The idea is to have integrated and comprehensive care for patients without hurting their religious sentiments. Although such collaborative initiatives are spread across the country, this one is occurring at a larger scale with involvement of governmental agencies [Table 1].Table 1. Details of the key developments and innovations in mental health care in IndiaClick here buy zithromax azithromycin to view Research Initiatives Although excellent evidence-based studies have come out in community settings, actual involvement of government machinery in these kinds of initiatives is few and far. Their involvement is imperative for the evidence to become pragmatic and generalizable.

Of course, by doing so, the methodological rigor compromises a bit. NIMHANS and Government of Karnataka have been collaborating for such service-driven buy zithromax azithromycin research initiatives for over a decade and a half. Community-based interventions are going on in three taluks – Thirthahalli, Turuvekere, and Jagaluru, wherein cohorts of severe mental disorders are being cared for. In addition, several research questions (of public health significance) are being answered.[6],[7] Exciting new initiatives are also underway.

Examining the magnitude of reduction of treatment gap by these community interventions, impact of care at doorsteps (CAD) services from the DMHP machinery, impact of technology-based mentoring program for DMHP staff, evaluation of the buy zithromax azithromycin impact of tele-OCT, etc. Discussion and Future Directions All the above-mentioned activities in Karnataka take it beyond the Bellary model of DMHP. For example, the Memorandum of understanding (MOU) between NIMHANS and the state gives the flexibility and easy maneuverability for active collaboration. Odisha is another state which has taken this path of buy zithromax azithromycin MOU.

This collaborative activity can be expanded pan India as there are several Centers of Excellence spread throughout India. Another aspect of the Karnataka story is collaborative research activity. As described buy zithromax azithromycin above, many activities going on across the state have the potential to inform public health policies. Karnataka has also been able to counter long-standing and well-known criticisms of DMHP/NMHP.

For example, issues related to human resources, availability of medications, funding, mentoring and monitoring, and sustenance, etc., at least to an extent. Of course, the state needs buy zithromax azithromycin to do much more for mental health care. For example, compliance with Mental Health Care Act-2017. Handling unequal distribution of mental health human resources.

Rigorous involvement of buy zithromax azithromycin local administration to tackle micro-level issues. Refining DMHP to suit special populations such as geriatric, children, and adolescents. And perinatal and upscaling urban DMHP, in areas such as Bengaluru Metropolitan City. Another area for improvement is that the DMHP evaluation strategies buy zithromax azithromycin should move beyond head counting and consider meaningful patient-related outcomes, including cost-effective analysis.

Digital technology should further be exploited. The upcoming Karnataka Mental Healthcare Management System is a step in the right direction.[8] Finally, the DMHP should involve health and wellness centers to cater to the mental health needs, particularly for follow-up services, case detection, providing basic counseling, stress management, advocating lifestyle changes, relapse prevention strategies, and other preventive and promotive strategies. References buy zithromax azithromycin 1.Manjunatha N, Kumar CN, Chander KR, Sadh K, Gowda GS, Vinay B, et al. Taluk Mental Health Program.

The new kid on the block?. Indian J Psychiatry buy zithromax azithromycin 2019;61:635-9. [PUBMED] [Full text] 2.Manjunatha N, Kumar CN, Math SB, Thirthalli J. Designing and implementing an innovative digitally driven primary care psychiatry program in India.

Indian J Psychiatry 2018;60:236-44 buy zithromax azithromycin. [PUBMED] [Full text] 3.Pahuja E, Santhosh KT, Fareeduzzafar, Manjunatha N, Kumar CK, Gupta R, et al. An impact of digitally-driven Primary Care Psychiatry Pr. Indian J Psychiatry buy zithromax azithromycin 2020;62 Suppl 1:S17.

4.Manjunatha N, Singh G. Manochaitanya. Integrating mental buy zithromax azithromycin health into primary health care. Lancet 2016;387:647-8.

5.Manjunatha N, Singh G, Chaturvedi SK. Manochaitanya programme for better utilization of buy zithromax azithromycin primary health centres. Indian J Med Res 2017;145:163-5. [PUBMED] [Full text] 6.Agarwal PP, Manjunatha N, Parthasarathy R, Kumar CN, Kelkar R, Math SB, et al.

A performance audit of first 30 months of Manochaitanya programme at secondary care level buy zithromax azithromycin of Karnataka, India. Indian J Community Med 2019;44:222-4. [PUBMED] [Full text] 7.Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN. Alcohol use disorders buy zithromax azithromycin in patients with schizophrenia.

Comparative study with general population controls. Addict Behav 2015;45:22-5. 8. Correspondence Address:Naveen Kumar ChannaveerachariDepartment of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka IndiaSource of Support.

Indian context buy azithromycin zithromax or doxycycline how to buy cheap zithromax. Indian J Psychiatry 2021;63:211Grief is a normal response to loss and bereavement. Human beings are aware of the concept of death and permanence of loss leading to grief and bereavement. It may be buy azithromycin zithromax or doxycycline seen in some other species also.

While there has been a neurobiological mechanism explaining grief, it primarily remains a sociocultural phenomenon affecting the brain and the body. The perception of death followed by the gradual “sinking in” of its consequences leads to psychobiological reaction. Grief which is unmanaged can lead to serious health reactions like increased cardiovascular mortality (broken heart) and psychiatric disorders like depression and suicide.buy antibiotics as an epidemic has brought grief and bereavement to the doorstep of each and every buy azithromycin zithromax or doxycycline person. Constantly hearing, seeing about death, and losing friends and family has brought enormous strain to people's lives.

Death rituals have a therapeutic function wherein they allow a family and a group to mourn in a ritualistic way. This allows people to share grief and keep the deceased as focus of attention for a fixed time and then buy azithromycin zithromax or doxycycline to move on with life. Sometimes, this process is hampered by what Kenneth Doka called “disenfranchised grief” in 1989 and defined it “as a process in which loss is felt as not being openly acknowledged, socially validated or publicly mourned.”[1] Externally imposed disenfranchised grief leads to grief remaining unresolved and unaddressed, and the person feels that his right to grieve has been denied.buy antibiotics has unexpectedly disturbed the process of death rituals as it leads to:Unexpected or sudden lossDepletion of emotional and coping resourcesLimitation in visiting and end of care supportNot able to perform last ritualsLack of social support due to buy antibiotics restrictions.[2]The mechanical and impersonal process has led to severe psychological trauma in the survivors, particularly in the early phase of the disease when the knowledge was less and health-care workers were burdened and under cover of personal protective equipment, communication was difficult. Realizing this, the Indian Council of Medical Research has come out with guidelines for health-care workers to deal with death and guide family members.

However, persistence of grief reaction remains a problem, and due to lack of social support due to buy antibiotics, people are increasingly relying on professionals to take care of their grief reactions.In India, the sharing of grief is very important buy azithromycin zithromax or doxycycline. People try to reach the grieving family. So, what should be the model of care for these people?. We should buy azithromycin zithromax or doxycycline try to increase the sharing of grief and the handling of the person should be allowed to take placeThe physical support and the economical support have to be arranged, particularly where both parents have diedThere are some common modes like “condolence meetings” or “smaran sabha” which should be attended by both family members and colleagues.buy antibiotics has brought an unprecedented amount of grief, and it is our duty to manage grief with innovative solutions to prevent the emergence of prolonged grief reaction, depression, and suicide.

References 1.Doka KJ, editor. Disenfranchised Grief. New Directions, Challenges, and Strategies buy azithromycin zithromax or doxycycline for Practice. Champaign, IL.

Research Press. 2002. 2.Albuquerque S, Teixeira AM, Rocha JC. buy antibiotics and Disenfranchised Grief.

Front Psychiatry 2021;12:638874. Correspondence Address:Om Prakash SinghDepartment of Psychiatry, WBMES, Kolkata, West Bengal. AMRI Hospitals, Kolkata, West Bengal IndiaSource of Support. None, Conflict of Interest.

NoneDOI. 10.4103/indianjpsychiatry.indianjpsychiatry_489_21How to cite this article:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J. Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program.

Indian J Psychiatry 2021;63:212-4How to cite this URL:Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J. Mental health care in Karnataka. Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry [serial online] 2021 [cited 2021 Jun 21];63:212-4.

Available from. Https://www.indianjpsychiatry.org/text.asp?. 2021/63/3/212/318719Karnataka state has taken many strides forward with regard to the District Mental Health Program (DMHP) and is one of the few states to have dedicated DMHP psychiatrists as team leaders in all the districts. Moreover, some of the recent developments have moved beyond the Bellary model and augur well for the nation.

This article attempts to provide a summary of such developments in the state and discusses the future directions. Core Services DMHP in Karnataka offers (a) clinical services, including the outreach services (on a rotation basis), covering the primary health centers (PHCs), community health centers, and taluk hospitals. (b) training of all the medical officers and other health professionals such as nurses and pharmacists of the district. (c) information, education, and communication (IEC) activities – posters, wall paintings in PHCs, IEC activities for schools, colleges, police personnel, judicial departments, elected representatives, faith healers, bus branding, radio talks, etc., In addition, sensitization of Anganwadi workers, accredited social health activists, auxiliary nurse midwives, police/prison staff, agriculture department/horticulture department/primary land development bank staff, village rehabilitation workers, staff of noncommunicable disease/revised National Tuberculosis Control Program, etc..

And (d) targeted interventions are being focused on life skills education and counseling in schools, college counseling services, workplace stress management, and suicide prevention services. These initiatives have led to a phenomenal increase in patient footfalls to clinics [Figure 1] and >100,000 stakeholders are trained in various aspects of mental health (in the past 3 years).Figure 1. Chart showing the phenomenal increase in the number of footfalls covered over the past 3 yearsClick here to view Seamless Medication Availability The procurement has been streamlined. The state-level purchase is done by the Karnataka Drugs and Logistics Society, based on the indents collated from each of the districts, and then, sent to their respective district warehouses.

Individual indenters (taluk hospitals, community health centers, and primary health centers) then need to procure them from the district warehouses. The amount spent for the purpose has gone up drastically to INR 3 crores (30 million rupees) in the past financial year (2017–2018). However, further streamlining is possible in the sense that the delays can be further curtailed. The Collaboration with the Karnataka State Wakf Board The WAKF board of Karnataka runs a “Darga” in south interior Karnataka.

Thousands of persons with mental illnesses do come over here for religious cure. On a day of every week, the attendance crosses 10,000 footfalls. Recently, the authorities have agreed to come up with an allopathic PHC inside the campus of the Darga. The idea is to have integrated and comprehensive care for patients without hurting their religious sentiments zithromax 200mg 5ml price.

Although such collaborative initiatives are spread across the country, this one is occurring at a larger scale with involvement of governmental agencies [Table 1].Table 1. Details of the key developments and innovations in mental health care in IndiaClick here to view Research Initiatives Although excellent evidence-based studies have come out in community settings, actual involvement of government machinery in these kinds of initiatives is few and far. Their involvement is imperative for the evidence to become pragmatic and generalizable. Of course, by doing so, the methodological rigor compromises a bit.

NIMHANS and Government of Karnataka have been collaborating for such service-driven research initiatives for over a decade and a half. Community-based interventions are going on in three taluks – Thirthahalli, Turuvekere, and Jagaluru, wherein cohorts of severe mental disorders are being cared for. In addition, several research questions (of public health significance) are being answered.[6],[7] Exciting new initiatives are also underway. Examining the magnitude of reduction of treatment gap by these community interventions, impact of care at doorsteps (CAD) services from the DMHP machinery, impact of technology-based mentoring program for DMHP staff, evaluation of the impact of tele-OCT, etc.

Discussion and Future Directions All the above-mentioned activities in Karnataka take it beyond the Bellary model of DMHP. For example, the Memorandum of understanding (MOU) between NIMHANS and the state gives the flexibility and easy maneuverability for active collaboration. Odisha is another state which has taken this path of MOU. This collaborative activity can be expanded pan India as there are several Centers of Excellence spread throughout India.

Another aspect of the Karnataka story is collaborative research activity. As described above, many activities going on across the state have the potential to inform public health policies. Karnataka has also been able to counter long-standing and well-known criticisms of DMHP/NMHP. For example, issues related to human resources, availability of medications, funding, mentoring and monitoring, and sustenance, etc., at least to an extent.

Of course, the state needs to do much more for mental health care. For example, compliance with Mental Health Care Act-2017. Handling unequal distribution of mental health human resources. Rigorous involvement of local administration to tackle micro-level issues.

Refining DMHP to suit special populations such as geriatric, children, and adolescents. And perinatal and upscaling urban DMHP, in areas such as Bengaluru Metropolitan City. Another area for improvement is that the DMHP evaluation strategies should move beyond head counting and consider meaningful patient-related outcomes, including cost-effective analysis. Digital technology should further be exploited.

The upcoming Karnataka Mental Healthcare Management System is a step in the right direction.[8] Finally, the DMHP should involve health and wellness centers to cater to the mental health needs, particularly for follow-up services, case detection, providing basic counseling, stress management, advocating lifestyle changes, relapse prevention strategies, and other preventive and promotive strategies. References 1.Manjunatha N, Kumar CN, Chander KR, Sadh K, Gowda GS, Vinay B, et al. Taluk Mental Health Program. The new kid on the block?.

Indian J Psychiatry 2019;61:635-9. [PUBMED] [Full text] 2.Manjunatha N, Kumar CN, Math SB, Thirthalli J. Designing and implementing an innovative digitally driven primary care psychiatry program in India. Indian J Psychiatry 2018;60:236-44.

[PUBMED] [Full text] 3.Pahuja E, Santhosh KT, Fareeduzzafar, Manjunatha N, Kumar CK, Gupta R, et al. An impact of digitally-driven Primary Care Psychiatry Pr. Indian J Psychiatry 2020;62 Suppl 1:S17. 4.Manjunatha N, Singh G.

Manochaitanya. Integrating mental health into primary health care. Lancet 2016;387:647-8. 5.Manjunatha N, Singh G, Chaturvedi SK.

Manochaitanya programme for better utilization of primary health centres. Indian J Med Res 2017;145:163-5. [PUBMED] [Full text] 6.Agarwal PP, Manjunatha N, Parthasarathy R, Kumar CN, Kelkar R, Math SB, et al. A performance audit of first 30 months of Manochaitanya programme at secondary care level of Karnataka, India.

Indian J Community Med 2019;44:222-4. [PUBMED] [Full text] 7.Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN. Alcohol use disorders in patients with schizophrenia. Comparative study with general population controls.

Addict Behav 2015;45:22-5. 8. Correspondence Address:Naveen Kumar ChannaveerachariDepartment of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka IndiaSource of Support. None, Conflict of Interest.

NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_345_19 Figures [Figure 1] Tables [Table 1].

Zithromax discount

The fact-based decision-making that scientists rely upon cheap zithromax online canada is zithromax discount the polar opposite of emotion-based decision-making. In his rhetoric, Trump does not address factual evidence. He dismisses or suppresses it even for events that are apparent to many, including global warming, foreign intervention in U.S. Elections, the trivial head count at his inauguration, and even the projected path of a destructive zithromax discount hurricane.

Instead, “alternative facts,” or fabrications, are substituted. This perspective from inside the brain’s neural networks also explains the Trump administration’s unprecedented erosion of government institutions with missions intended to protect the public (ranging from the Centers for Disease Control to the FBI). These diversions distract attention from real, uncontrollable threats, such as the antibiotics zithromax discount zithromax, that may undermine Trump’s political and economic objectives. Reason cannot always overcome fear, as PTSD demonstrates.

But the brain’s second mechanism of neutralizing its fear circuitry—experience—can do so. Repeated exposure to the fearful situation where the outcome is safe will rewire the brain’s zithromax discount subcortical circuitry. This is the basis for “extinction therapy” used to treat PTSD and phobias. For many, credibility has been eroded by Trump’s outlandish assertions, like suggesting injections of bleach might cure buy antibiotics, or enthusing over a plant toxin touted by a pillow salesman, while scientific experts in attendance grimace and bite their lips.

In the last election Trump was a little-known newcomer as a political figure, but that zithromax discount is not the case this time with either candidate. The “gut -reaction” decision-making process excels in complex situations where there is not enough factual information or time to make a reasoned decision. We follow gut instinct, for example, when selecting a dish from a menu at a new restaurant, where we have never seen or tasted the offering before. We’ve had our fill of zithromax discount the politics this time, no matter what position one may favor.

Whether voters choose to vote for Trump on the basis of emotion or reason, they will be better able to articulate the reasons, or rationalizations, for their choice. This should give pollsters better data to make a more accurate prediction.One of the most impressive, disturbing works of science journalism I’ve encountered is Anatomy of an Epidemic. Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness zithromax discount in America, published in 2010. In the book, which I review here, award-winning journalist Robert Whitaker presents evidence that medications for mental illness, over time and in the aggregate, cause net harm.

In 2012, I brought Whitaker to my school to give a talk, in part to check him out. He struck me as a smart, sensible, meticulous reporter whose in-depth research had zithromax discount led him to startling conclusions. Since then, far from encountering persuasive rebuttals of Whitaker’s thesis, I keep finding corroborations of it. If Whitaker is right, modern psychiatry, together with the pharmaceutical industry, has inflicted iatrogenic harm on millions of people.

Reports of surging mental distress during the zithromax have me zithromax discount thinking once again about Whitaker’s views and wondering how they have evolved. Below he answers some questions. €”John Horgan
 Horgan. When and why did you zithromax discount start reporting on mental health?.

Whitaker. It came about in a very roundabout way. In 1994, I had co-founded a publishing company called CenterWatch that covered the business aspects of the “clinical trials industry,” zithromax discount and I soon became interested in writing about how financial interests were corrupting drug trials. Risperdal and Zyprexa had just come to market, and after I used a Freedom of Information request to obtain the FDA’s review of those two drugs, I could see that psychiatric drug trials were a prime example of that corruption.

In addition, I had learned of NIMH-funded research that seemed abusive of schizophrenia patients, and in 1998, I co-wrote a series for the Boston Globe on abuses of patients in psychiatric research. My interest was in zithromax discount that broader question of corruption and abuse in research settings, and not specific to psychiatry. At that time, I still had a conventional understanding of psychiatric drugs. My understanding was that researchers were making great advances in understanding mental disorders, and that they had found that schizophrenia and depression were due to chemical imbalances in the brain, which psychiatric medications then put back in balance.

However, while reporting that series, I stumbled upon studies that didn’t make sense to me, for they belied what I knew to be “true,” and that was zithromax discount what sent me down this path of reporting on mental health. First, there were two studies by the World Health Organization that found that longer-term outcomes for schizophrenia patients in three “developing” countries were much better than in the U.S. And five other “developed” countries. This didn’t really make zithromax discount sense to me, and then I read this.

In the developing countries, they used antipsychotic drugs acutely, but not chronically. Only 16 percent of patients in the developing countries were regularly maintained on antipsychotics, whereas in the developed countries this was the standard of care. That didn’t fit zithromax discount with my understanding that these drugs were an essential treatment for schizophrenia patients. Second, a study by Harvard researchers found that schizophrenia outcomes had declined in the previous 20 years, and were now no better than they had been in the first third of the 20th century.

That didn’t fit with my understanding that psychiatry had made great progress in treating people so diagnosed. Those studies led to my questioning the story that our society told about those we call “mad,” and I zithromax discount got a book contract to dig into that question. That project turned into Mad in America, which told of the history of our society’s treatment of the seriously mentally ill, from colonial times until today—a history marked by bad science and societal mistreatment of those so diagnosed. Horgan.

Do you still see yourself as a zithromax discount journalist, or are you primarily an activist?. Whitaker. I don’t see myself as an “activist” at all. In my zithromax discount own writings, and in the webzine I direct, Mad in America, I think you’ll see journalistic practices at work, albeit in the service of an “activist” mission.

Here is our mission statement. €œMad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.” Thus, our starting point is that “change” is needed, and while that does have an activist element, I think journalism—serving as zithromax discount an informational source—is fundamental to that effort. As an organization, we are not asserting that we have the answers for what that change should be, which would be the case if we were striving to be activists.

Instead, we strive to be a forum for promoting an informed societal discussion about this subject. Here’s what zithromax discount we do. We publish daily summaries of scientific research with findings that are rarely covered in the mainstream media. You’ll find, in the archives of our research reports, a steady parade of findings that counter the conventional narrative.

For instance, there are reports of how the zithromax discount effort to find genes for mental disorders has proven rather fruitless, or of how social inequalities trigger mental distress, or of poor long-term outcomes with our current paradigm of care. And so forth—we simply want these scientific findings to become known.
We regularly feature interviews with researchers and activists, and podcasts that explore these issues. We launched MIA Reports as a showcase for our print journalism. We have zithromax discount published in-depth articles on promising new initiatives in Europe.

Investigative pieces on such topics as compulsory outpatient treatment. Coverage of “news” related to mental health policy in the United States. And occasional reports on zithromax discount how the mainstream media is covering mental health issues. €¨We also publish blogs by professionals, academics, people with lived experience, and others with a particular interest in this subject.

These blogs and personal stories are meant to help inform society’s “rethinking” of psychiatric care. All of these efforts, I think, fit within the framework of “journalism.” However, I do understand that I am going zithromax discount beyond the boundaries of usual “science journalism” when I publish critiques of the “evidence base” related to psychiatric drugs. I did this in my books Mad in America and Anatomy of an Epidemic, as well as a book I co-wrote, Psychiatry Under the Influence. I have continued to do this with MIA Reports.

The usual practice in “science journalism” is to look to the “experts” in the field and report on zithromax discount what they tell about their findings and practices. However, while reporting and writing Mad in America, I came to understand that when “experts” in psychiatry spoke to journalists they regularly hewed to a story that they were expected to tell, which was a story of how their field was making great progress in understanding the biology of disorders and of drug treatments that—as I was told over and over when I co-wrote the series for the Boston Globe—fixed chemical imbalances in the brain. But their own science, I discovered, regularly belied the story they were telling to the media. That’s why I turned to focusing on the story that could be dug out from a critical look zithromax discount at their own scientific literature.

So what I do in these critiques—such as suicide in the Prozac era and the impact of antipsychotics on mortality—is review the relevant research and put those findings together into a coherent report. I also look at research cited in support of mainstream beliefs and see if the data, in those articles, actually supports the conclusions presented in the abstract. None of this is really that difficult, and yet I zithromax discount know it is unusual for a journalist to challenge conventional “medical wisdom” in this way. Horgan.

Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a zithromax discount fair summary?. Whitaker. Yes, although my thinking has evolved somewhat since I wrote that book.

I am more convinced than ever that psychiatric medications, zithromax discount over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes. However, my thinking has evolved in this way. I am not so sure any more that the medications provide a short-term benefit for zithromax discount patient populations as a whole.

When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal, and fails to rise to the level of a “clinically meaningful” benefit. Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their psychiatric medications zithromax discount and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects.

A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?. In short, research on the short-term effects of psychiatric zithromax discount drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first episode patients. Which is rather startling, when you think of it.

Horgan. Have any of your critics—E. Fuller Torrey, for example—made you rethink your thesis?. Whitaker.

When the first edition of Anatomy of an Epidemic was published (2010), I knew there would be critics, and I thought, this will be great. This is just what is needed, a societal discussion about the long-term effects of psychiatric medications. I have to confess that I have been disappointed in the criticism. They mostly have been ad hominem attacks—I cherry-picked the data, or I misunderstood findings, or I am just biased, but the critics don’t then say what data I missed, or point to findings that tell of medications that improve long-term outcomes.

I honestly think I could do a much better job of critiquing my own work. You mention E. Fuller Torrey’s criticism, in which he states that I both misrepresented and misunderstood some of the research I cited. I took this seriously, and answered it at great length.

Now if your own “thesis” is indeed flawed, then a critic should be able to point out its flaws while accurately detailing what you wrote. If that is the case, then you have good reason to rethink your beliefs. But if a critique doesn’t meet that standard, but rather relies on misrepresenting what you wrote, then you have reason to conclude that the critic lacks the evidence to make an honest case. And that is how I see Torrey’s critique.

For example, Torrey said that I misunderstood Martin Harrow’s research on long-term outcomes for schizophrenia patients. Harrow reported that the recovery rate was eight times higher for those who got off antipsychotic medication compared to those who stayed on the drugs. However, in his 2007 paper, Harrow stated that the better outcomes for those who got off medication was because they had a better prognosis and not because of negative drug effects. If you read Anatomy of an Epidemic, you’ll see that I present his explanation.

Yet, in my interview with Harrow, I noted that his own data showed that those who were diagnosed with milder psychotic disorders who stayed on antipsychotics fared worse over the long term than schizophrenia patients who stopped taking the medication. This was a comparison that showed the less ill maintained on antipsychotics doing worse than the more severely ill who got off these medications. And I presented that comparison in Anatomy of an Epidemic. By doing that, I was going out on a limb.

I was saying that maybe Harrow’s data led to a different conclusion than he had drawn, which was that the antipsychotic medication, over the long-term, had a negative effect. After Anatomy was published, Harrow and his colleague Thomas Jobe went back to their data and investigated this very possibility. They have subsequently written several papers exploring this theme, citing me in one or two instances for raising the issue, and they found reason to conclude that it might be so. They wrote.

€œHow unique among medical treatments is it that the apparent efficacy of antipsychotics could diminish over time or become harmful?. There are many examples for other medications of similar long-term effects, with this often occurring as the body readjusts, biologically, to the medications.” Thus, in this instance, I did the following. I accurately reported the results of Harrow’s study and his interpretation of his results, and I accurately presented data from his research that told of a possible different interpretation. The authors then revisited their own data to take up this inquiry.

And yet Torrey’s critique is that I misrepresented Harrow’s research. This same criticism, by the way, is still being flung at me. Here is a recent article in Vice which, once again, quotes people saying I misrepresent and misunderstand research, with Harrow cited as an example. I do want to emphasize that critiques of “my thesis” regarding the long-term effects of psychiatric drugs are important and to be welcomed.

See two papers in particular that take this on (here and here), and my response in general to such criticisms, and to the second one. Horgan. When I criticize psychiatric drugs, people sometimes tell me that meds saved their lives. You must get this reaction a lot.

How do you respond?. Whitaker. I do hear that, and when I do, I reply, “Great!. I am so glad to know that the medications have worked for you!.

€ But of course I also hear from many people who say that the drugs ruined their lives. I do think that the individual’s experience of psychiatric medication, whether good or bad, should be honored as worthy and “valid.” They are witnesses to their own lives, and we should incorporate those voices into our societal thinking about the merits of psychiatric drugs. However, for the longest time, we’ve heard mostly about the “good” outcomes in the mainstream media, while those with “bad” outcomes were resigned to telling their stories on internet forums. What Mad in America has sought to do, in its efforts to serve as a forum for rethinking psychiatry, is provide an outlet for this latter group, so their voices can be heard too.

The personal accounts, of course, do not change the bottom-line “evidence” that shows up in outcome studies of larger groups of patients. Unfortunately, that tells of medications that, on the whole, do more harm than good. As a case in point, in regard to this “saving lives” theme, this benefit does not show up in public health data. The “standard mortality rate” for those with serious mental disorders, compared to the general public, has notably increased in the last 40 years.

Horgan. Do you see any promising trends in psychiatry?. Whitaker. Yes, definitely.

You have the spread of Hearing Voices networks, which are composed of people who hear voices and offer support for learning to live with voices as opposed to squashing them, which is what the drugs are supposed to do. These networks are up and running in the U.S., and in many countries worldwide. You have Open Dialogue approaches, which were pioneered in northern Finland and proved successful there, being adopted in the United States and many European countries (and beyond.) This practice puts much less emphasis on treatment with antipsychotics, and much greater emphasis on helping people re-integrate into family and community. You have many alternative programs springing up, even at the governmental level.

Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it, and there is now a private hospital in Norway that is devoted to helping chronic patients taper down from their psychiatric medications. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.” You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress. All of those initiatives tell of an effort to find a new way.

But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold. More and more research tells of how the conventional narrative, in all its particulars, has failed to pan out. The diagnoses in the Diagnostic and Statistical Manual (DSM) have not been validated as discrete illnesses. The genetics of mental disorders remain in doubt.

MRI scans have not proven to be useful. Long-term outcomes are poor. And the notion that psychiatric drugs fix chemical imbalances has been abandoned. Ronald Pies, the former editor in chief of Psychiatric Times, has even sought to distance psychiatry, as an institution, from ever having made such a claim.

Horgan. Do brain implants or other electrostimulation devices show any therapeutic potential?. Whitaker. I don’t have a ready answer for this.

We have published two articles about the spinning of results from a trial of deep-brain stimulation, and the suffering of some patients so treated over the long-term. Those articles tell of why it may be difficult to answer that question. There are financial influences that push for published results that tell of a therapeutic success, even if the data doesn’t support that finding, and we have a research environment that fails to study long-term outcomes. The history of somatic treatments for mental disorders also provides a reason for caution.

It’s a history of one somatic treatment after another being initially hailed as curative, or extremely helpful, and then failing the test of time. The inventor of frontal lobotomy, Egas Moniz, was awarded a Nobel Prize for inventing that surgery, which today we understand as a mutilation. It’s important to remain open to the possibility that somatic treatments may be helpful, at least for some patients. But there is plenty of reason to be wary of initial claims of success.

Horgan. Should psychedelic drugs be taken seriously as treatments?. Whitaker. I think caution applies here too.

Surely there are many risks with psychedelic drugs, and if you were to do a study of first-episode psychosis today, you would find a high percentage of the patients had been using mind-altering drugs before their psychotic break—antidepressants, marijuana, LSD and so forth. At the same time, we’ve published reviews of papers that have reported positive results with use of psychedelics. What are the benefits versus the risks?. Can possible benefits be realized while risks are minimized?.

It is a question worth exploring, but carefully so. Horgan. What about meditation?. Whitaker.

I know that many people find meditation helpful. I also know other people find it difficult—and even threatening—to sit with the silence of their minds. Mad in America has published reviews of research about meditation, we have had a few bloggers write about it, and in our resource section on “non-drug therapies,” we have summarized research findings regarding its use for depression. We concluded that the research on this is not as robust as one would like.

However, I think your question leads to this broader thought. People struggling with their minds and emotions may come up with many different approaches they find helpful. Exercise, diet, meditation, yoga and so forth all represent efforts to change one’s environment, and ultimately, I think that can be very helpful. But the individual has to find his or her way to whatever environmental change that works best for them.

Horgan. Do you see any progress toward understanding the causes of mental illness?. Whitaker. Yes, and that progress might be summed up in this way.

Researchers are http://diamaritorres.com/2010/11/01/photoshop-tutorials-that-rock/ returning to investigations of how we are impacted by what has “happened to us.” The Adverse Childhood Experiences study provides compelling evidence of how traumas in childhood—divorce, poverty, abuse, bullying and so forth—exact a long-term toll on physical and mental health. Interview any group of women diagnosed with a serious mental disorder, and you’ll regularly find accounts of sexual abuse. Racism exacts a toll. So too poverty, oppressive working conditions, and so forth.

You can go on and on, but all of this is a reminder that we humans are designed to respond to our environment, and it is quite clear that mental distress, in large part, arises from difficult environments and threatening experiences, past and present. And with a focus on life experiences as a source of “mental illness,” a related question is now being asked. What do we all need to be mentally well?. Shelter, good food, meaning in life, someone to love and so forth—if you look at it from this perspective, you can see why, when those supporting elements begin to disappear, psychiatric difficulties appear.

I am not discounting that there may be biological factors that cause “mental illness.” While biological markers that tell of a particular disorder have not been discovered, we are biological creatures, and we do know, for instance, that there are physical illnesses and toxins that can produce psychotic episodes. However, the progress that is being made at the moment is a moving away from the robotic “it’s all about brain chemistry” toward a rediscovery of the importance of our social lives and our experiences. Horgan. Do we still have anything to learn from Sigmund Freud?.

Whitaker. I certainly think so. Freud is a reminder that so much of our mind is hidden from us and that what spills into our consciousness comes from a blend of the many parts of our mind, our emotional centers and our more primal instincts. You can still see merit in Freud’s descriptions of the id, ego and superego as a conceptualization of different parts of the brain.

I read Freud when I was in college, and it was a formative experience for me. Horgan. I fear that American-style capitalism doesn’t produce good health care, including mental-health care. What do you think?.

Whitaker. It’s clear that it doesn’t. First, we have for-profit health-care that is set up to treat “disease.” With mental-health care, that means there is a profit to be made from seeing people as “diseased” and treating them for that “illness.” Take a pill!. In other words, American-style capitalism, which works to create markets for products, provides an incentive to create mental patients, and it has done this to great success over the past 35 years.

Second, without a profit to be made, you don’t have as much investment in psychosocial care that can help a person remake his or her life. There is a societal expense, but little corporate profit, in psychosocial care, and American-style capitalism doesn’t lend itself to that equation. Third, with our American-style capitalism (think neoliberalism), it is the individual that is seen as “ill” and needs to be fixed. Society gets a free pass.

This too is a barrier to good “mental health” care, for it prevents us from thinking about what changes we might make to our society that would be more nurturing for us all. With our American-style capitalism, we now have a grossly unequal society, with more and more wealth going to the select few, and more and more people struggling to pay their bills. That is a prescription for psychiatric distress. Good “mental health care” starts with creating a society that is more equal and just.

Horgan. How might the buy antibiotics zithromax affect care of the mentally ill?. Whitaker. That is something Mad in America has reported on.

The zithromax, of course, can be particularly threatening to people in mental hospitals, or in group homes. The threat is more than just the exposure to the zithromax that may come in such settings. People who are struggling in this way often feel terribly isolated, alone, and fearful of being with others. buy antibiotics measures, with calls for social distancing, can exacerbate that.

I think this puts hospital staff and those who run residential homes into an extraordinarily difficult position—how can they help ease the isolation of patients even as they are being expected to enforce a type of social distancing?. Horgan. If the next president named you mental health czar, what would be at the top of your To Do list?. Whitaker.

Well, I am pretty sure that’s not going to happen, and if it did, I would quickly confess to my being utterly unqualified for the job. But from my perch at Mad in America, here is what I would like to see happen in our society. As you can see from my answers above, I think the fundamental problem is that our society has organized itself around a false narrative, which was sold to us as a narrative of science. In the early 1980s, we began to hear that psychiatric disorders were discrete brain illnesses, which were caused by chemical imbalances in the brain, and that a new generation of psychiatric drugs fixed those imbalances, like insulin for diabetes.

That is a story of an amazing medical breakthrough. Researchers had discovered the very chemicals in our brain that cause madness, depression, anxiety or ADHD, and they had developed drugs that could put brain chemistry back into a normal state. Given the complexity of the human brain, if this were true, it would arguably be the greatest achievement in medical history. And we understood it to be true.

We came to believe that there was a sharp line between the “normal” brain and the “abnormal” brain, and that it was medically helpful to screen for these illnesses, and that psychiatric drugs were very safe and effective, and often needed to be taken for life. But what can be seen clearly today is that this narrative was a marketing story, not a scientific one. It was a story that psychiatry, as an institution, promoted for guild purposes, and it was a story that pharmaceutical companies promoted for commercial reasons. Science actually tells a very different story.

The biology of psychiatric disorders remains unknown. The disorders in the DSM have not been validated as discrete illnesses. The drugs do not fix chemical imbalances but rather perturb normal neurotransmitter functions. And even their short term efficacy is marginal at best.

As could be expected, organizing our thinking around a false narrative has been a societal disaster. A sharp rise in the burden of mental illness in our society. Poor long-term functional outcomes for those who are continuously medicated. The pathologizing of childhood.

And so on. What we need now is a new narrative to organize ourselves around, one steeped in history, literature, philosophy, and good science. I think step one is ditching the DSM. That book presents the most impoverished “philosophy of being” imaginable.

Anyone who is too emotional, or struggles with his or her mind, or just doesn’t like being in a boring environment (think ADHD) is a candidate for a diagnosis. We need a narrative that, if truth be told, can be found in literature. Novels, Shakespeare, the Bible—they all tell of how we humans struggle with our minds, our emotions and our behaviors. That is the norm.

It is the human condition. And yet the characters we see in literature, if they were viewed through the DSM lens, would regularly qualify for a diagnosis. At the same time, literature tells of how humans can be so resilient, and that we change as we age and move through different environments. We need that to be part of a new narrative too.

Our current disease-model narrative tells of how people are likely going to be chronically ill. Their brains are defective, and so the therapeutic goal is to manage the symptoms of the “disease.” We need a narrative that replaces that pessimism with hope. If we embraced that literary understanding of what it is to be human, then a “mental health” policy could be forged that would begin with this question. How do we create environments that are more nurturing for us all?.

How do we create schools that build on a child’s curiosity?. How do we bring nature back into our lives?. How do we create a society that helps provide people with meaning, a sense of community, and a sense of civic duty?. How do we create a society that promotes good physical health, and provides access to shelter and medical care?.

Furthermore, with this conception in mind, individual therapy would help people change their environments. You could encourage walks in nature. Recommend volunteer work. Provide settings where people could go and recuperate, and so forth.

Most important, in contrast to a “disease-based” paradigm of care, a “wellness-based” paradigm would help people feel hopeful, and help them find a way to create a different future for themselves. This is an approach, by the way, that can be helpful to people who have suffered a psychotic episode. Soteria homes and Open Dialogue are “therapies” that strive to help psychotic patients in this manner. Within this “wellness” paradigm of care, there would still be a place for use of medications that help people feel differently, at least for a time.

Sedatives, tranquilizers, and so forth. And you would still want to fund science that seeks to better understand the many pathways to debilitating mood states and to “psychosis”—trauma, poor physical health, physical disease, lack of sleep, setbacks in life, isolation, loneliness, and yes, whatever biological vulnerabilities that may be present. At the same time, you would want to fund science that seeks to better understand the pillars of “wellness.” Horgan. What’s your utopia?.

Whitaker. My “utopia” would be a world like the one I just described, based on a new narrative about mental illness, rooted in an understanding of how emotional we humans are, of how we struggle with our minds, and of how we are built to be responsive to our environments. And that really is the mission of Mad in America. We want it to be a forum for creating a new societal narrative for “mental health.” Further Reading.

Can Psychiatry Heal Itself?. Are Psychiatric Medications Making Us Sicker?. Meta-Post. Posts on Mental Illness Meta-Post.

Posts on Brain Implants Meta-Post. Posts on Psychedelics Meta-Post. Posts on Buddhism and Meditation See also “The Meaning of Madness,” a chapter in my free online book Mind-Body Problems.1970 Sweet Suburbia “Massive movement from central cities to their suburbs, a population boom in the West and Southwest, and a lower rate of population growth in the 1960's than in the 1950's are the findings that stand out in the preliminary results of the 1970 Census as issued by the U.S. Bureau of the Census.

The movement to the suburbs was pervasive. Its extent is indicated by the fact that 13 of the 25 largest cities lost population, whereas 24 of the 25 largest metropolitan areas gained. Washington, D.C., was characteristic. The population of the city changed little between 1960 and 1970, but the metropolitan area grew by 800,000, or more than 38 percent.” 1920 Air Cargo “The proposed machine, known as the ‘Pelican Four-Ton Lorry,' is a colossal cantilever monoplane designed for two 460-horse-power Napier engines.

Its cruising speed is 72 miles per hour. Its total weight is to be 24,100 pounds. The useful load is four tons, with sufficient fuel for the London-Paris journey. Most interesting of all, however, is the novel system of quick loading and unloading which has been planned.

This permits handling of shipments with the utmost speed, and is based on a similar practice in the motor truck field. Idle airplanes mean a large idle capital, hence the designers plan to keep the airplane in the air for the greater part of the time.” Don't Try This Anywhere “Dr. Charles Baskerville points out that while the data thus far obtained on chlorine and influenza do not warrant drawing conclusions, such facts as have been established would indicate to the medical man the advisability of trying experimentally dilute chlorinated air as a prophylactic in such epidemics as so-called influenza. Dr.

Baskerville determined to what extent workers in plants where small amounts of chlorine were to be found in the atmosphere were affected seriously by influenza. Many of those from whom information was requested expressed the opinion that chlorine workers are noticeably free from colds and other pneumatic diseases.” 1870 The Rise of Telegraphy “The rapid progress of the telegraph during the last twenty-five years has changed the whole social and commercial systems of the world. Its advantages and capabilities were so evident that immediately on its introduction, and demonstration of its true character, the most active efforts were made to secure them for every community which desired to keep pace with the advances of modern times. The Morse or signal system seemed for a time to be the perfection of achievement, until Professor Royal E.

House astonished the world with his letter printing telegraph. Now, almost every considerable expanse of water is traversed, or soon will be, by the slender cords which bind continents and islands together and practically bring the human race into one great family.” The Transport of Goods 1887. Cargo ship launched as Golconda had room for 6,000 tons of cargo, loaded and unloaded by crane and cargo nets, and 108 passengers. Credit.

Scientific American Supplement, Vol. XXIII, No. 574. January 1, 1887 Oxcarts, railroad cars and freight ships can be loaded and unloaded one item at a time, but it is more efficient to handle cargo packed into “intermodal shipping containers” that are a standardized size and shape.

Our October 1968 issue noted that a “break-bulk” freighter took three days to unload, a container ship less than one (including loading new cargo). Air transport became a link in this complex system, but the concept in the 1920 illustration shown is a little ahead of its time. These days air cargo (and luggage) makes abundant use of “unit load devices,” cargo bins shaped to fit the fuselage of specific aircraft models.The items below are highlights from the free newsletter, “Smart, useful, science stuff about buy antibiotics.” To receive newsletter issues daily in your inbox, sign-up here. Are you in need of a “dose of optimism” about the zithromax, at least in the U.S.?.

Check out this 10/12/20 story at The New York Times by by Donald McNeil Jr., who has covered infectious diseases and epidemics for many years. McNeil notes the 215,000 people in the U.S. Dead so far from the novel antibiotics, as well as the estimates that the figure could go as high as 400,000 before this era draws to a close. But here is some of the good news that he tallies.

1) mask-wearing by the public is “widely accepted”. 2) the development of treatments to protect against antibiotics and of treatments for buy antibiotics are proceeding at record speed. 3) “experts are saying, with genuine confidence, that the zithromax in the United States will be over far sooner than they expected, possibly by the middle of next year”. And 4) fewer infected people die today than did earlier this year, even at nursing homes.

About 10 percent of people in the U.S. Have been infected with the zithromax so far, according to the U.S. Centers for Disease Control, the story states. €œzithromaxs don’t end abruptly.

They decelerate gradually,” McNeil writes. A 10/14/20 story by Carl Zimmer for The New York Times puts into context three late-stage (Phase 3 safety and effectiveness) buy antibiotics experiments that have been paused in recent weeks due to illness among some study participants. Pauses in treatment studies — in this case Johnson &. Johnson’s treatment candidate and AstraZeneca’s treatment candidate — are “not unusual,” the story states, partly because the safety threshold is extremely high for a product that, if approved, could be given to millions or billions of people.

But pauses are rare in treatment studies — in this case Eli Lilly’s monoclonal antibody cocktail drug. Once a drug or treatment experiment (trial) is paused, a safety board determines whether the ill participant was given the new product or a placebo. If it was the placebo, the study can resume. If not, the board looks deeper into the case to determine whether or not the illness is related to the drug or treatment.

If a clear connection is discovered, “the trial may have to stop,” Zimmer writes. Dr. Eric Topol at Scripps Research is quoted in the piece as saying he is “still fairly optimistic” about monoclonal antibody treatments for buy antibiotics. The safety-related pauses of all three experiments are “an example of how things are supposed to work,” says Dr.

Anna Durbin of Johns Hopkins Bloomberg School of Public Health in the story. The top of a story at The Washington Post features an instructive interactive that sketches “Scienceville,” a fictional place where “politicians and public health officials use every tool at their disposal to contain the antibiotics.” It basically shows how genetic analysis and tracing of viral strains found in a frequently and widely tested population could help officials control outbreaks of antibiotics. Then the 10/13/20 text story below, by Brady Dennis, Chris Mooney, Sarah Kaplan, and Harry Stevens, focuses on the details of such a “genomic epidemiology” approach and describes some real-life efforts under way, primarily in the UK, to implement the approach. The U.S.

Has not been able to effectively use the approach, in part because genetic sequencing of viral strains “has largely been left up to states and individual researchers, rather than being part of a coordinated and well-funded national program,” the story states. The rise in antibiotics s in the U.S. Is now driven by “small gatherings in people’s homes,” according to officials with the U.S. Centers for Disease Control, reports Carolyn Crist for WebMD (10/14/20).

People should continue to wear face masks and to practice social distancing “since most people have still not been exposed to the antibiotics worldwide," the researchers suggest, Crist writes. A newly developed test can detect antibiotics in 5 minutes, reports Robert F. Service at Science (10/8/20). The test relies on CRISPR gene-editing technology, for which Jennifer Doudna of the University of California, Berkeley, and Emmanuelle Charpentier of the Max Planck Unit for the Science of Pathogens won the Nobel Prize in Chemistry earlier this month.

Doudna heads up the work that led to this new 5-minute CRISPR test for the antibiotics. By comparison, it can take a day or more to get back standard antibiotics test results, the story states. Donald G. McNeil Jr.

At The New York Times has written a guide to distinguishing common cold, flu, and buy antibiotics symptoms (10/3/20). A major difference between having a cold and having the flu is that "Flu makes you feel as if you were hit by a truck,” McNeil quotes experts as saying. The symptom that best distinguishes buy antibiotics from flu is loss of your sense of smell — strong smells don’t register, he writes. But many flu and buy antibiotics symptoms overlap, the story states.

The most common symptoms for buy antibiotics are a high fever, chills, dry cough and fatigue. For flu, it’s a fever, headaches, body aches, sore throat, runny nose, stuffed sinuses, coughing and sneezing, the story states. Dr. Anthony Fauci’s three daughters do not plan to visit him for Thanksgiving to avoid potentially transmitting the new antibiotics to their parents, reports Ralph Ellis at WebMD.

The story includes holiday traveling and visiting tips from a pulmonary critical care doctor at the University of Washington Medical Center who “believes traveling for the holidays is risky.” The tips include ensuring you have no buy antibiotics-like symptoms two weeks before traveling, getting tested before traveling, quarantining in a hotel for at least 48 hours before visiting with loved ones, traveling by car, and cutting down on “close contact and talking without a mask” (10/9/20). Adele Chapin has written a guide for reducing kids’ risk of catching and spreading antibiotics at the playground. The 10/8/20 piece in The Washington Post makes the usual recommendations for mask-wearing, hand-washing, hand-sanitizer, disinfecting wipes, and distancing. It quotes a Children’s National Hospital pediatrician advises against gloves, because “people wearing them often touch their faces, which defeats the purpose.” The piece also recommends visiting playgrounds at less busy times and choosing playgrounds with more than one play structure, which makes it easier for kids to distance from one another.

A story by Carl Zimmer for The New York Times beautifully describes and illustrates some of the amazing imaging work that scientists have done to study the structure of antibiotics and how it infects our cells and multiplies (10/9/20). For starters, check out a mesmerizing video about a quarter of the way down-page that simulates spike proteins (complex molecules) doing a “molecular dance” on the zithromax membrane. The video (just one of several in this stunning piece) is part of research by a computational biophysicist at the Max Planck Institute of Biophysics and colleagues. The spikes appear to shimmy, which “increases the odds of encountering the protein on the surface of our cells it uses to attach,” the researchers suspect, Zimmer writes.

You might enjoy, “A letter of recommendation in the age of Zoom,” by Matt Cheung, for McSweeney’s (10/14/20).Editor’s Note (10/16/20). This story is being republished in light of the interim results of a large international clinical trial of remdesivir by the World Health Organization. The trial found that the drug, which is widely used to treat buy antibiotics patients, failed to prevent deaths. An experimental drug—and one of the world’s best hopes against buy antibiotics—could shorten the time to recovery from antibiotics , according to the largest and most rigorous clinical trial of the compound.

The experimental drug, called remdesivir, interferes with replication of some zithromaxes, including the antibiotics zithromax responsible for the current zithromax. On 29 April, Anthony Fauci, director of the US National Institute of Allergy and Infectious Disease (NIAID), announced that a clinical trial of more than a thousand people showed that people taking remdesivir recovered in 11 days on average, compared to 15 days for those on a placebo. €œAlthough a 31% improvement doesn’t seem like a knockout 100%, it is a very important proof of concept,” Fauci said. €œWhat it has proven is that a drug can block this zithromax.” Deaths were also lower in trial participants who received the drug, he said, but that trend was not statistically significant.

The shortened recovery time, however, was significant, and was enough of a benefit that investigators decided to stop the trial early for ethical reasons, he said, to ensure that those participants who were receiving placebo could now access the drug. Fauci added that remdesivir would become a standard treatment for buy antibiotics. The news comes after weeks of data leaks and on a day of mixed results from clinical trials of the drug. In a trial run by the drug’s maker, Gilead Sciences of Foster City, California, more than half of 400 participants with severe buy antibiotics recovered from their illness within two weeks of receiving treatment.

But the study lacked a placebo controlled arm, making the results difficult to interpret.

It provokes the limbic buy azithromycin zithromax or doxycycline system. In the 2016 election, undecided voters were influenced by the brain’s fear-driven impulses—more simply, gut instinct—once they arrived inside the voting booth, even though they were unable to explain their decision to pre-election pollsters in a carefully reasoned manner. In 2020, Trump continues to use the same strategy of appealing to the brain’s threat-detection circuitry and emotion-based decision process to attract votes and vilify opponents. €œBiden wants to buy azithromycin zithromax or doxycycline surrender our country to the violent left-wing mob….

If Biden wins, very simple, China wins. If Biden wins, the mob wins. If Biden wins, the rioters, anarchists, arsonists and flag-burners, they win,” buy azithromycin zithromax or doxycycline Trump declared at his Wisconsin campaign rally on September 17, 2020, offering new alleged threats to our nation as his 2016 bogeymen of rapist immigrants and foreign terrorists have lost potency. As Trump invokes threats of anarchy and street violence, any tangible rise in violence at political assemblies will benefit the Trump strategy of generating fear.

Trump supporters have reacted by brandishing and sometimes using firearms at public demonstrations. In the 2016 campaign, Trump egged his supporters on to commit violence, suggesting that buy azithromycin zithromax or doxycycline an assassination of Hillary Clinton by gun rights advocates could be used to prevent her from picking Supreme Court justices. The president has inflamed the atmosphere surrounding large protests by calling to the scene military and unidentified federal security agents, even as local officials object. He continues to make bombastic statements.

€œI am your wall between the American dream and chaos,” he told an audience in buy azithromycin zithromax or doxycycline Minnesota. When asked by debate moderator Chris Wallace whether he was willing to condemn white supremacists and paramilitary groups, he would not do so. Instead, he barked out what sounded like strategic instructions to the right-wing Proud Boys, widely regarded as an extremist hate group, “Proud Boys—stand back, and stand by.” But fear-driven appeals will likely persuade fewer voters this time, because we overcome fear in two ways. By reason buy azithromycin zithromax or doxycycline and experience.

Inhibitory neural pathways from the prefrontal cortex to the limbic system will enable reason to quash fear if the dangers are not grounded in fact. The type of street violence Trump rails against now was not the norm during the Obama and Biden years. Nor was fear that Biden would buy azithromycin zithromax or doxycycline turn the U.S. Into a socialist state an issue even a year ago.

On the contrary, Biden defeated the self-described “democratic socialist” candidate Bernie Sanders in the presidential primaries. A psychology- and neuroscience-based perspective also illuminates Trump’s constant interruptions and insults during the first presidential debate, steamrolling over the moderator’s futile efforts to have a reasoned airing of facts buy azithromycin zithromax or doxycycline and positions. The structure of a debate is designed to engage the deliberative reasoning in the brain’s cerebral cortex, so Trump annihilated the format to inflame emotion in the limbic system. Trump’s dismissal of experts, be they military generals, career public servants, scientists or even his own political appointees, is necessary for him to sustain the subcortical decision-making in voters’ minds that won him election and sustains his support.

The fact-based decision-making that scientists rely upon is the polar opposite of emotion-based decision-making buy azithromycin zithromax or doxycycline. In his rhetoric, Trump does not address factual evidence. He dismisses or suppresses it even for events that are apparent to many, including global warming, foreign intervention in U.S. Elections, the buy azithromycin zithromax or doxycycline trivial head count at his inauguration, and even the projected path of a destructive hurricane.

Instead, “alternative facts,” or fabrications, are substituted. This perspective from inside the brain’s neural networks also explains the Trump administration’s unprecedented erosion of government institutions with missions intended to protect the public (ranging from the Centers for Disease Control to the FBI). These diversions distract attention from real, uncontrollable threats, such as the antibiotics zithromax, that may undermine Trump’s political and economic objectives buy azithromycin zithromax or doxycycline. Reason cannot always overcome fear, as PTSD demonstrates.

But the brain’s second mechanism of neutralizing its fear circuitry—experience—can do so. Repeated exposure to the fearful situation where the outcome is safe buy azithromycin zithromax or doxycycline will rewire the brain’s subcortical circuitry. This is the basis for “extinction therapy” used to treat PTSD and phobias. For many, credibility has been eroded by Trump’s outlandish assertions, like suggesting injections of bleach might cure buy antibiotics, or enthusing over a plant toxin touted by a pillow salesman, while scientific experts in attendance grimace and bite their lips.

In the buy azithromycin zithromax or doxycycline last election Trump was a little-known newcomer as a political figure, but that is not the case this time with either candidate. The “gut -reaction” decision-making process excels in complex situations where there is not enough factual information or time to make a reasoned decision. We follow gut instinct, for example, when selecting a dish from a menu at a new restaurant, where we have never seen or tasted the offering before. We’ve had our fill of the politics this time, no matter what position one may buy azithromycin zithromax or doxycycline favor.

Whether voters choose to vote for Trump on the basis of emotion or reason, they will be better able to articulate the reasons, or rationalizations, for their choice. This should give pollsters better data to make a more accurate prediction.One of the most impressive, disturbing works of science journalism I’ve encountered is Anatomy of an Epidemic. Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness buy azithromycin zithromax or doxycycline in America, published in 2010. In the book, which I review here, award-winning journalist Robert Whitaker presents evidence that medications for mental illness, over time and in the aggregate, cause net harm.

In 2012, I brought Whitaker to my school to give a talk, in part to check him out. He struck me as a smart, sensible, meticulous reporter whose in-depth research had led him to startling buy azithromycin zithromax or doxycycline conclusions. Since then, far from encountering persuasive rebuttals of Whitaker’s thesis, I keep finding corroborations of it. If Whitaker is right, modern psychiatry, together with the pharmaceutical industry, has inflicted iatrogenic harm on millions of people.

Reports of buy azithromycin zithromax or doxycycline surging mental distress during the zithromax have me thinking once again about Whitaker’s views and wondering how they have evolved. Below he answers some questions. €”John Horgan
 Horgan. When and buy azithromycin zithromax or doxycycline why did you start reporting on mental health?.

Whitaker. It came about in a very roundabout way. In 1994, I had co-founded a publishing company called CenterWatch that covered the business aspects of the buy azithromycin zithromax or doxycycline “clinical trials industry,” and I soon became interested in writing about how financial interests were corrupting drug trials. Risperdal and Zyprexa had just come to market, and after I used a Freedom of Information request to obtain the FDA’s review of those two drugs, I could see that psychiatric drug trials were a prime example of that corruption.

In addition, I had learned of NIMH-funded research that seemed abusive of schizophrenia patients, and in 1998, I co-wrote a series for the Boston Globe on abuses of patients in psychiatric research. My interest was in that broader question of corruption and abuse buy azithromycin zithromax or doxycycline in research settings, and not specific to psychiatry. At that time, I still had a conventional understanding of psychiatric drugs. My understanding was that researchers were making great advances in understanding mental disorders, and that they had found that schizophrenia and depression were due to chemical imbalances in the brain, which psychiatric medications then put back in balance.

However, while reporting that series, I stumbled upon studies that didn’t make sense to me, for they belied what buy azithromycin zithromax or doxycycline I knew to be “true,” and that was what sent me down this path of reporting on mental health. First, there were two studies by the World Health Organization that found that longer-term outcomes for schizophrenia patients in three “developing” countries were much better than in the U.S. And five other “developed” countries. This didn’t really make sense to me, and then buy azithromycin zithromax or doxycycline I read this.

In the developing countries, they used antipsychotic drugs acutely, but not chronically. Only 16 percent of patients in the developing countries were regularly maintained on antipsychotics, whereas in the developed countries this was the standard of care. That didn’t fit with my understanding that these drugs were an essential buy azithromycin zithromax or doxycycline treatment for schizophrenia patients. Second, a study by Harvard researchers found that schizophrenia outcomes had declined in the previous 20 years, and were now no better than they had been in the first third of the 20th century.

That didn’t fit with my understanding that psychiatry had made great progress in treating people so diagnosed. Those studies led to my questioning the story that our society told about those we call “mad,” and I got a buy azithromycin zithromax or doxycycline book contract to dig into that question. That project turned into Mad in America, which told of the history of our society’s treatment of the seriously mentally ill, from colonial times until today—a history marked by bad science and societal mistreatment of those so diagnosed. Horgan.

Do you still see yourself buy azithromycin zithromax or doxycycline as a journalist, or are you primarily an activist?. Whitaker. I don’t see myself as an “activist” at all. In my own writings, and in the webzine I direct, Mad in America, I buy azithromycin zithromax or doxycycline think you’ll see journalistic practices at work, albeit in the service of an “activist” mission.

Here is our mission statement. €œMad in America’s mission is to serve as a catalyst for rethinking psychiatric care in the United States (and abroad). We believe that the current drug-based paradigm of care has failed our society, and that scientific research, as well as the lived experience of those who have been diagnosed with a psychiatric disorder, calls for profound change.” Thus, our starting point is that “change” is needed, and while that does have an activist element, buy azithromycin zithromax or doxycycline I think journalism—serving as an informational source—is fundamental to that effort. As an organization, we are not asserting that we have the answers for what that change should be, which would be the case if we were striving to be activists.

Instead, we strive to be a forum for promoting an informed societal discussion about this subject. Here’s what buy azithromycin zithromax or doxycycline we do. We publish daily summaries of scientific research with findings that are rarely covered in the mainstream media. You’ll find, in the archives of our research reports, a steady parade of findings that counter the conventional narrative.

For instance, there are reports of how the effort to find genes for mental disorders has proven rather fruitless, or of buy azithromycin zithromax or doxycycline how social inequalities trigger mental distress, or of poor long-term outcomes with our current paradigm of care. And so forth—we simply want these scientific findings to become known.
We regularly feature interviews with researchers and activists, and podcasts that explore these issues. We launched MIA Reports as a showcase for our print journalism. We have published in-depth articles on promising buy azithromycin zithromax or doxycycline new initiatives in Europe.

Investigative pieces on such topics as compulsory outpatient treatment. Coverage of “news” related to mental health policy in the United States. And occasional reports on how the mainstream media buy azithromycin zithromax or doxycycline is covering mental health issues. €¨We also publish blogs by professionals, academics, people with lived experience, and others with a particular interest in this subject.

These blogs and personal stories are meant to help inform society’s “rethinking” of psychiatric care. All of these efforts, I think, fit within the framework of “journalism.” However, I do understand that I am going beyond the boundaries of usual “science journalism” when I buy azithromycin zithromax or doxycycline publish critiques of the “evidence base” related to psychiatric drugs. I did this in my books Mad in America and Anatomy of an Epidemic, as well as a book I co-wrote, Psychiatry Under the Influence. I have continued to do this with MIA Reports.

The usual practice in “science journalism” is buy azithromycin zithromax or doxycycline to look to the “experts” in the field and report on what they tell about their findings and practices. However, while reporting and writing Mad in America, I came to understand that when “experts” in psychiatry spoke to journalists they regularly hewed to a story that they were expected to tell, which was a story of how their field was making great progress in understanding the biology of disorders and of drug treatments that—as I was told over and over when I co-wrote the series for the Boston Globe—fixed chemical imbalances in the brain. But their own science, I discovered, regularly belied the story they were telling to the media. That’s why I turned to focusing on the story that could be dug out from a critical look buy azithromycin zithromax or doxycycline at their own scientific literature.

So what I do in these critiques—such as suicide in the Prozac era and the impact of antipsychotics on mortality—is review the relevant research and put those findings together into a coherent report. I also look at research cited in support of mainstream beliefs and see if the data, in those articles, actually supports the conclusions presented in the abstract. None of this is really that difficult, and yet I know it is unusual for a journalist to challenge conventional “medical wisdom” in this buy azithromycin zithromax or doxycycline way. Horgan.

Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a fair buy azithromycin zithromax or doxycycline summary?. Whitaker. Yes, although my thinking has evolved somewhat since I wrote that book.

I am more convinced than ever that buy azithromycin zithromax or doxycycline psychiatric medications, over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes. However, my thinking has evolved in this way. I am not so sure any more that the medications provide a short-term benefit for patient buy azithromycin zithromax or doxycycline populations as a whole.

When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal, and fails to rise to the level of a “clinically meaningful” benefit. Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their buy azithromycin zithromax or doxycycline psychiatric medications and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects.

A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?. In short, research on the short-term buy azithromycin zithromax or doxycycline effects of psychiatric drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first episode patients. Which is rather startling, when you think of it.

Horgan. Have any of your critics—E. Fuller Torrey, for example—made you rethink your thesis?. Whitaker.

When the first edition of Anatomy of an Epidemic was published (2010), I knew there would be critics, and I thought, this will be great. This is just what is needed, a societal discussion about the long-term effects of psychiatric medications. I have to confess that I have been disappointed in the criticism. They mostly have been ad hominem attacks—I cherry-picked the data, or I misunderstood findings, or I am just biased, but the critics don’t then say what data I missed, or point to findings that tell of medications that improve long-term outcomes.

I honestly think I could do a much better job of critiquing my own work. You mention E. Fuller Torrey’s criticism, in which he states that I both misrepresented and misunderstood some of the research I cited. I took this seriously, and answered it at great length.

Now if your own “thesis” is indeed flawed, then a critic should be able to point out its flaws while accurately detailing what you wrote. If that is the case, then you have good reason to rethink your beliefs. But if a critique doesn’t meet that standard, but rather relies on misrepresenting what you wrote, then you have reason to conclude that the critic lacks the evidence to make an honest case. And that is how I see Torrey’s critique.

For example, Torrey said that I misunderstood Martin Harrow’s research on long-term outcomes for schizophrenia patients. Harrow reported that the recovery rate was eight times higher for those who got off antipsychotic medication compared to those who stayed on the drugs. However, in his 2007 paper, Harrow stated that the better outcomes for those who got off medication was because they had a better prognosis and not because of negative drug effects. If you read Anatomy of an Epidemic, you’ll see that I present his explanation.

Yet, in my interview with Harrow, I noted that his own data showed that those who were diagnosed with milder psychotic disorders who stayed on antipsychotics fared worse over the long term than schizophrenia patients who stopped taking the medication. This was a comparison that showed the less ill maintained on antipsychotics doing worse than the more severely ill who got off these medications. And I presented that comparison in Anatomy of an Epidemic. By doing that, I was going out on a limb.

I was saying that maybe Harrow’s data led to a different conclusion than he had drawn, which was that the antipsychotic medication, over the long-term, had a negative effect. After Anatomy was published, Harrow and his colleague Thomas Jobe went back to their data and investigated this very possibility. They have subsequently written several papers exploring this theme, citing me in one or two instances for raising the issue, and they found reason to conclude that it might be so. They wrote.

€œHow unique among medical treatments is it that the apparent efficacy of antipsychotics could diminish over time or become harmful?. There are many examples for other medications of similar long-term effects, with this often occurring as the body readjusts, biologically, to the medications.” Thus, in this instance, I did the following. I accurately reported the results of Harrow’s study and his interpretation of his results, and I accurately presented data from his research that told of a possible different interpretation. The authors then revisited their own data to take up this inquiry.

And yet Torrey’s critique is that I misrepresented Harrow’s research. This same criticism, by the way, is still being flung at me. Here is a recent article in Vice which, once again, quotes people saying I misrepresent and misunderstand research, with Harrow cited as an example. I do want to emphasize that critiques of “my thesis” regarding the long-term effects of psychiatric drugs are important and to be welcomed.

See two papers in particular that take this on (here and here), and my response in general to such criticisms, and to the second one. Horgan. When I criticize psychiatric drugs, people sometimes tell me that meds saved their lives. You must get this reaction a lot.

How do you respond?. Whitaker. I do hear that, and when I do, I reply, “Great!. I am so glad to know that the medications have worked for you!.

€ But of course I also hear from many people who say that the drugs ruined their lives. I do think that the individual’s experience of psychiatric medication, whether good or bad, should be honored as worthy and “valid.” They are witnesses to their own lives, and we should incorporate those voices into our societal thinking about the merits of psychiatric drugs. However, for the longest time, we’ve heard mostly about the “good” outcomes in the mainstream media, while those with “bad” outcomes were resigned to telling their stories on internet forums. What Mad in America has sought to do, in its efforts to serve as a forum for rethinking psychiatry, is provide an outlet for this latter group, so their voices can be heard too.

The personal accounts, of course, do not change the bottom-line “evidence” that shows up in outcome studies of larger groups of patients. Unfortunately, that tells of medications that, on the whole, do more harm than good. As a case in point, in regard to this “saving lives” theme, this benefit does not show up in public health data. The “standard mortality rate” for those with serious mental disorders, compared to the general public, has notably increased in the last 40 years.

Horgan. Do you see any promising trends in psychiatry?. Whitaker. Yes, definitely.

You have the spread of Hearing Voices networks, which are composed of people who hear voices and offer support for learning to live with voices as opposed to squashing them, which is what the drugs are supposed to do. These networks are up and running in the U.S., and in many countries worldwide. You have Open Dialogue approaches, which were pioneered in northern Finland and proved successful there, being adopted in the United States and many European countries (and beyond.) This practice puts much less emphasis on treatment with antipsychotics, and much greater emphasis on helping people re-integrate into family and community. You have many alternative programs springing up, even at the governmental level.

Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it, and there is now a private hospital in Norway that is devoted to helping chronic patients taper down from their psychiatric medications. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.” You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress. All of those initiatives tell of an effort to find a new way.

But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold. More and more research tells of how the conventional narrative, in all its particulars, has failed to pan out. The diagnoses in the Diagnostic and Statistical Manual (DSM) have not been validated as discrete illnesses. The genetics of mental disorders remain in doubt.

MRI scans have not proven to be useful. Long-term outcomes are poor. And the notion that psychiatric drugs fix chemical imbalances has been abandoned. Ronald Pies, the former editor in chief of Psychiatric Times, has even sought to distance psychiatry, as an institution, from ever having made such a claim.

Horgan. Do brain implants or other electrostimulation devices show any therapeutic potential?. Whitaker. I don’t have a ready answer for this.

We have published two articles about the spinning of results from a trial of deep-brain stimulation, and the suffering of some patients so treated over the long-term. Those articles tell of why it may be difficult to answer that question. There are financial influences that push for published results that tell of a therapeutic success, even if the data doesn’t support that finding, and we have a research environment that fails to study long-term outcomes. The history of somatic treatments for mental disorders also provides a reason for caution.

It’s a history of one somatic treatment after another being initially hailed as curative, or extremely helpful, and then failing the test of time. The inventor of frontal lobotomy, Egas Moniz, was awarded a Nobel Prize for inventing that surgery, which today we understand as a mutilation. It’s important to remain open to the possibility that somatic treatments may be helpful, at least for some patients. But there is plenty of reason to be wary of initial claims of success.

Horgan. Should psychedelic drugs be taken seriously as treatments?. Whitaker. I think caution applies here too.

Surely there are many risks with psychedelic drugs, and if you were to do a study of first-episode psychosis today, you would find a high percentage of the patients had been using mind-altering drugs before their psychotic break—antidepressants, marijuana, LSD and so forth. At the same time, we’ve published reviews of papers that have reported positive results with use of psychedelics. What are the benefits versus the risks?. Can possible benefits be realized while risks are minimized?.

It is a question worth exploring, but carefully so. Horgan. What about meditation?. Whitaker.

I know that many people find meditation helpful. I also know other people find it difficult—and even threatening—to sit with the silence of their minds. Mad in America has published reviews of research about meditation, we have had a few bloggers write about it, and in our resource section on “non-drug therapies,” we have summarized research findings regarding its use for depression. We concluded that the research on this is not as robust as one would like.

However, I think your question leads to this broader thought. People struggling with their minds and emotions may come up with many different approaches they find helpful. Exercise, diet, meditation, yoga and so forth all represent efforts to change one’s environment, and ultimately, I think that can be very helpful. But the individual has to find his or her way to whatever environmental change that works best for them.

Horgan. Do you see any progress toward understanding the causes of mental illness?. Whitaker. Yes, and that progress might be summed up in this way.

Researchers are returning to investigations of how we are impacted by what has “happened to us.” The Adverse Childhood Experiences study provides compelling evidence of how traumas in childhood—divorce, poverty, abuse, bullying and so forth—exact a long-term toll on physical and mental health. Interview any group of women diagnosed with a serious mental disorder, and you’ll regularly find accounts of sexual abuse. Racism exacts a toll. So too poverty, oppressive working conditions, and so forth.

You can go on and on, but all of this is a reminder that we humans are designed to respond to our environment, and it is quite clear that mental distress, in large part, arises from difficult environments and threatening experiences, past and present. And with a focus on life experiences as a source of “mental illness,” a related question is now being asked. What do we all need to be mentally well?. Shelter, good food, meaning in life, someone to love and so forth—if you look at it from this perspective, you can see why, when those supporting elements begin to disappear, psychiatric difficulties appear.

I am not discounting that there may be biological factors that cause “mental illness.” While biological markers that tell of a particular disorder have not been discovered, we are biological creatures, and we do know, for instance, that there are physical illnesses and toxins that can produce psychotic episodes. However, the progress that is being made at the moment is a moving away from the robotic “it’s all about brain chemistry” toward a rediscovery of the importance of our social lives and our experiences. Horgan. Do we still have anything to learn from Sigmund Freud?.

Whitaker. I certainly think so. Freud is a reminder that so much of our mind is hidden from us and that what spills into our consciousness comes from a blend of the many parts of our mind, our emotional centers and our more primal instincts. You can still see merit in Freud’s descriptions of the id, ego and superego as a conceptualization of different parts of the brain.

I read Freud when I was in college, and it was a formative experience for me. Horgan. I fear that American-style capitalism doesn’t produce good health care, including mental-health care. What do you think?.

Whitaker. It’s clear that it doesn’t. First, we have for-profit health-care that is set up to treat “disease.” With mental-health care, that means there is a profit to be made from seeing people as “diseased” and treating them for that “illness.” Take a pill!. In other words, American-style capitalism, which works to create markets for products, provides an incentive to create mental patients, and it has done this to great success over the past 35 years.

Second, without a profit to be made, you don’t have as much investment in psychosocial care that can help a person remake his or her life. There is a societal expense, but little corporate profit, in psychosocial care, and American-style capitalism doesn’t lend itself to that equation. Third, with our American-style capitalism (think neoliberalism), it is the individual that is seen as “ill” and needs to be fixed. Society gets a free pass.

This too is a barrier to good “mental health” care, for it prevents us from thinking about what changes we might make to our society that would be more nurturing for us all. With our American-style capitalism, we now have a grossly unequal society, with more and more wealth going to the select few, and more and more people struggling to pay their bills. That is a prescription for psychiatric distress. Good “mental health care” starts with creating a society that is more equal and just.

Horgan. How might the buy antibiotics zithromax affect care of the mentally ill?. Whitaker. That is something Mad in America has reported on.

The zithromax, of course, can be particularly threatening to people in mental hospitals, or in group homes. The threat is more than just the exposure to the zithromax that may come in such settings. People who are struggling in this way often feel terribly isolated, alone, and fearful of being with others. buy antibiotics measures, with calls for social distancing, can exacerbate that.

I think this puts hospital staff and those who run residential homes into an extraordinarily difficult position—how can they help ease the isolation of patients even as they are being expected to enforce a type of social distancing?. Horgan. If the next president named you mental health czar, what would be at the top of your To Do list?. Whitaker.

Well, I am pretty sure that’s not going to happen, and if it did, I would quickly confess to my being utterly unqualified for the job. But from my perch at Mad in America, here is what I would like to see happen in our society. As you can see from my answers above, I think the fundamental problem is that our society has organized itself around a false narrative, which was sold to us as a narrative of science. In the early 1980s, we began to hear that psychiatric disorders were discrete brain illnesses, which were caused by chemical imbalances in the brain, and that a new generation of psychiatric drugs fixed those imbalances, like insulin for diabetes.

That is a story of an amazing medical breakthrough. Researchers had discovered the very chemicals in our brain that cause madness, depression, anxiety or ADHD, and they had developed drugs that could put brain chemistry back into a normal state. Given the complexity of the human brain, if this were true, it would arguably be the greatest achievement in medical history. And we understood it to be true.

We came to believe that there was a sharp line between the “normal” brain and the “abnormal” brain, and that it was medically helpful to screen for these illnesses, and that psychiatric drugs were very safe and effective, and often needed to be taken for life. But what can be seen clearly today is that this narrative was a marketing story, not a scientific one. It was a story that psychiatry, as an institution, promoted for guild purposes, and it was a story that pharmaceutical companies promoted for commercial reasons. Science actually tells a very different story.

The biology of psychiatric disorders remains unknown. The disorders in the DSM have not been validated as discrete illnesses. The drugs do not fix chemical imbalances but rather perturb normal neurotransmitter functions. And even their short term efficacy is marginal at best.

As could be expected, organizing our thinking around a false narrative has been a societal disaster. A sharp rise in the burden of mental illness in our society. Poor long-term functional outcomes for those who are continuously medicated. The pathologizing of childhood.

And so on. What we need now is a new narrative to organize ourselves around, one steeped in history, literature, philosophy, and good science. I think step one is ditching the DSM. That book presents the most impoverished “philosophy of being” imaginable.

Anyone who is too emotional, or struggles with his or her mind, or just doesn’t like being in a boring environment (think ADHD) is a candidate for a diagnosis. We need a narrative that, if truth be told, can be found in literature. Novels, Shakespeare, the Bible—they all tell of how we humans struggle with our minds, our emotions and our behaviors. That is the norm.

It is the human condition. And yet the characters we see in literature, if they were viewed through the DSM lens, would regularly qualify for a diagnosis. At the same time, literature tells of how humans can be so resilient, and that we change as we age and move through different environments. We need that to be part of a new narrative too.

Our current disease-model narrative tells of how people are likely going to be chronically ill. Their brains are defective, and so the therapeutic goal is to manage the symptoms of the “disease.” We need a narrative that replaces that pessimism with hope. If we embraced that literary understanding of what it is to be human, then a “mental health” policy could be forged that would begin with this question. How do we create environments that are more nurturing for us all?.

How do we create schools that build on a child’s curiosity?. How do we bring nature back into our lives?. How do we create a society that helps provide people with meaning, a sense of community, and a sense of civic duty?. How do we create a society that promotes good physical health, and provides access to shelter and medical care?.

Furthermore, with this conception in mind, individual therapy would help people change their environments. You could encourage walks in nature. Recommend volunteer work. Provide settings where people could go and recuperate, and so forth.

Most important, in contrast to a “disease-based” paradigm of care, a “wellness-based” paradigm would help people feel hopeful, and help them find a way to create a different future for themselves. This is an approach, by the way, that can be helpful to people who have suffered a psychotic episode. Soteria homes and Open Dialogue are “therapies” that strive to help psychotic patients in this manner. Within this “wellness” paradigm of care, there would still be a place for use of medications that help people feel differently, at least for a time.

Sedatives, tranquilizers, and so forth. And you would still want to fund science that seeks to better understand the many pathways to debilitating mood states and to “psychosis”—trauma, poor physical health, physical disease, lack of sleep, setbacks in life, isolation, loneliness, and yes, whatever biological vulnerabilities that may be present. At the same time, you would want to fund science that seeks to better understand the pillars of “wellness.” Horgan. What’s your utopia?.

Whitaker. My “utopia” would be a world like the one I just described, based on a new narrative about mental illness, rooted in an understanding of how emotional we humans are, of how we struggle with our minds, and of how we are built to be responsive to our environments. And that really is the mission of Mad in America. We want it to be a forum for creating a new societal narrative for “mental health.” Further Reading.

Can Psychiatry Heal Itself?. Are Psychiatric Medications Making Us Sicker?. Meta-Post. Posts on Mental Illness Meta-Post.

Posts on Brain Implants Meta-Post. Posts on Psychedelics Meta-Post. Posts on Buddhism and Meditation See also “The Meaning of Madness,” a chapter in my free online book Mind-Body Problems.1970 Sweet Suburbia “Massive movement from central cities to their suburbs, a population boom in the West and Southwest, and a lower rate of population growth in the 1960's than in the 1950's are the findings that stand out in the preliminary results of the 1970 Census as issued by the U.S. Bureau of the Census.

The movement to the suburbs was pervasive. Its extent is indicated by the fact that 13 of the 25 largest cities lost population, whereas 24 of the 25 largest metropolitan areas gained. Washington, D.C., was characteristic. The population of the city changed little between 1960 and 1970, but the metropolitan area grew by 800,000, or more than 38 percent.” 1920 Air Cargo “The proposed machine, known as the ‘Pelican Four-Ton Lorry,' is a colossal cantilever monoplane designed for two 460-horse-power Napier engines.

Its cruising speed is 72 miles per hour. Its total weight is to be 24,100 pounds. The useful load is four tons, with sufficient fuel for the London-Paris journey. Most interesting of all, however, is the novel system of quick loading and unloading which has been planned.

This permits handling of shipments with the utmost speed, and is based on a similar practice in the motor truck field. Idle airplanes mean a large idle capital, hence the designers plan to keep the airplane in the air for the greater part of the time.” Don't Try This Anywhere “Dr. Charles Baskerville points out that while the data thus far obtained on chlorine and influenza do not warrant drawing conclusions, such facts as have been established would indicate to the medical man the advisability of trying experimentally dilute chlorinated air as a prophylactic in such epidemics as so-called influenza. Dr.

Baskerville determined to what extent workers in plants where small amounts of chlorine were to be found in the atmosphere were affected seriously by influenza. Many of those from whom information was requested expressed the opinion that chlorine workers are noticeably free from colds and other pneumatic diseases.” 1870 The Rise of Telegraphy “The rapid progress of the telegraph during the last twenty-five years has changed the whole social and commercial systems of the world. Its advantages and capabilities were so evident that immediately on its introduction, and demonstration of its true character, the most active efforts were made to secure them for every community which desired to keep pace with the advances of modern times. The Morse or signal system seemed for a time to be the perfection of achievement, until Professor Royal E.

House astonished the world with his letter printing telegraph. Now, almost every considerable expanse of water is traversed, or soon will be, by the slender cords which bind continents and islands together and practically bring the human race into one great family.” The Transport of Goods 1887. Cargo ship launched as Golconda had room for 6,000 tons of cargo, loaded and unloaded by crane and cargo nets, and 108 passengers. Credit.

Scientific American Supplement, Vol. XXIII, No. 574. January 1, 1887 Oxcarts, railroad cars and freight ships can be loaded and unloaded one item at a time, but it is more efficient to handle cargo packed into “intermodal shipping containers” that are a standardized size and shape.

Our October 1968 issue noted that a “break-bulk” freighter took three days to unload, a container ship less than one (including loading new cargo). Air transport became a link in this complex system, but the concept in the 1920 illustration shown is a little ahead of its time. These days air cargo (and luggage) makes abundant use of “unit load devices,” cargo bins shaped to fit the fuselage of specific aircraft models.The items below are highlights from the free newsletter, “Smart, useful, science stuff about buy antibiotics.” To receive newsletter issues daily in your inbox, sign-up here. Are you in need of a “dose of optimism” about the zithromax, at least in the U.S.?.

Check out this 10/12/20 story at The New York Times by by Donald McNeil Jr., who has covered infectious diseases and epidemics for many years. McNeil notes the 215,000 people in the U.S. Dead so far from the novel antibiotics, as well as the estimates that the figure could go as high as 400,000 before this era draws to a close. But here is some of the good news that he tallies.

1) mask-wearing by the public is “widely accepted”. 2) the development of treatments to protect against antibiotics and of treatments for buy antibiotics are proceeding at record speed. 3) “experts are saying, with genuine confidence, that the zithromax in the United States will be over far sooner than they expected, possibly by the middle of next year”. And 4) fewer infected people die today than did earlier this year, even at nursing homes.

About 10 percent of people in the U.S. Have been infected with the zithromax so far, according to the U.S. Centers for Disease Control, the story states. €œzithromaxs don’t end abruptly.

They decelerate gradually,” McNeil writes. A 10/14/20 story by Carl Zimmer for The New York Times puts into context three late-stage (Phase 3 safety and effectiveness) buy antibiotics experiments that have been paused in recent weeks due to illness among some study participants. Pauses in treatment studies — in this case Johnson &. Johnson’s treatment candidate and AstraZeneca’s treatment candidate — are “not unusual,” the story states, partly because the safety threshold is extremely high for a product that, if approved, could be given to millions or billions of people.

But pauses are rare in treatment studies — in this case Eli Lilly’s monoclonal antibody cocktail drug. Once a drug or treatment experiment (trial) is paused, a safety board determines whether the ill participant was given the new product or a placebo. If it was the placebo, the study can resume. If not, the board looks deeper into the case to determine whether or not the illness is related to the drug or treatment.

If a clear connection is discovered, “the trial may have to stop,” Zimmer writes. Dr. Eric Topol at Scripps Research is quoted in the piece as saying he is “still fairly optimistic” about monoclonal antibody treatments for buy antibiotics. The safety-related pauses of all three experiments are “an example of how things are supposed to work,” says Dr.

Anna Durbin of Johns Hopkins Bloomberg School of Public Health in the story. The top of a story at The Washington Post features an instructive interactive that sketches “Scienceville,” a fictional place where “politicians and public health officials use every tool at their disposal to contain the antibiotics.” It basically shows how genetic analysis and tracing of viral strains found in a frequently and widely tested population could help officials control outbreaks of antibiotics. Then the 10/13/20 text story below, by Brady Dennis, Chris Mooney, Sarah Kaplan, and Harry Stevens, focuses on the details of such a “genomic epidemiology” approach and describes some real-life efforts under way, primarily in the UK, to implement the approach. The U.S.

Has not been able to effectively use the approach, in part because genetic sequencing of viral strains “has largely been left up to states and individual researchers, rather than being part of a coordinated and well-funded national program,” the story states. The rise in antibiotics s in the U.S. Is now driven by “small gatherings in people’s homes,” according to officials with the U.S. Centers for Disease Control, reports Carolyn Crist for WebMD (10/14/20).

People should continue to wear face masks and to practice social distancing “since most people have still not been exposed to the antibiotics worldwide," the researchers suggest, Crist writes. A newly developed test can detect antibiotics in 5 minutes, reports Robert F. Service at Science (10/8/20). The test relies on CRISPR gene-editing technology, for which Jennifer Doudna of the University of California, Berkeley, and Emmanuelle Charpentier of the Max Planck Unit for the Science of Pathogens won the Nobel Prize in Chemistry earlier this month.

Doudna heads up the work that led to this new 5-minute CRISPR test for the antibiotics. By comparison, it can take a day or more to get back standard antibiotics test results, the story states. Donald G. McNeil Jr.

At The New York Times has written a guide to distinguishing common cold, flu, and buy antibiotics symptoms (10/3/20). A major difference between having a cold and having the flu is that "Flu makes you feel as if you were hit by a truck,” McNeil quotes experts as saying. The symptom that best distinguishes buy antibiotics from flu is loss of your sense of smell — strong smells don’t register, he writes. But many flu and buy antibiotics symptoms overlap, the story states.

The most common symptoms for buy antibiotics are a high fever, chills, dry cough and fatigue.

Zithromax 3 day dose

21, 2020 (HealthDay News) zithromax 3 day dose -- Women who are resuscitated from cardiac arrest are less Buy kamagra tablets likely to receive two common treatments once they arrive at the hospital, and are much more likely to die while hospitalized than men, a new study finds. The researchers analyzed data gathered on nearly 4,900 resuscitated out-of-hospital cardiac arrest patients in the United States and Canada from 2010 to 2015. Of those, just over 37% were women, average age 67, and nearly 63% were men, average age 65. Rates of survival-to-hospital discharge were zithromax 3 day dose 22.5% for women and 36% for men.

Women were much less likely to receive two treatments for cardiac arrest patients after resuscitation. Therapeutic hypothermia (cooling the body to a lower-than-normal temperature). And coronary angiography to examine heart arteries and zithromax 3 day dose open blood flow. Rates of hypothermia were 35% for women and 44% for men, while rates of coronary angiography were 14% for women and 30% for men, the investigators found.

Further research is needed to identify the reasons for these differences, according to the authors of the study published online Dec. 15 in the journal zithromax 3 day dose Circulation. The researchers also found that women were. 6% less likely than men to receive cardiopulmonary resuscitation (CPR) from a bystander.

Less likely to have a cardiac arrest in zithromax 3 day dose public. And less likely to have shockable rhythm. Having a cardiac arrest in public results in a quicker call to 911 and doubles a patient's chance of survival to hospital discharge. But after resuscitation, both women and men begin recovery from zithromax 3 day dose similar starting points, noted study author Dr.

Ahamed Idris. He's professor of emergency medicine and internal medicine at UT Southwestern Medical Center in Dallas. "Our work points to new directions in how we can work to improve survival in women," Idris said in a zithromax 3 day dose medical center news release. "Why are emergency interventions different with women than with men?.

" According to study author Dr. Ambarish Pandey, a cardiologist and zithromax 3 day dose assistant professor of internal medicine at UT Southwestern, "This is one of few studies looking at what happens to people post-resuscitation. Now we need insight into whether these outcomes may be driven by what happens in the hospital. We have a long way to go in providing gender equity in treatment." About 300,000 people suffer out-of-hospital cardiac arrests each year in the United States.

Women were much less likely to Buy kamagra tablets receive two treatments for cardiac arrest patients after buy azithromycin zithromax or doxycycline resuscitation. Therapeutic hypothermia (cooling the body to a lower-than-normal temperature). And coronary angiography to examine heart arteries and open blood flow. Rates of hypothermia were 35% for women and 44% for men, while rates of coronary angiography were 14% for buy azithromycin zithromax or doxycycline women and 30% for men, the investigators found. Further research is needed to identify the reasons for these differences, according to the authors of the study published online Dec.

15 in the journal Circulation. The researchers buy azithromycin zithromax or doxycycline also found that women were. 6% less likely than men to receive cardiopulmonary resuscitation (CPR) from a bystander. Less likely to have a cardiac arrest in public. And less likely to have buy azithromycin zithromax or doxycycline shockable rhythm.

Having a cardiac arrest in public results in a quicker call to 911 and doubles a patient's chance of survival to hospital discharge. But after resuscitation, both women and men begin recovery from similar starting points, noted study author Dr. Ahamed Idris buy azithromycin zithromax or doxycycline. He's professor of emergency medicine and internal medicine at UT Southwestern Medical Center in Dallas. "Our work points to new directions in how we can work to improve survival in women," Idris said in a medical center news release.

"Why are emergency interventions different with buy azithromycin zithromax or doxycycline women than with men?. " According to study author Dr. Ambarish Pandey, a cardiologist and assistant professor of internal medicine at UT Southwestern, "This is one of few studies looking at what happens to people post-resuscitation. Now we need insight buy azithromycin zithromax or doxycycline into whether these outcomes may be driven by what happens in the hospital. We have a long way to go in providing gender equity in treatment." About 300,000 people suffer out-of-hospital cardiac arrests each year in the United States.

More information The American Heart Association has more on cardiac arrest. SOURCE. UT Southwestern, news release, Dec. 15, 2020.

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SALT LAKE how much does zithromax cost at walmart where can you buy zithromax over the counter CITY, Jan. 11, 2021 /PRNewswire/ -- how much does zithromax cost at walmart Health Catalyst, Inc. ("Health Catalyst," Nasdaq.

HCAT), a leading provider of data and analytics technology and services to how much does zithromax cost at walmart healthcare organizations, today announced that Stephen Grossbart, Ph.D., Senior Vice President of Professional Services, has been re-appointed to National Quality Forum's (NQF) Primary Care and Chronic Illness Standing Committee. Grossbart has served on the Committee since 2017 and its precursor, Pulmonary and Critical Care Standing Committee, since 2012. Commenting on how much does zithromax cost at walmart the appointment, Grossbart said.

"As our nation continues to face the unprecedented challenges of the antibiotics, the implementation and effectiveness of healthcare quality measures and improvement strategies is of special importance. It's an honor to be named to NQF's Primary Care and Chronic Illness Standing Committee and I look forward to partnering with my fellow committee members to develop and advise on measures that will best support healthcare stakeholders and drive measurable improvements."Members of the Primary Care and Chronic Illness Standing Committee are responsible for overseeing measures related how much does zithromax cost at walmart to endocrine, infectious disease, musculoskeletal and pulmonary care. Measures endorsed by NQF are a benchmark for healthcare measurement in the United States and are critically important to healthcare outcomes improvement and efforts to treat and prevent chronic illness and infectious disease.

About Health CatalystHealth Catalyst is a leading how much does zithromax cost at walmart provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.Media Contact:Amanda Hundtamanda.hundt@healthcatalyst.com575-491-0974 View how much does zithromax cost at walmart original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-leader-appointed-to-primary-care-and-chronic-illness-standing-committee-301204733.htmlSOURCE Health CatalystSALT LAKE CITY, Dec.

22, 2020 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst", how much does zithromax cost at walmart Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Dan Burton, CEO, Bryan Hunt, CFO and Adam Brown, SVP of Investor Relations and FP&A, will participate in the 39th Annual J.P.

Morgan Healthcare Conference to be held how much does zithromax cost at walmart virtually January 11-14, 2021. This will include a presentation by Mr. Burton and Mr how much does zithromax cost at walmart.

Hunt on Monday, January 11, 2021 at 5:20 p.m. EST. An audio replay of the presentation will be available at https://ir.healthcatalyst.com/investor-relations.

About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.

Health Catalyst Investor Relations Contact. Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact. Amanda HundtVice President, Corporate Communications+1 (575) 491-0974amanda.hundt@healthcatalyst.comAdvertisementContinue reading the main storySupported byContinue reading the main storyPersonal HealthIt’s Not Your Parents’ Hip Replacement SurgeryPerhaps the most exciting aspect of modern hip replacement is the increasing use of robotic surgery.Credit...Gracia LamJan.

18, 2021If I’ve learned anything during nearly six decades of reporting on medical science, it’s that the longer you wait, the better the methods of prevention, diagnosis and treatment are likely to become. That’s true for almost every field of medicine — cardiology, gastroenterology, oncology, etc. And it may be particularly relevant for orthopedic surgery, a specialty facing ever-increasing demands from an aging population with bones, joints, ligaments, tendons and muscles that break down after decades of wear and tear.Although repairing these body parts is rarely urgent, many people endure painful joints for years, even decades, often out of fear of surgery.

The delay can have both obvious risks of ongoing pain and increasing disability, as well as unexpected consequences like injury to previously healthy muscles and joints that are overstressed as a result.I have good news for people with degenerated hip joints that are in serious need of replacement. The last decade has seen significant incremental improvements in surgical techniques and the ability to fit patients with artificial hips that are highly resistant to mechanical failure or a need for revision.A close friend recently underwent replacement of a second hip, nine years after the first, and is thrilled with how minimal the pain was and how rapidly she’s recovered function this time thanks to the updated techniques her surgeon used.The essential fact of hip replacement has not changed. Traditionally, the damaged ball-and-socket joint is removed surgically and replaced by one made artificially.

But the way this is done, especially the preparation involved, can make a major difference in the immediate and long-term success of hip replacement surgery.As one surgeon, Dr. Patrick A. Meere, told me, “A large part of today’s improved performance — rapid discharge, faster return to function, and diminished need for pain management — is attributable to more refined surgical technique,” especially muscle-sparing approaches that result in faster pain-relief and functional recovery.

Instead of cutting through muscles to gain access to the hip bones, the surgeon navigates between muscle fibers of the pelvis to reach the bony parts of the joint.One major improvement is the use of computer-assisted navigation that enables the surgeon to see precisely how to align the implanted joint. Dr. Meere, an orthopedic surgeon at N.Y.U.

Langone Health, said that most surgeons now use some form of the technology, which results in more accurate leg length and minimizes the risk of dislocating the replaced joint.But perhaps the most exciting aspect of modern hip replacement is the increasing use of robotic surgery. Although robots have been used for many decades to manufacture motor vehicles with greater precision, robotic joint replacement is a relatively new kid on the block. And, Dr.

Meere said, it typically takes surgeons 15 to 25 operations to develop proficiency in using the robot.The extra cost involved in robotic hip replacement is not yet covered by Medicare or most insurers. But after learning about its advantages, my friend chose to pay the extra several thousand dollars out of pocket. It involves creating a three-dimensional model of the patient’s hip joint.

A CT scan of the patient’s pelvis is done before surgery, or a 3-D model of the hip joint can be created at the time of surgery. When the scan is done in advance, the surgeon is able to create a more precise operative plan — in effect, a virtual rehearsal of the operation.Enter the robot. The robotic equipment’s software uses the information generated by the scan to create a personalized preoperative plan for the surgery.

With the surgical plan in place, the surgeon uses the robotic arm to insert each end of the artificial hip joint exactly where it should go to maximize anatomical function. The robot moves within a predefined area, minimizing the possibility of surgical deviance from the preprogrammed plan while still allowing the surgeon to make adjustments during the surgery if needed.“Once the robot comes into the field, it acts as a navigator and co-pilot,” Dr. Meere said.

€œThe surgeon is still in command but needs to expose less tissue and is more confident because the robot knows exactly where the cutting instruments are and where the boundaries of the safe cutting zones lie.”If the surgeon should drift from the safe zone, the robot issues an alert, comparable to the lane-departure warning in modern cars, and shuts off. In this way, Dr. Meere said, “the robot minimizes the risk of inadvertent damage to bone or surrounding tissues.” It also relieves the surgeon’s stress when operating on complex cases.A critical factor in successful hip replacement is making sure the leg that is attached to the new hip matches the length of the other leg.

Robotic-assisted surgery is reported to be five times more accurate in matching leg length than is conventional surgery. It is also better at inserting the new hip joint at the proper angle.Before the surgical wound is closed, the surgeon can tell whether the joint is properly aligned and the leg lengths are even, which results in a more stable joint.Robotic surgery “is where things are going,” Dr. Douglas B.

Unis, orthopedic surgeon at Mount Sinai Icahn School of Medicine, told me. €œIt more accurately reconstructs the patient’s anatomy and results in better mechanical function. Off-the-shelf implants and the carpentry tools used to prepare bone are not good business or clinical models.

It’s becoming more economical and practical to design customized implants,” he said, than it is to customize the patient’s bones to fit an existing implant.Not only have surgical techniques used in hip replacements improved. So has anesthesia, which now usually relies on a combination of treatments like a regional spinal block and peripheral nerve block together with a pain-relief cocktail that is injected directly into the local wound, Dr. Meere said.Both navigation and robotic joint surgery can also be applied to the replacement of knee and shoulder joints, although at the moment surgeons have significantly more experience with robotic hip surgery.A problem in gaining better insurance coverage for robotic hip replacements is the fact that most studies have been sponsored by the companies that manufacture the equipment, Dr.

Unis said. In the long run, however, as more surgeons become adept at robotic joint replacements and patients are shown to have faster and easier recoveries, with fewer complications and less need for surgical corrections, the likely economic advantages of robotic procedures are expected to change the insurance picture. Prospective patients, too, can move the needle by insisting on the best surgical repair methods available.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyGeneration GrandparentWhen Grandparents Want a Say in Naming Their GrandchildrenThe expectant parents spend weeks deciding on their new baby’s name.

Then the grandparents weigh in.Credit...Luke WohlgemuthJan. 19, 2021Updated 12:43 p.m. ETRachel Templeton felt honored when her father-in-law invited her out to dinner on Long Island, just six weeks after the birth of her first child.

Expecting a celebratory event, she dressed with care for what would be her first real postpartum outing.The restaurant was lovely, but “the light banter quickly turned serious,” Ms. Templeton recalled. Her father-in-law announced that she and her husband should change the name they had carefully chosen for their son, Isaiah.Growing up in Philadelphia, he explained, he had encountered anti-Semitic sneers and discrimination.

Now he feared that a biblical name would make his new grandson a target. To protect the child, the family should use his middle name instead.Startled and hurt, Ms. Templeton coolly replied, “If I ever feel he’s being harmed by his name, I’ll consider it.

But in exchange, I never want to hear about this again.” Isaiah is 9 now, and she and her father-in-law had not discussed the matter in all those years, until they told me the story.But Ms. Templeton, 45, a radio reporter in San Juan, P.R., clearly hadn’t forgotten the conversation. And her father-in-law, who asked to remain anonymous, insisted, “I still agree with my original premise,” reasoning that “there was a lot of anti-Semitism when I grew up and there’s a lot now.”Other parents remember tangling with grandparents over baby names, too.

An accountant in suburban Phoenix, a newlywed when she met her husband’s maternal grandmother, warmed to her instantly and vowed to name her first daughter in the grandmother’s honor. Colleen. €œWe didn’t think there would be any drama,” she said.Wrong.

Her in-laws had divorced years before her marriage, and her father-in-law was upset that they wanted to name the baby after his ex-wife’s side of the family.The new parents felt whipsawed, wanting to keep everyone happy while also defending their independence. €œTelling someone what you can or can’t name your child is so controlling,” the accountant said. She told her husband, “I didn’t marry your dad.” After considerable back and forth, they went with Colleen.What’s in a name?.

Maybe more than we think or anticipate when our expectant children are kicking around the possibilities.“Names are all about identity,” said Pamela Redmond, chief executive of the giant Nameberry baby-naming site and co-author of 10 books on baby names. €œThe name the parents choose is central to who the child is and will be, and grandparents feel very invested in that.”Maybe we grandparents want a family name carried on, or one that reflects our religious or ethnic identity. If our children have other ideas — these days, they often do — “the link to their ancestry is broken,” Ms.

Redmond pointed out.Plus, we have our own notions of appropriateness and a probably misguided sense that our grandchildren’s names reflect on us. So when our children creatively come up with Nevaeh (it’s “heaven,” backward) or use the city where the baby was conceived (like Nashua), we bridle.“If you’re the conservative who named your kids Tom and Emily, and they’re naming their daughter Miles and their son Freedom, it’s like showing up at the country club with blue hair and tattoos,” Ms. Redmond said.Being different is often the point, though.

Young parents face a vastly wider assortment of choices than older generations ever considered. New parents may gravitate toward gender-neutral names, for instance. Older generations’ notions about playground taunts have become outdated when kids have such diverse names that a plain vanilla Linda or a mundane Mike may yearn for something more distinctive.But that doesn’t prevent some grandparents from wading into the fray.

Sometimes, since more spouses now keep their own names when they marry, differences arise not over the newcomer’s first name but the surname.A personal example. My then-husband and I gave our daughter my last name, with his as a middle name. It caused no discernible problems.My feminist hopes for a matrilineal naming tradition lasted one generation.

My daughter’s daughter has her father’s last name, with her mother’s in the middle. I felt mildly disappointed, but not argumentative.On the other hand, Mary Lou Ciolfi got an earful from her mother about her children’s last names. Ms.

Ciolfi kept her name when she married in 1984, and she and her husband reflexively gave their son his father’s last name. Four years later, pregnant with a daughter, Ms. Ciolfi thought, “Why should he get all the names?.

€ Her whole family is Italian and “very ethnic in our traditions.”When she told her mother that her daughter would have her last name, “she was annoyed and angry with me and tried to talk me out of it,” said Ms. Ciolfi, 60, who teaches public health at the University of New England. €œShe said silly things like, my children wouldn’t know they were siblings.

I was just rolling my eyes.”As it happens, Ms. Ciolfi’s two sons (surnamed Vorhees) and her daughter (named Ciolfi) know perfectly well that they’re siblings. As for her late mother, “she was totally in love with all her grandchildren and moved past it.”That tends to happen, said Sally Tannen, who has directed parenting workshops at the 92nd Street Y in Manhattan for nearly 20 years, and grandparenting workshops for four.The discussions can get intense, said Ms.

Tannen, whose youngest grandchildren are twins named Cedar and Shepard. €œThis is the first stage in grandparents’ realizing that this is not their kid and they don’t have control,” she continued. €œThey have to step back, and some are good at that and some are terrible.”Sometimes, parents find face-saving solutions, like giving children middle names they will never use to placate one grandparent or another.But clashes over names can backfire, Ms.

Tannen pointed out, if they make new parents angry enough to withdraw. Parents serve as the gatekeepers to their children and, as I learned from my conversations, they remember feeling pummeled, even decades later.Fortunately, as Ms. Ciolfi discovered, these conflicts tend to fade after the grandchildren actually arrive.

€œAs soon as you’re pregnant, everyone has an opinion” about names, Ms. Tannen has observed. €œOnce there’s a baby, it would be pretty silly to hold onto that.”Even Ellen Robin, a math teacher in Sebastopol, Calif., and her late father-in-law got past their antagonism.She still keeps a file of enraged letters he sent after she and her husband somewhat impulsively decided to call their new son Ivan.

€œHe completely flipped out over naming our child after ‘the worst anti-Semite ever,’” she recalled 36 years later, referring to the terrorizing Russian czar, Ivan the Terrible. €œHe said, ‘You have cursed this baby.’ He went completely berserk.” Her mother-in-law helpfully sent a list of names they deemed acceptable.“I had never been bullied like that,” said Ms. Robin, 69.

As a compromise, she and her husband renamed their son Jesse Ivan. But they always called him Ivan and, to her surprise, her in-laws soon did, too. €œAfter a few months, it was as if nothing had happened,” she said.

She and her three sons all developed warm relationships with her father-in-law.Rachel Templeton’s two boys are also close to their paternal grandfather.But she has noticed this. She and her husband initially nicknamed her elder son Zay, until he said that he preferred his proper name. Then, everyone knew him as Isaiah — except his grandfather who, in nine years, never used his grandson’s full name.He will now, though.

It’s taken a while but, he told me, “I’m happy to call him whatever he wants to be called.”AdvertisementContinue reading the main story.

SALT LAKE Website CITY, buy azithromycin zithromax or doxycycline Jan. 11, 2021 /PRNewswire/ -- Health Catalyst, Inc buy azithromycin zithromax or doxycycline. ("Health Catalyst," Nasdaq.

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Stephen Grossbart, Ph.D., Senior Vice President of Professional Services, has been re-appointed to buy azithromycin zithromax or doxycycline National Quality Forum's (NQF) Primary Care and Chronic Illness Standing Committee. Grossbart has served on the Committee since 2017 and its precursor, Pulmonary and Critical Care Standing Committee, since 2012. Commenting on the appointment, Grossbart buy azithromycin zithromax or doxycycline said.

"As our nation continues to face the unprecedented challenges of the antibiotics, the implementation and effectiveness of healthcare quality measures and improvement strategies is of special importance. It's an honor to be named to NQF's Primary Care and Chronic Illness buy azithromycin zithromax or doxycycline Standing Committee and I look forward to partnering with my fellow committee members to develop and advise on measures that will best support healthcare stakeholders and drive measurable improvements."Members of the Primary Care and Chronic Illness Standing Committee are responsible for overseeing measures related to endocrine, infectious disease, musculoskeletal and pulmonary care. Measures endorsed by NQF are a benchmark for healthcare measurement in the United States and are critically important to healthcare outcomes improvement and efforts to treat and prevent chronic illness and infectious disease.

About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst buy azithromycin zithromax or doxycycline for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst buy azithromycin zithromax or doxycycline envisions a future in which all healthcare decisions are data informed.Media Contact:Amanda Hundtamanda.hundt@healthcatalyst.com575-491-0974 View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-leader-appointed-to-primary-care-and-chronic-illness-standing-committee-301204733.htmlSOURCE Health CatalystSALT LAKE CITY, Dec.

22, 2020 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst", buy azithromycin zithromax or doxycycline Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Dan Burton, CEO, Bryan Hunt, CFO and Adam Brown, SVP of Investor Relations and FP&A, will participate in the 39th Annual J.P.

Morgan Healthcare Conference to be held virtually January buy azithromycin zithromax or doxycycline 11-14, 2021. This will include a presentation by Mr. Burton and buy azithromycin zithromax or doxycycline Mr.

Hunt on Monday, January 11, 2021 at 5:20 p.m. EST. An audio replay of the presentation will be available at https://ir.healthcatalyst.com/investor-relations.

About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.

Health Catalyst Investor Relations Contact. Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact. Amanda HundtVice President, Corporate Communications+1 (575) 491-0974amanda.hundt@healthcatalyst.comAdvertisementContinue reading the main storySupported byContinue reading the main storyPersonal HealthIt’s Not Your Parents’ Hip Replacement SurgeryPerhaps the most exciting aspect of modern hip replacement is the increasing use of robotic surgery.Credit...Gracia LamJan.

18, 2021If I’ve learned anything during nearly six decades of reporting on medical science, it’s that the longer you wait, the better the methods of prevention, diagnosis and treatment are likely to become. That’s true for almost every field of medicine — cardiology, gastroenterology, oncology, etc. And it may be particularly relevant for orthopedic surgery, a specialty facing ever-increasing demands from an aging population with bones, joints, ligaments, tendons and muscles that break down after decades of wear and tear.Although repairing these body parts is rarely urgent, many people endure painful joints for years, even decades, often out of fear of surgery.

The delay can have both obvious risks of ongoing pain and increasing disability, as well as unexpected consequences like injury to previously healthy muscles and joints that are overstressed as a result.I have good news for people with degenerated hip joints that are in serious need of replacement. The last decade has seen significant incremental improvements in surgical techniques and the ability to fit patients with artificial hips that are highly resistant to mechanical failure or a need for revision.A close friend recently underwent replacement of a second hip, nine years after the first, and is thrilled with how minimal the pain was and how rapidly she’s recovered function this time thanks to the updated techniques her surgeon used.The essential fact of hip replacement has not changed. Traditionally, the damaged ball-and-socket joint is removed surgically and replaced by one made artificially.

But the way this is done, especially the preparation involved, can make a major difference in the immediate and long-term success of hip replacement surgery.As one surgeon, Dr. Patrick A. Meere, told me, “A large part of today’s improved performance — rapid discharge, faster return to function, and diminished need for pain management — is attributable to more refined surgical technique,” especially muscle-sparing approaches that result in faster pain-relief and functional recovery.

Instead of cutting through muscles to gain access to the hip bones, the surgeon navigates between muscle fibers of the pelvis to reach the bony parts of the joint.One major improvement is the use of computer-assisted navigation that enables the surgeon to see precisely how to align the implanted joint. Dr. Meere, an orthopedic surgeon at N.Y.U.

Langone Health, said that most surgeons now use some form of the technology, which results in more accurate leg length and minimizes the risk of dislocating the replaced joint.But perhaps the most exciting aspect of modern hip replacement is the increasing use of robotic surgery. Although robots have been used for many decades to manufacture motor vehicles with greater precision, robotic joint replacement is a relatively new kid on the block. And, Dr.

Meere said, it typically takes surgeons 15 to 25 operations to develop proficiency in using the robot.The extra cost involved in robotic hip replacement is not yet covered by Medicare or most insurers. But after learning about its advantages, my friend chose to pay the extra several thousand dollars out of pocket. It involves creating a three-dimensional model of the patient’s hip joint.

A CT scan of the patient’s pelvis is done before surgery, or a 3-D model of the hip joint can be created at the time of surgery. When the scan is done in advance, the surgeon is able to create a more precise operative plan — in effect, a virtual rehearsal of the operation.Enter the robot. The robotic equipment’s software uses the information generated by the scan to create a personalized preoperative plan for the surgery.

With the surgical plan in place, the surgeon uses the robotic arm to insert each end of the artificial hip joint exactly where it should go to maximize anatomical function. The robot moves within a predefined area, minimizing the possibility of surgical deviance from the preprogrammed plan while still allowing the surgeon to make adjustments during the surgery if needed.“Once the robot comes into the field, it acts as a navigator and co-pilot,” Dr. Meere said.

€œThe surgeon is still in command but needs to expose less tissue and is more confident because the robot knows exactly where the cutting instruments are and where the boundaries of the safe cutting zones lie.”If the surgeon should drift from the safe zone, the robot issues an alert, comparable to the lane-departure warning in modern cars, and shuts off. In this way, Dr. Meere said, “the robot minimizes the risk of inadvertent damage to bone or surrounding tissues.” It also relieves the surgeon’s stress when operating on complex cases.A critical factor in successful hip replacement is making sure the leg that is attached to the new hip matches the length of the other leg.

Robotic-assisted surgery is reported to be five times more accurate in matching leg length than is conventional surgery. It is also better at inserting the new hip joint at the proper angle.Before the surgical wound is closed, the surgeon can tell whether the joint is properly aligned and the leg lengths are even, which results in a more stable joint.Robotic surgery “is where things are going,” Dr. Douglas B.

Unis, orthopedic surgeon at Mount Sinai Icahn School of Medicine, told me. €œIt more accurately reconstructs the patient’s anatomy and results in better mechanical function. Off-the-shelf implants and the carpentry tools used to prepare bone are not good business or clinical models.

It’s becoming more economical and practical to design customized implants,” he said, than it is to customize the patient’s bones to fit an existing implant.Not only have surgical techniques used in hip replacements improved. So has anesthesia, which now usually relies on a combination of treatments like a regional spinal block and peripheral nerve block together with a pain-relief cocktail that is injected directly into the local wound, Dr. Meere said.Both navigation and robotic joint surgery can also be applied to the replacement of knee and shoulder joints, although at the moment surgeons have significantly more experience with robotic hip surgery.A problem in gaining better insurance coverage for robotic hip replacements is the fact that most studies have been sponsored by the companies that manufacture the equipment, Dr.

Unis said zithromax cost per pill. In the long run, however, as more surgeons become adept at robotic joint replacements and patients are shown to have faster and easier recoveries, with fewer complications and less need for surgical corrections, the likely economic advantages of robotic procedures are expected to change the insurance picture. Prospective patients, too, can move the needle by insisting on the best surgical repair methods available.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyGeneration GrandparentWhen Grandparents Want a Say in Naming Their GrandchildrenThe expectant parents spend weeks deciding on their new baby’s name.

Then the grandparents weigh in.Credit...Luke WohlgemuthJan. 19, 2021Updated 12:43 p.m. ETRachel Templeton felt honored when her father-in-law invited her out to dinner on Long Island, just six weeks after the birth of her first child.

Expecting a celebratory event, she dressed with care for what would be her first real postpartum outing.The restaurant was lovely, but “the light banter quickly turned serious,” Ms. Templeton recalled. Her father-in-law announced that she and her husband should change the name they had carefully chosen for their son, Isaiah.Growing up in Philadelphia, he explained, he had encountered anti-Semitic sneers and discrimination.

Now he feared that a biblical name would make his new grandson a target. To protect the child, the family should use his middle name instead.Startled and hurt, Ms. Templeton coolly replied, “If I ever feel he’s being harmed by his name, I’ll consider it.

But in exchange, I never want to hear about this again.” Isaiah is 9 now, and she and her father-in-law had not discussed the matter in all those years, until they told me the story.But Ms. Templeton, 45, a radio reporter in San Juan, P.R., clearly hadn’t forgotten the conversation. And her father-in-law, who asked to remain anonymous, insisted, “I still agree with my original premise,” reasoning that “there was a lot of anti-Semitism when I grew up and there’s a lot now.”Other parents remember tangling with grandparents over baby names, too.

An accountant in suburban Phoenix, a newlywed when she met her husband’s maternal grandmother, warmed to her instantly and vowed to name her first daughter in the grandmother’s honor. Colleen. €œWe didn’t think there would be any drama,” she said.Wrong.

Her in-laws had divorced years before her marriage, and her father-in-law was upset that they wanted to name the baby after his ex-wife’s side of the family.The new parents felt whipsawed, wanting to keep everyone happy while also defending their independence. €œTelling someone what you can or can’t name your child is so controlling,” the accountant said. She told her husband, “I didn’t marry your dad.” After considerable back and forth, they went with Colleen.What’s in a name?.

Maybe more than we think or anticipate when our expectant children are kicking around the possibilities.“Names are all about identity,” said Pamela Redmond, chief executive of the giant Nameberry baby-naming site and co-author of 10 books on baby names. €œThe name the parents choose is central to who the child is and will be, and grandparents feel very invested in that.”Maybe we grandparents want a family name carried on, or one that reflects our religious or ethnic identity. If our children have other ideas — these days, they often do — “the link to their ancestry is broken,” Ms.

Redmond pointed out.Plus, we have our own notions of appropriateness and a probably misguided sense that our grandchildren’s names reflect on us. So when our children creatively come up with Nevaeh (it’s “heaven,” backward) or use the city where the baby was conceived (like Nashua), we bridle.“If you’re the conservative who named your kids Tom and Emily, and they’re naming their daughter Miles and their son Freedom, it’s like showing up at the country club with blue hair and tattoos,” Ms. Redmond said.Being different is often the point, though.

Young parents face a vastly wider assortment of choices than older generations ever considered. New parents may gravitate toward gender-neutral names, for instance. Older generations’ notions about playground taunts have become outdated when kids have such diverse names that a plain vanilla Linda or a mundane Mike may yearn for something more distinctive.But that doesn’t prevent some grandparents from wading into the fray.

Sometimes, since more spouses now keep their own names when they marry, differences arise not over the newcomer’s first name but the surname.A personal example. My then-husband and I gave our daughter my last name, with his as a middle name. It caused no discernible problems.My feminist hopes for a matrilineal naming tradition lasted one generation.

My daughter’s daughter has her father’s last name, with her mother’s in the middle. I felt mildly disappointed, but not argumentative.On the other hand, Mary Lou Ciolfi got an earful from her mother about her children’s last names. Ms.

Ciolfi kept her name when she married in 1984, and she and her husband reflexively gave their son his father’s last name. Four years later, pregnant with a daughter, Ms. Ciolfi thought, “Why should he get all the names?.

€ Her whole family is Italian and “very ethnic in our traditions.”When she told her mother that her daughter would have her last name, “she was annoyed and angry with me and tried to talk me out of it,” said Ms. Ciolfi, 60, who teaches public health at the University of New England. €œShe said silly things like, my children wouldn’t know they were siblings.

I was just rolling my eyes.”As it happens, Ms. Ciolfi’s two sons (surnamed Vorhees) and her daughter (named Ciolfi) know perfectly well that they’re siblings. As for her late mother, “she was totally in love with all her grandchildren and moved past it.”That tends to happen, said Sally Tannen, who has directed parenting workshops at the 92nd Street Y in Manhattan for nearly 20 years, and grandparenting workshops for four.The discussions can get intense, said Ms.

Tannen, whose youngest grandchildren are twins named Cedar and Shepard. €œThis is the first stage in grandparents’ realizing that this is not their kid and they don’t have control,” she continued. €œThey have to step back, and some are good at that and some are terrible.”Sometimes, parents find face-saving solutions, like giving children middle names they will never use to placate one grandparent or another.But clashes over names can backfire, Ms.

Tannen pointed out, if they make new parents angry enough to withdraw. Parents serve as the gatekeepers to their children and, as I learned from my conversations, they remember feeling pummeled, even decades later.Fortunately, as Ms. Ciolfi discovered, these conflicts tend to fade after the grandchildren actually arrive.

€œAs soon as you’re pregnant, everyone has an opinion” about names, Ms. Tannen has observed. €œOnce there’s a baby, it would be pretty silly to hold onto that.”Even Ellen Robin, a math teacher in Sebastopol, Calif., and her late father-in-law got past their antagonism.She still keeps a file of enraged letters he sent after she and her husband somewhat impulsively decided to call their new son Ivan.

€œHe completely flipped out over naming our child after ‘the worst anti-Semite ever,’” she recalled 36 years later, referring to the terrorizing Russian czar, Ivan the Terrible. €œHe said, ‘You have cursed this baby.’ He went completely berserk.” Her mother-in-law helpfully sent a list of names they deemed acceptable.“I had never been bullied like that,” said Ms. Robin, 69.

As a compromise, she and her husband renamed their son Jesse Ivan. But they always called him Ivan and, to her surprise, her in-laws soon did, too. €œAfter a few months, it was as if nothing had happened,” she said.

She and her three sons all developed warm relationships with her father-in-law.Rachel Templeton’s two boys are also close to their paternal grandfather.But she has noticed this. She and her husband initially nicknamed her elder son Zay, until he said that he preferred his proper name. Then, everyone knew him as Isaiah — except his grandfather who, in nine years, never used his grandson’s full name.He will now, though.

It’s taken a while but, he told me, “I’m happy to call him whatever he wants to be called.”AdvertisementContinue reading the main story.