Hospitals & Asylums
Public Health Department
To Amend Chapter 9 Hospitalization of Mentally Ill Nationals Returned From Foreign
Countries by transferring the contents to Article 6 of Chapter 4, to transfer Public Health
Service statute, in Title 42 Chapter 6A to Chapter 1, to repeal 42USC(1)A§26, to market
generic antibiotics Over-the-counter, to trade for a sample of the new broad spectrum
antiviral DRACO, to limit inflation in health care costs to 3% annually, to limit federal
medical spending to $784 billion in FY 2012 calculating 3% annual growth since F
Y2008, to change the name of the Department of Health and Human Services (DHHS) to
the Public Health Department (PHD) on the condition that an Education Division (ED) to
the Agency for Toxic Substances and Disease Registry (ATSDR) be created to secure
toxic laboratory supplies, to change the name of the Drug Enforcement Administration
(DEA) Office of Diversion Control to the Drug Evaluation Agency (DEA) and transfer it
to the Food and Drug Administration (FDA), to change the name of the Substance Abuse
Mental Health Services Administration (SAMHSA) to Social Work Administration
(SWA), to change the trademark of the Centers for Medicare, Medicaid & SCHIP (CMS)
to National Health Insurance (NHI), to terminate payments for psychiatric
hospitalization, and psychiatry in general that needs to be terminated as a medical degree,
and pay for social work and group homes for recovery from mental and physical illness,
to recuse all lawyers from Administrative Law Judgeships (ALJ) and employ either
licensed social workers or physicians in their place, to transfer NHI and all other
Mandatory Benefits Programs to the management of the Social Security Administration
(SSA), to finance Children‘s Health Insurance with 100% of the proceeds of the Attorney
General Master‘s Tobacco Settlement, to limit medical costs by enabling patients to
refuse to pay for abusive, involuntary, overpriced and/or unnecessary treatment, to settle
ethical grievances and buy patient research, to salary health professionals so they would
provide services to the public for free, to improve epidemiological statistics, to require
medical ethics committees be employed by all health institutions and redistribute wealth
to patients, to limit medical residency rotations to less than 60 hours a week, to reduce
payments to high paid specialists and promote family practice capping physician salaries
around $100,000, to prohibit the abuse of bio-medical laboratory supplies, and to ban
tans-fat.
Be the 111th Congress and the Democratic and Republican (DR) disease party Dissolved,
Referred to the Food and Drug Administration (FDA)
1st Draft 2 Aug. 2005, 2nd 7 April 2006, 3rd 7 April 2007, 4th 9 Aug. 2007, 5th 26
September 2009, 6th 28 August 2011 for unveiling the Martin Luther King Jr. statue
Art. 1 Mission
§321 Legitimate Purpose
§322 Medical Progress
§323 Public Health
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§324 Global Health
§325 Privacy Rights
Art. 2 Medical Ethics
§326 Ethical Review of Family Practice
§326a Opinion 10.07 Caregiving for Children, Elders and the Disabled
§326b Opinion 10.08 Social Work, the Psychiatric Inheritance
§326c Opinion 10.09 Family Law: Maiden Name, Support and Probate Avoidance
§326d Opinion 10.10 Comp. for Torture, Biological Experimentation and Work
§327 Hippocratic Oath
§328 International Code of Medical Ethics
§329 AMA Code of Medical Ethics
§330 Patient Rights
§331 Rights of Persons with Disabilities
§332 Counsel Against Euthanasia and Abortion
§333 Prescriptions of Law
§334 Malpractice Liability
§335 Product Liability
§336 Medical Education
Art. 3 Laboratory Security
§337 The Crime of Bioterrorism
§338 Biosecurity and Biosafety
§339 Nuremburg Code
§340 Institutional Ethics Committee
§341 Pathogen Patent Protection
Art. 4 Epidemics
§342 Epidemiology
§343 Mental Health
§344 Genetic Disease
§345 Virology
§345a HIV/AIDS
§346 Cancer
§347 Bacteriology
§348 Cadiovascular Disease
§349 Diabetes
§350 Respiratory Infection
§351 TB, Malaria and Tropical Diseases
§351a Polio, Plague and Smallpox
Art.5 International Standards
1289
§352 International Health Regulation
§353 International Classification of Diseases
§354 International Classification of Functioning, Disability and Health
§355 Codex Alimentarius
§356 Conference on the Metric System of 1875 (CMS)
Art. 6 International Organisation
§357 Constitution of WHO
§358 World Health Organization
§359 Director General
§360 Executive Board
§361 Health Assembly
§362 WHO Regional Offices
§363 International Narcotics Control Board
§364 International Committee of the Red Cross
§365 International Federation of Red Cross and Red Crescent Societies
§366 International Humanitarian Law
Art. 7 National Affiliates
§367 American Medical Association
§368 Health Committees
§369 Department of Agriculture
§370 Environmental Protection Agency
§371 State and County Boards of Health
§372 National Association of Medical Examiners
Art. 8 Public Health Department
§373 Public Health Service
§374 Office of Secretary
§375 Office of the Surgeon General
§376 Centers for Disease Control and Prevention
§377 Agency for Toxic Substances and Disease Registry
§378 Food and Drug Administration
§379 Drug Evaluation Agency
§380 National Institutes of Health
§381 National Library of Medicine
§382 Agency for Healthcare Research and Quality
§383 Health Resources and Services Administration
§384 Program Support Center
§385 Indian Health Services
§386 Administration on Aging
§387 Administration for Children and Families
§388 Social Work Administration
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Art. 9 Health Economics
§389 Health Care Finance
§390 Health Insurance
§391 History of Health Insurance
§392 National Health Insurance
Art. 10 First Aid
§393 Cardio Pulmonary Rescuscitation
§394 Midwives and Maternity Care
§395 Immunization
§396 Fractures, Dislocations and Bandaging
§397 Traditional Medicine
§398 Active Aging
§399 Diet, Exercise and Hygiene
Fig. 9-1: Mandatory Benefit Program Spending (2008-2012)
Fig. 9-2: DHHS Spending 2008-2012 (in millions of US dollars)
Fig. 9-3: 15 Leading Causes of Death World Wide by Age 1998
Fig. 9-4: Number and Amount, Medical Malpractice Payments, 1990-2005
Fig. 9-5: Serious Disciplinary Actions by State Medical Boards 2000-2008
Fig. 9-6: Higher Education R&D Expenditure, by Field, 2007
Fig. 9-7: Trends in Infectious Disease Mortality, US, 1900-1996
Fig. 9-8: Institutionalization in the United States, 1928-2000
Fig. 9-9: Viral Families
Fig. 9-10: Some laboratory procedures in diagnostic virology
Fig. 9-11: Seven classes of Retroviral Medicine
Fig. 9-12: Common AIDS Symptoms and Medicine
Fig. 9-13: New Cases of Cancer, Death and Survival Rate in the U.S., 2009
Fig. 9-14: Some human cancers that may be caused by viruses
Fig. 9-15: Bacterial Infections
Fig. 9-16: Mechanisms of Action of Resistance to Antibacterial Agents
Fig. 9-17: Diagram of Atherosclerosis
Fig. 9-18: Classification of Cholesterol and Triglyceride Levels
Fig. 9-19: Diagnosis and Treatment of Respiratory Infections
Fig. 9-20: Metric Conversion
Fig. 9-21: WHO Budget 2006-2007
Fig. 9-22: HHS Budget by Operating Divisions, in million, 2008-2010
Fig. 9-23: Mandatory Benefit Programs, in millions, 2008-2010
Fig. 9-24: Budget of the National Institutes of Health, In Thousands, 2007-2009
Fig. 9-25: Health Expenditure as % of the U.S. GDP, 1965-2005
Fig. 9.26: Per Capita Health Spending, Industrialized Nations, 1970-2003 (% GDP)
Fig. 9-27: National Health Expenditures and Growth by Source of Funds 1970-2007
Fig. 9-28: Pie Charts of Health Care Finance, 2006
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Fig. 9-29: National Health Expenditures by Spending Category, 1970-2005
Fig. 9-30: Annual Inflation in Public and Private Health Care Costs, 1970-2005
Fig. 9-31: Uninsured Americans, 2001-2005
Fig. 9-32: Increases in Health Insurance Premiums Compared, 1988-2007
Fig. 9-33: Average Annual Firm and Worker Premium Contribution, 2007
Fig. 9-34: Medicare Part B Premiums and Deductibles, 2007
Fig. 9-35: Distribution of Assets of Health Insurance Companies, 2006
Fig. 9-36: Pie Chart of $389 billion U.S. Government Healthcare Expenses, 2000
Fig. 9-37: Government Health Expenditure as a % of the GDP 1965-2000
Fig. 9.38: Medicare Trust Funds Operations, 2004
Fig. 9-39: Medicaid Enrollees and Expenditures by Group, 2003
Fig. 9-40: Percent Change in Medicaid Spending and Enrollment, 1998-2008
Fig. 9-41: State Population and Medicaid Payment, 1999
Fig. 9-42: Health Insurance Coverage of Children, 2001-2005
Fig. 9-43: Tax Estimate of Nationalizing Health Insurance
Fig. 9-44: Black Mothers and Babies Have Highest Mortality, US, 2008
Fig. 9-45: Recommended Immunization Schedule Ages 0-6 Years, US, 2009
Fig. 9-46: Infant Mortality and Life Expectancy in the United States 1900-2000
Fig. 9-47: Caloric Intake Chart for Ideal Weight
Fig. 9-48: Vitamins and Minerals, What they do, Food Source
Fig. 9-49: Exercise Calorie Expenditure Chart, by Weight and Activity
Fig. 9-50: Global Vital Statistics, 2005
Bibliography
Art. 1 Mission
§321 Legitimate Purpose
A. This Chapter amends Title 24 US Code Chapter 9 §321- §329 Hospitalization of
Mentally Ill Nations Returned from Foreign Countries, the contents of which have been
transferred to Article 6 of Chapter IV State Mental Institution Library Education
(SMILE), this Chapter 9. This Act shall raise the Public Health Service, to the highest
attainable level of health by conferring the title of Public Health Department (PHD) to the
Department of Health and Human Services (DHHS), as should have been done in the
Department of Education Re-organization Act on May 4, 1980, as codified at
20USC(48)V§3508. It may be cited as the Public health Department (PhD) Act and
establishes the protocol for the US Department of Health and Human Services (DHHS) to
achieve the name of Public Health Department (PHD).
1. The Centers for Medicare, Medicaid and S-CHIP (CMS) needs to change its name to
National Health Insurance (NHI), to cease inciting militant feminism which undermines
women‘s rights, and protect personally identifying health information against the Public
Health Service (PHS) as the condition for the transfer of all Mandatory Benefit Programs,
to the independent management of the Social Security Trustees. The statistical
consolidation of mandatory benefit programs, including the Social Security
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Administration and Department of Agriculture Supplemental Nutrition Assistance
Program (SNAP), the food stamp program, amounts to an estimated $1.75 trillion in FY
2012, 67 percent of $2.9 trillion in revenues and 47% of $3.7 trillion in expenses, and
would reduce PHS spending to $87 billion, from a total of $892 billion, $804 billion of
which is mandatory outlays for benefit programs.
a. Mandatory benefit programs must be independent from the PHS to reduce corruption,
bioterrorism and exortion in defense of the Prohibition of interference with the medical
profession 42USC§1395. The PHS would be retained to conduct periodic epidemiologic
check-ups with the permission of the head of the benefit granting agency. To protect
benefit programs from the false independence of the judiciary, all mandatory benefit
program executives and in particular Administrative Law Judge (ALJs) postitions shall
be filled by licensed social workers, in all programs, and/or physicians, in HI, SMI, DEA
and Worker Compensation, only. To protect the immunity of the archives agency
lawyers are recused to represent their employing agency in cases before Courts of Law
and Houses of Correction only and are epidemiogically a public health nuisance in
legislative office and an outright threat in executive office or with unfettered access to
records on other than a case by case basis under 18USC(11)§205.
c. To ensure the independence of benefit programs is beneficial the President needs to
approve statistical surveys of the number of beneficiaries and benefit amount to ensure
non-discrimination against beneficiaries and employees of Federal Assistance Programs
on the basis of race, national origin, age, sex or disability under Title VI and VII of the
Civil Rights Act of 1964 P.L.88-352, as codified at 42USC(21)V§2000d-1.
d. Mandatory benefit programs provide the social safety net which keeps the national
economy functioning despite the failure of the cruel and unusual American legal system
to redistribute wealth from the extortionate rich to the deserving poor. The rationale for
independent mandatory benefit progarms is primarily to protect personally identifying
patient health information from the politcal and medical propaganda and corruption the
public health system processes. Independent mandatory benefit programs create a clear
separation of the rights of the people and the professional duties of public health officials
corrupted and confused not only by the nefarious processes of disease that continue to
baffle medical science, but also by the unique incompetent trademark infringement of the
totalitarian Democratic and Republican (DR) two party system, who have allowed the
extortionate U.S. health sector to become the most expensive in the world, more than
16% of the Gross Domestic Product (GDP).
e. Although the independence of mandatory benefit programs can be done for the
betterment of public health alone it should also be done with the intention of reducing the
distortion to the HHS budget caused by the Recovery Act of 2009 by $100 billion in FY
2012 to bring health spending to within 3% annual growth of FY 2008 and continue
normal agency growth. $107 billion in savings could be accrued by limiting annual
Medicare and Medicaid expenditure growth to 3 percent, $432 billion for Medicare,
saving $63 billion and $225 billion for Medicaid, saving $44 billion. In practice this
1293
could be easily realized by terminating payments for cruel and unusual treatment patients
write to Medicare and Medicaid to stop payment about, the cruel costs of condemned
practice of involuntary psychiatric hospitalization, dramatically reducing payments for
hospital stays, and the dubious costs of routine surgeries, easily preventable with drug
therapy and medical counsel, such as appendectomies and angioplasty from tens and
hundreds of thousands of dollars to only $1,000 or $2,000, with wage and medical supply
guarantees for health professionals and a legal limit of 3% in health care cost inflation.
In FY 2012 Medicare and Medicaid spending must be reduced by $100 billion to undo
the corruption caused by the Recovery Act. Once wages and prices have been
normalized by competent federal regulation, nationalization of the health insurance
industry can occur.
Fig. 9-1: Mandatory Benefit Program Spending 2008-2012
Mandatory
Programs
(Outlays) :
Millions $ 2008 2009 2010 2011 2012
Medicare 385,782 425,423 452,370 468,601 485,804
Medicaid 201,426 262,389 289,763 296,841 269,068
Temporary
Assistance for
Needy Families 17,880 20,283 19,447 21,001 18,049
Foster Care &
Adoption
Assistance 6,750 7,079 7,198 7,442 7,236
Children 's
Health
Insurance
Program 6,900 8,566 10,095 10,485 9,981
Child Support
Enforcement 4,283 4,472 4,588 4,434 3,780
Child Care 2,909 2,927 2,938 3,417 3,477
Social Services
Block Grant 1,843 1,909 2,009 1,832 1,802
Other
Mandatory
Programs 1,626 2,437 2,601 4,825 11,595
Offsetting
Collections -1,199 -1,324 -1,102 -992 -6,600
Subtotal,
Mandatory
Outlays 628,200 734,161 789,907 817,886 804,192
Total HHS 70,647 82,037 89,289 92,763 87,405
1294
(excl.
Mandatory
Programs)
Total,
HHS Outlays 698,847 816,198 879,196 910,679 891,597
Social Security
Expenditure 644,000 683,000 709,000 735,000 773,000
USDA Food
Card 37,639 53,625 68,308 72,000 80,000
Combined
Federal Benefit
Programs 1,380,683 1,552,823 1,626,504 1,717,679 1,744,597
Source: HHS, SSA and USDA 2008-2010 2011 and 2012 estimated
2. The Drug Enforcement Administration (DEA) Office of Diversion Control needs to be
transferred to the Food and Drug Administration (FDA) to more professionally regulate
the conduct of health care professionals with DEA licenses, on the condition that it (a)
change its name Drug Evaluation Agency (DEA), (b) employ doctors as ALJ (c) cease
financing police action and terminate their international offices, (d) continue accounting
for drug seizures and arrests and (e) be charged with inspecting, catalogueing, controlling
and eliminating disease pathogens used in research laboratories,
3. The Substance Abuse Mental Health Administration (SAMHSA) needs to change its
name to the Social Work Administration (SWA). SWA will help (a) terminate the
licenses of all non-forensic psychiatric hospitals, (b) terminate the licenses pertaining to
the psychiatric medical degree whose cruelty has become obsolete with advent of
licensed social workers and group homes, (c) coordinate the appointment of licensed
social workers to judge all traffic, domestic relations, mental health, substance abuse,
tenant-landlord and small-claims Courts and funeral directors to avoid Probate.
4. With the no more confusion regarding the confidentiality of personally identifying
health information in the Department, the Agency for Toxic Substances and Disease
Registry (ATSDR) shall appoint an Education Division (ED) to catalogue the toxic
substances, viruses, and pathogens used in academic and corporate bio-medical research
that cause diagnosable diseases. States shall continue to be responsible for the majority
of regulation of diagnostic laboratories.
5. When the Schedules of the Controlled Substances Act (CSA) have been amended to
set up a working comprehensive regulatory regime of potentially harmful substances for
Customs so Type I is deadly poison II deadly pathogens III disabling pathogens IV
chemotherapy and hard drugs V prescription drugs VI over the counter drugs VII alcohol,
tobacco, raw opium, coca leaf and marijuana; VIII endangered species, toxic plants and
animals IX medicinal herbs, dietary supplements, vitamins and minerals, pursuant to
Drug Evaluation Agency Reform of the CSA HA-31-10-09, Human Rats Amendments to
Human Research Protection HA-25-10-09, CWC Protocol for the Elimination of
1295
Pathogens HA-23-10-09 and the Pathogen Patent Protocol HA-23-10-09 the United
States will have achieved their Public Health Department (PHD). There is however
nothing preventing the Department from changing their name as is, to relieve Americans
of this great impoverishing shame - DHHS.
C. The foundation of the public health service is typically attributed to July 16, 1798,
when President John Adams Esq, author of the despised Alien and Sedition Act of 1800,
signed a bill into law that created what we now know as the U.S. Public Health Service
by establishing the U.S. Marine Hospital Service. After gaining considerable control
over the regulation of biological products at the turn of the century the Public Health
Service was created in the Public Health Service Act of 1912. It was however not until
the Department of Health Education and Welfare (HEW) was founded on April 11, 1953
that the Public Health Service became a genuinely civilian form of government, except
for the strange inferiority complex surrounding being relegated to Chapter 6A of Title 42
for not repealing the last remaining militants from Chapter 1 and relocating Public Health
Service statute there.
1.The Medicare Amendment to the Social Security Act in 1965 was created during the
Vietnam War and has been nothing but trouble. After becoming jurisdicted to illicit
drugs as the result of the Controlled Substances Act that misplaced the DEA in the
Department of Justice, and failing to explicitly prohibit the malevolent distribution of
laboratory supplies in the National Research Act of 1974 that seems to have ousted
President Richard Nixon, and after Medicare and Medicaid dropped out of the Social
Security Administration in 1977, the DHHS dropped out of the DHEW as the result of
the Department of Education Organization Act PL96-88 that was signed on Oct. 17,
1979. Congress then established a Court of International Trade of the United States
(COITUS) in the Customs Court Act of 1980 that seems to hold the trade secret of the
etiologic agent causing the HIV/AIDS epidemic that overthrew the aphartheid system, of
can-sir and angina, in southern Africa, reducing the life expectancy there from 50 to 30
years before the advent of lifesaving retroviral therapy. In 1995 SSA broke away from
DHHS after many years as a sub-cabinet agency from 1939, and was again the
independent agency it was founded in 1935. Medicare and Medicaid, and other federal
holders of confidential patient records under the Social Security Act, and other
Mandatory Benefit Programs, must follow suit, and rejoin SSA, so that health records are
not exposed to the disease pathogens studied by the Public Health Service, who will be
retained to conduct periodic epidemiologic surveys of program beneficiaries.
2.The United States owes the people, health care professionals and patients the highest
attaineable level of health. A Ph.D is the highest attainable academic degree. To earn
such a title it is however imperative to understand the true end of the alma mater – poison
– and understand the relation of toxicity to higher education. Socrates, a great teacher,
died from hemlock poisoning. Typically, however, it is the student, scholar, political
dissident, patient or disability advocate who tends to be victimized by a person of such
exalted rank as university professor to have access to the toxins of the biomedical
research laboratories and clandestine corruption and delivery services. It would seem
that, as it has been designed, higher education does not in fact make people more
1296
peaceful, it merely causes them to respect the unnamed and unidentifiable biological and
chemical weapons more immature people might consider sissy. This degradation of the
system of higher education must be reversed. Most of all however it is presumed that by
adopting the name of PHD the government would no longer rely upon the testimony of
people with high academic degrees and admit the truth from people of all walks of life.
3. In modern society the average life expectancy from bith is 77 and 60% of all
mortalities in the United States are the result of angina or cancer. Both of these diseases
are often caused by mysterious toxic substances used in peer reviewed medical literature
to cause illness and death in animal laboratory research. The federal government cannot
continue to turn a blind eye to the ―keg‖ parties of university oligarchs and the
brainwashed toxic agents they recruit to assault the saints, the elders and all people wiser
than the propaganda. It is not enough for the federal government to plead incompentency
with a Half High School (HHS) degree and rely completely upon academics for their
understanding of health. For public health to move forward toxic substances proven to
cause diseases in laboratory animals must cease to be held as the sacred sacraments of
higher education and prohibited as the dangerous and abusive poisons that they are. To
fulfill the degree of protection society is due the Agency for Toxic Substances and
Disease Registry (ATSDR) must establish an Education Division (ED) to prohibit the
toxic substances used in academic research, collected in diagnostic laboratories, rewrite
the CSA and prohibit misconduct.
4. While the military might be useful to the Public Health Service, even necessary, to
crush the supply of Nazi scientists in university and corporate laboratories and closing the
superfluous community demand for hospitals, because the judiciary tends to patronize
these upper class criminals as ―respectable members of the community‖, the military
must not continue to be allowed to drive this persecution of individual citizens nor indeed
allowed to manufacture or stockpile biological and chemical weapons, in the same vein
as chemical and biological weapons and spy networks are prohibited to health
professionals and the general public. Wherefore the following final remaining
unommitted section of the Public Health Service Act must be repealed and the contents of
Chapter 6A of Title 42 relocated to vacated Chapter 1.
a.42USC(1)A§26 Isolation of civilians for protection of military, air and naval forces
that states, The Secretary of the Army, the Secretary of the Air Force and the Secretary of
the Navy are authorized and directed to adopt measures for the purpose of assisting the
various States in caring for civilian persons whose detention, isolation, quarantine, or
commitment to institutions may be found necessary for the protection of the military, air
and naval forces of the United States against venereal diseases.
5. The 111th Congress needs to be dissolved whereas they butchered federal terrorism and
anti-torture statute at Title 18 of the United States Code at Chapter 113C whereby all
civil and criminal penalties have been repealed within the continental United States in
contravention to Arts. 2, 4 and 14 of the Convention against Torture and Other Cruel,
Inhuman and Degrading Treatment or Punishment of 26 June 1987. To compound this
grievous negligence in regards to the Draft Articles of State Responsibility for
1297
Internationally Wrongful Acts of 2001 the 111th Congress unwisely chose this self-
declared window of freedom from criminal and tort liability for the crime of torture to
embark upon the Recovery Act of 2009 that dramatically distorted the DHHS budget,
undermining the credibility of the Patient Protection and Affordable Care Act of 2010,
which does foster creative financing, that does not need special statutory protection. As a
rule the health sector must be extremely distrustful of infringement by the Congress and
Democratic and Republican (DR) two party system on the medical establishment, and
must limit their lobbying activities to relevant health agencies, to prevent totalitarianism.
6. The American Recovery and Reinvestment Act (the Recovery Act) poses a grave fiscal
problem because it provided HHS programs with an estimated $141 billion for Fiscal
Years 2009 – 2019 and stole that money from the 2009 economy causing devastating job
loss and economic recession and defending its loot with biological weapons from
diagnostic laboratories, more treatable than the chemical weapons of disease research
2004-2008. Having already been paid for, full faith and credit can be given that the
Recovery Act slush fund shall ease the process of limiting budgetary inflation to 3% from
FY 2008 in order to control market-wide inflation to less than an annual 3%. $107
billion in savings to the budget could be accrued by limiting annual Medicare and
Medicaid expenditure growth to 3 percent, $432 billion for Medicare, saving $63 billion
and $225 billion for Medicaid, saving $44 billion. Whereas the U.S. sovereign debt
rating has been downgraded from AAA+ to AA+ HHS agencies must be very careful not
to commit themselves to more contracts than can be paid for with existing funds or an
agency budget within 3 percent annual growth of FY 2008. While health spending can
and must be cut, because the health sector is engorged with far more capital than they are
competent to manage, social welfare spending must be protected whereas employment
and benevolent society is low, and the people are poorer and needier than usual. HHS
must be careful to cut $100 billion from their budget request to reduce Department-wide
spending from $886 billion to $783 billion in FY 2012.
Fig. 9-2: DHHS Spending 2008-2012 (in millions of US dollars)
2008 2009 2010 2011 2012 2012
3% Prop.
growth Budget
adjusted Authority
Health and Human 700,442 796,267 868,762 934,426 783,157 885,789
Services OMB
% Change 4.2% 13.7% 9.1% 7.6% -16% -5.1%
HHS Budget Authority 700,980 779,419 800,271 880,861 783,157 885,789
HHS Recovery Act 121,315 55,087 45,162 21,066 4,027 4,027
ARRA Total of 3 yr.
spread
HHS Total Budget 700,980 834,506 845,432 901,927 787,184 889,816
Authority ARRA
spread
HHS Outlays, inc. 700,980 794,234 859,763 910,679 788,965 891,597
1298
ARRA 09-12
HHS Discretionary 67,650 75,603 90,703 92,903 75,768 79,915
Budget Authority
HHS Food and Drug 1,641 2,055 2,363 2,508 1,838 2,746
Administration
HHS Health Resources 5,708 9,743 7,483 7,511 6,393 9,198
and Resources
Administration
HHS Indian Health 3,271 4,081 4,052 4,406 3,664 4,773
Service
HHS Centers for 5,762 6,868 6,475 6,432 6,453 6,702
Disease Control and
Prevention
HHS National 28,700 40,796 31,089 32,089 32,144 31,979
Institutes of Health
HHS Substance Abuse 3,046 3,335 3,432 3,541 3,412 3,387
Mental Health
Services
HHS Agency for 330 700 403 417 370 390
Healthcare Research
and Quality
HHS Centers for 3,240 3,230 3,415 3,601 3,629 4,397
Medicare and
Medicaid Services
HHS Administration 12,329 22,457 17,336 17,480 13,808 16,179
for Children and
Family Services
HHS Administration 1,335 1,594 1,516 1,625 1,495 2,447
on Aging
HHS General 392 382 490 544 439 524
Department
Management
HHS Office for Civil 37 40 41 44 41 47
Rights
HHS Office of the 90 2,044 42 78 101 57
National Coordinator
HHS Medicare 70 65 71 78 78 81
Hearing and Appeals
HHS Office of the 45 62 50 52 50 53
Inspector General
HHS Health Care 0 before 198 311 561 0 581
Fraud and Abuse 2008
Control
HHS Public Health 1,754 10,661 738 734 595 595
and Social Services 250 in
Emergency Fund 2007
1299
HHS Prevention and 1,000 244 483 0 0
Wellness ARRA
HHS Mandatory 628,200 718,631 859,763 910,679 703,584 804,192
Outlays
HHS Medicare 390,782 424,747 444,003 468,601 437,676 485,804
HHS Medicaid 209,310 250,924 275,383 296,841 234,427 269,068
HHS TANF 17,880 18,933 22,083 21,001 20,026 18,049
HHS Foster Care & 6,750 6,859 7,403 7,442 7,560 7,236
Adoption Assistance
HHS Children‘s 6,900 7,547 9,103 10,485 7,728 9,981
Health Insurance
Program
HHS Child Support 4,283 4,352 4,710 4,434 4,797 3,780
Enforcement
HHS Child Care 2,909 2,952 2,925 3,417 3,258 3,477
HHS Social Services 1,843 1,854 2,118 1,832 2,064 1,802
Block Grant
HHS Other Mandatory 1,626 1,686 2,340 4,825 1,821 11,595
Programs Total
44,183
HHS Offsetting -1,199 -1,223 -1,008 -992 -1,343 -6,600
Collections
HHS Total Outlays 698,847 779,419 800,271 880,861 782,709 891,597
Source: HA. Table 21 Federal Budget in Balance FY 2011: Comparison of Bush and
Obama HA-28-2-10 (corrected), HHS Budget Authority FY 2010, HHS Budget
Authority FY 2012, HHS Budget Authority FY 2008
7. To make up for the loss of $100 billion in budget authority HHS needs to begin
nationalizing health insurance and health corporations to keep costs reasonable, quality of
care high, inflation below 3% and health care accessible for everyone, while outlawing
the medical b(k)illing that undermines medical ethics in the United States. The United
States is the only industrialized nation to not have a universal health insurance program,
and 50 million people are uninsured. The inefficiencies of the quasi private health
insurance system cause the national health expenditure to be, far and away the most
expensive in the world, greater than 16% of the Gross Domestic Product (GPD). Despite
the high cost health outcomes are not any better in the United States, in fact, life
expectancy and freedom from illness in the United States tends to rank at the bottom of
the first world, below many emerging market countries with innovative health care
system like Mexico and Cuba. The PHS needs to take a more ethical approach to health
care, and whereas so much capital has been overinvested in this sector, it is time for the
United States to withdraw these funds to pay for the maintenance and wage and price
socialization of the health sector as it transitions to a genuinely confidential salaried
national health service whose care is free for everybody.
A There are therefore two sources of revenue that the PHS should have not trouble
levying the paltry sum of $100 billion from (a) fines against health and pharmaceutical
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corporations who have engaged in unethical and corrupt practices for extended periods of
time and (b) nationalization of health insurance on the condition that the government pay
the health care costs of people who previously paid premiums. Whereas the economy is
sluggish nationalization of health insurance should be done slowly in hopes of recovering
the full $4 trillion value at a later date, without unduly disturbing financial markets, and
fines and license terminations are long overdue against psychiatric slavery, bioterrorists
and profiteering surgeons and high priced specialists who neglect to cure the diseases
they treat with affordable generic drugs. Have no fear, studies around the world have
shown fewer people die when doctors are on strike, and the people and government can
take everything from violent reactionaries. Negotiations must insure health
professionals‘ reasonable wages and prices as the quasi private fee-for-service, medical
b(k)illing system evolves into a salaried national health service loyal to the best interest
of patient. The priority for the U.S. health sector at this time is to reduce costs through
prudent regulation, that does not pay for cruel and abusive treatment patients complain
about, calming the artificial public fear of health spending cuts by proactively capping
physician salaries, for all specialties, around $100,000 a year, to provide reduced cost or
free medical services to everyone.
§322 Medical Progress
A.Broad spectrum antibiotics are the best medicine of the 20th century. The only
inventions that increased longevity longer are clean water and sanitation. In the 21st
century a new antiviral drug, DRACO, now reaching animal and human trials, kills
dozens of common cold viruses and HIV and genetically mutated cells in the laboratory
without harming human cells, might cure the AIDS epidemic and increase life
expectancy, and quality of life, in sub-saharan Africa and infected populations around
the world. Having made considerable progress against cancer in the past two decades,
the American public should be made aware that in conjunction with a vegan diet and
daily cardiovascular exercise antibiotics cure bacterial endocarditis.
1.The discoveries of the sulphonamide (1939), penicillin (1945) and streptomycin
(1952) classes of antibiotics won the Nobel Prize for Medicine. Sulfamethoxazole-
trimethoprim (Bactrim) is easier on the gut than most antibiotics. Ampicillin
(Principen), made from penicillin nucleus and 3H2O is the first choice organic
antibiotic for pneumonia. Doxycycline (1967), the once a day antibiotic, is cheapest
and highly effective against Methicillin Resistant Staphylococcus Aureus (MRSA) and
acne but tetracycline class antibiotics cause permanent yellowing of developing teeth in
children, and are for adults only. Metronidazole (Flagyl ER) (1960) is the first choice
for dentistry and gastroenteritis; it treats antibiotic resistant Clostridium difficile that
causes antibiotic associated colitis and the yeast Candida albicans that causes vaginal
and dental candidiasis, but is carcinogenic. The edict of Frederic II of 1240 separated
the pharmacy and medicine professions. American colonists blended Native American
Indian and European medicine exercising a right to self-medication. The primary
objective of progressive drug policy is to permit the Over-the-counter sale of antibiotics
and other well-known, life saving, nosocomial infection curing, drugs, such as
DRACO, if proven safe and effective, under 21CFR§330.10.
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2. These generic antibiotics and much more, can be imported from India
$ 1 Paid in personal quantities without prescription from the online pharmacy
Indian www.generics-discount.com. To reciprocate with the Indians for
Septic
Society saving our lives the FDA must be convinced to market Indian full
Mun. service generic pharmaceuticals Over-the-counter under
Bond #
21CFR§330.10 and donate $1 from every course of antibiotics sold to
municipal bonds dedicated to the construction of sewers and clean water in
urban slums and rural communities in India, where the life expectancy is only 66 years,
whereby few people around the world believe in the importance of a vegan diet for
health and longevity. The Indian export corporation might have more success with
Customs if they put a $1 Paid Indian Septic Society Municipal Bond Number sticker on
the envelopes of customers who make the voluntary contribution for the enforcement of
Ayurvedic ―no open defecation laws‖.
a.Cogentin, is particularly useful in the public health system to treat of Parkinsonlike
extra-pyramidal side effects of anti-psychotic drugs intentionally caused by third
generation antipsychotrics after illegal experimentation on adverse drug combinations
of second generation antipsychotics, wherefore it should be made available over-the-
counter. Narcan is useful to instantly reverse the potentially fatal respiratory depressant
effects of opiate overdose. It turns out that the paranoid attitude of the mentally ill and
drug addicted towards a medical establishment that slaves and tortures them is quite
likely the attitude for patients and households to take against the panoply of hospital
acquired nosocomial infections better treated with generic drugs purchased online
without prescription pursuant to Best Medicine Monographs HA-15-1-11
B. Title II of the Family Smoking Prevention and Tobacco Control Act P.L.111-31
signed June 22, 2009 Section 201 Cigarette Labels and Advertising Warnings Section 4
(a) directs Each label statement shall comprise the top 50 percent of the front and rear
panels of the package. A model warning label has been prepared to consolidate the
prescribed one liners into comprehensive instruction for cigarette consumers that states,
Front flip top: Cigarettes are addictive. Tobacco smoke contains carbon monoxide and
is a cause of lung disease, osteoporosis, cancer, stroke and heart disease, that can kill you.
Front: Smoking during pregnancy can harm your baby. Tobacco smoke can harm child
development and cause fatal lung disease in nonsmokers.
Side: Quitting smoking now greatly reduces serious risks to your health. Please consult a
physician or attend a local meeting of www.nicotine-anonymous.org.
Side: Nicotine withdrawal is a mental illness. Nicorette gum and prescription drugs help.
Smoke Jimson weed for asthma and mullein for pulmonary ailments. E-cigarettes may be
used in public.
Back: Nicotiana tabacum (tobacco) was first cultivated for smoking by Native
Americans. After discovery people around the world became addicted. American
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colonists used tobacco as money. As early 1761 snuff was linked to cancer. Numerous
U.S. Surgeon General Reports blame smelly tobacco smoke for deadly diseases more
caused by nosocomial infection. Many States have banned smoking in public places. Get
plenty of cardiovascular exercise.
1.Although required to do so by July 22, 2010 the Federal Cigarette Labeling and
Advertising Act has yet to be amended and industry to implement the new labels.
C. The first physicians were generalists. For thousands of years, generalists provided all
of the medical care available. They diagnosed and treated illnesses, performed surgery,
and delivered babies. Germ Theory developed in the 1600s by Dr. Girolamo Fracastoro
was proven with the application of the microscope to observe microscopic organisms by
Antoni van Leeuwenhoek in 1674. Sterilization advanced one step with Louis Pasteur
beginning in 1857 and took two steps back with the disgrace, wrongful imprisonment and
death in a psychiatric institution of hospital hygienist Dr. Ignaz Philipp Semmelweis in
1965. With World War II, despite the marketing of broad spectrum antibiotics,
discovered by Alexander Fleming in 1929, specialization began to flourish. In the two
decades following the war, the number of specialists and subspecialists increased at a
phenomenal rate, while the number of generalists declined dramatically. The concept of
the generalist has been reborn and has yet to learn to walk to visit patients in hospitals
and their homes and make recommendation to ensure their living environment is
hygienic.
1.When flour was first ground around 10,000 BC the number of caries in the dental record rose
from 2% to 10%. Since sugar was introduced in the 1600s the number of people with significant
caries rose to 95%. Tobacco, salt, sugar, baked goods, caffeine, alcohol, fat, particularly trans-
fat, all animal products, namely dairy and eggs and other unnecessary recreational, addictive and
dangerous substances should be avoided completely. The consumption of fat, protein and
carbohydrate macronutrients should be eliminated or minimized to speed up digestion and
absorption from 3 weeks for beef, 1 week for chicken and 3 days for fish, to less than one day for
the micronutrients found in fruit, vegetables and whole grain. The preference for fresh fruit,
vegetables and whole grains is that they do not betray the animal kingdom to flesh eating bacteria
and their fiber is excreted efficiently. Clean water, sanitation, antibiotics and vaccines were
successful in eliminating or reducing the danger from most infections. Since the decadence of the
automobile and television the number of people struggling with obesity and the related chronic
diseases of diabetes, heart disease and cancer have risen. Some progress has been made in
reducing cancer deaths with public knowledge regarding environmental carcinogens, diet,
exercise, antivirals and religious aftercare. Public knowledge regarding the bacterial, dietary and
sedentary causes of diabetes and endocarditis must be disseminated to the public with refillable
prescriptions for antibiotics, vegan diet and exercise.
2. The basic regimen prescribed for longevity is to be vaccinated by a physician as a child, take
antibiotics to treat infections, sleep on your side, drink purified water, brush your teeth at least
twice a day, shower daily and after exercise, maintain good personal and environmental hygiene,
wash your hands and food before eating, wear proper protective gear and use disposable gloves
when touching patients, eat only fresh fruits, vegetables and whole grains, with rice for digestion,
and exercise daily. Exercise can be minimized by running a 3 mile cross country course daily or
two hours walking will be needed, especially if you are employed in a sedentary occupation, like
watching television. Elders and athletes often use anti-fungal foot powder. Stretches are useful
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for treating rheumatism, reducing injury from more energetic exercises, and getting some exercise
throughout the day. Strength exercises such as push-ups, sit-ups, pull-ups and weight lifting are
popular. To afford a sedentary lifestyle the human body must be engaged in some sort of
physical activity no less than 24 hours a week including cooking, cleaning and gardening. One
should be exposed to sunlight for around 30 minutes a day or a multivitamin containing Vitamin
D should be taken to prevent and treat osteoarthritis. Vitamin C, found in high quantity in citrus,
is highly effective at preventing and treating viral infections.
3. The pneumococcal vaccine for 24 of 97 serotypes of Streptococcus invented in 1977 is the
most promising experimental treatment for American sufferers of pneumonia, meningitis and
endocarditis. Pneumococcal sensitive bacterial endocarditis is ten to twenty times more prevalent
than cancer, and in the new millennium, edged ahead of viral and chemical sensitive cancer, as
the leading cause of death. Pneumonia is the leading cause of the innocent transmission of
disease vectors from one human to another. Bacterial infections can be treated with antibiotics
whose resistance is mitigated by the practice of metronidazole, the unfortunately carcinogenic
antibiotic of first resort in dentistry and abdominal infection. Chronic disease results from
necrotic tissue that is susceptible to bacterial infection and must be sterilized with courses of
antimicrobial agents, as needed, while the wound heals over extended periods of perfect living
that might be hastened when stem cell treatments come into use. The Author-Doctors of the
Hippocrates shall sterilize their medical libraries, cite their sources and email prescriptions for the
benefit of the sick, with an absolute minimum of non-medically necessary physical and social
contact, in pursuit of the restoration of hospital visits, house calls and mutual financial freedom
from well written legal briefs that cite both statute and medical literature to ensure immunity from
all forms of epidemics. Opinion 10.06 Family Medicine of Family Opinions on the Patient
Physician Relationship HA-14-4-11
§323 Public Health
A. Public health is the study of the impact of illness, mortality and healthcare upon
society. Public health ensures:
1. sufficient vaccines for the population,
2. supply of technological treatments,
3. networking of national laboratories,
4. financing and recognition of important research,
5. the detection and neutralization of laboratory facilities and supplies engaged in the
manufacture and marketing of biological and chemical weapons (New).
6. education in regards to hygiene, exercise, nutrition and the dangers of health risks,
7. health insurance,
8. national health surveys,
8. the management of epidemics
10. identification of barriers to the achievement of health goals and development of
programs to overcome them.
B. Public health is different than the practice of medicine or a person‘s private health
because private health issues are confidential whereas the objective of public health is
keep accurate statistical surveillance of epidemics and come up with solutions to common
public health issues. The moral and material interest of public health is therefore to:
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1. improve understanding of public health, including the distinction between publicly
funded medical care and public health;
2. determine the roles and responsibilities of private physicians in public health,
particularly in the delivery of personal medical care to underserved populations;
3. advocate for essential public health programs and services;
4. monitor legislative proposals that affect the nation's public health system;
5. monitor the influence of managed care organizations and other third party payers and
assess the roles and responsibilities of these organizations for providing preventive
services in communities;
6. monitor trends in education, certification requirements, corruption in the local
government and malevolent research in public and private research institutions of higher
education.
7. effectively communicate with practicing physicians and the general public about
important public health issues H-440.912 Health Policy of the AMA House of Delegates.
C. The/ Public Health Initiative H-440.911 of the Health and Ethics Policies of the AMA
House of Delegates recommends that to be effective a public health organization or
professional should:.
1. Engage the community. Seek to change existing thinking within academic health
centers, health-oriented community organizations, health care delivery systems and
providers, and among health care purchasers to focus on improving the health of the
community.
2. Create joint research efforts. Develop a common research agenda for public health and
medicine using a three-fold approach:
a. First, educate clinical and public health researchers about the advantages of joining and
applying their knowledge in the formulation, design, and execution of research projects.
b. Second, focus these projects on remedying significant health issues.
c. Third, review the public and private funding of public health and medicine.
3. Jointly Develop Health Care Assessment Measures. Synthesize the knowledge of
medicine and public health to improve the quality, effectiveness, and outcome measures
of health care. Specific implementation strategies might include:
a. Developing better measurement, monitoring, and accountability indices for the use of
practitioners, health care provider institutions, and policy-makers.
b. Developing better methods and criteria to establish databases, sufficiently standardized
so that they can be readily shared by investigators without endangering medical record
confidentiality through such program as hospital and community burden of illness,
treatment and mortality statistics.
D. The accuracy of public health and vital statistics needs to be improved in the United
States. The political integrity of the national statistics is questionable and difficult to
impossible to compare with state and county statistics. In 2008 mortality statistics for
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2006 were cast into doubt by their release at the same time as the FISA re-authorization.
In 2009 the mortality statistics for 2007 were cast into doubt by its concurrence with the
disbursement of a large grant for Internet health records and the death of Sen. Edward
Kennedy. The Centers for Disease Control should improve their epidemiological
surveillance and vital statistics so that the federal, state and county statistics can be found
on one easy to use website. These statistics should furthermore be up to date, to the most
recent full year. Full automization could allow for monthly and daily notifications to
heighten the identification of and esponse to, causes of concern to public health.
E.In 2007 DHHS unveiled a new website called Hospital Compare that locates all
hospitals grades hospitals on their compliance with Process of Care measures for heart
attack, heart failure, pneumonia and surgical. The website is a good lesson in basic
medical procedure but falls short of the comparison sought by public health researchers
and consumers. Every hospital should regularly publish certain key statistics over time to
give the public a general overiew of the public health situation to facilitate discussion.
1. Number of employees by type.
2. Number of beds.
3. Number of patients treated over a year.
4. Number of admissions.
5. Common reasons for admission
6. Number of discharges.
7. Number of deaths.
8. Common causes of death.
9. Revenues.
10. Expenditures.
a.Every health district should compile for theh public certain health statistics, over time,
of the geographic area for which they have responsibility, that must include, but is not
limited to:
1.General population.
2. Number of hospitals, hospital beds, admissions and discharges.
3. Number of licensed health care professionals, and outpatient health care providers, by
by specialty.
4. Number of medical and health education institutions and enrollment.
5. Number of professional laboratories.
6. Number of biomedical research laboratories and how many have high security
clearance for toxic substances.
7. Mortality rate, over time.
8. Mortality rate, by cause of death.
9. Number of cases of confirmed illness regarding diseases of public concern, such heart
disease, cancer, influenza, etc.
10. Public health budget, sources of revenue and program expenditures.
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F. In 2006 the US reported an average life expectancy of 77.85 years, 40th amongst 222
nations, and 14th amongst nations with populations over a million. Life expectancy is the
primary indicator of public health. In the US, with a population of 295 million, it is
estimated that 2,416,425 people died in 2001, 8.48 per 1,000.
1.The leading causes of death in the USA are diseases of the heart claiming 700,142
lives, of 7 million suffering angina and 65 million with high cholesterol. Malignant
neoplasms (cancer) claiming 553,768 of 1.5 million diagnoses. Cerebrovascular diseases
claiming 163,538. Chronic lower respiratory diseases claiming 123,013 of 30 million
people with COPD. Accidents (unintentional injuries) 101,537. diabetes mellitus
claiming 71,372 of 24 million people with diabetes. Influenza and pneumonia claiming
62,034 of 5 million flu season patients. Alzheimer‘s disease claiming 53,852. Nephritis,
nephritic syndrome and nephrosis claiming 39,480. Septicema claiming 32,238. Suicide
claiming 30,622. Chronic liver disease and cirrhosis claiming 27,035. Homicide
claiming 20,308. Hypertension and hypertensive renal disease claiming 19,250.
Pneumonities due to solids and liquids claiming 17,301. All other diseases claiming
400,935 lives.
G.The Bureau of Labor Statistics reports that as the largest industry in 2006, health care
provided 14 million jobs—13.6 million jobs for wage and salary workers and about
438,000 jobs for the self-employed.
1.There were an estimated 633,000 physicians and surgeons. Physicians are one of the
highest paid professions. They range in salary from $350,000 for cardiologists, $320,000
for anesthesiologists, $280,000 for general surgery. $247,000 for Ostetrics and
Gynecology, $180,000 for psychiatry, $166,000 for internal medicine, $161,000 for
pediatrics to $156,000 for a family practice.
2.Registered nurses constitute the largest health care occupation, with 2.5 million jobs.
About 59 percent of jobs are in hospitals. The three major educational paths to registered
nursing are a bachelor‘s degree, an associate degree, and a diploma from an approved
nursing program. Registered nurses are projected to generate about 587,000 new jobs
over the 2006-16 period, one of the largest numbers among all occupations; overall job
opportunities are expected to be excellent, but may vary by employment setting. 7 of the
20 fastest growing occupations are health care related. Health care will generate 3 million
new wage and salary jobs between 2006 and 2016, more than any other industry. Most
workers have jobs that require less than 4 years of college education, but health
diagnosing and treating practitioners are among the most educated workers.
3. There are many health professions and allied health professionals. There are an
estimated 2.5 million administrative and health insurance staff. One to two million of
these positions would become superfluous, as the result of the administrative
simplification, if the US evolved to a single payer system. There are also numerous
specialties such clinical laboratory technician, audiologist, genetic counselor etc.
Nursing assistant, medical assistant, receptionist, secretary and positions require little
education. There are nearly 450,000 home health aids, for which a high school degree is
not necessarily required. Home health aid is one of the fastest growing fields. The
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government needs to verify that the patients actually consent to this home health care, so
that home health aids are not a government funded torture, and that home health aids are
trained, supervised and supported so as not to abuse the health or confidentiality of their
patients.
H. According to the American Hospital Association there were a total of 5,708 hospitals
in the United States in 2007. 4,897 were community hospitals, 2,913 were
nongovernment not for profit hospitals,873 were investor owned for profit hospitals,
1,111 were state or local government owned community hospitals, 213 were federal
government hospitals, 444 were nonfederal psychiatric hospitals, 136 were nonfederal
long term care hospitals, and there 18 hospitals units of institutions such as prison
hospitals and college infirmaries.
1. In 2007 there were a total of 945,199 hospital beds, of which 800,892 were staffed
beds in community hospitals. There were a total of 37,120,387 hospital admissions,
35,345,986 to community hospitals. The total expenses of all hospitals were $641
billion, $588 billion for community hospitals. Of the community hospitals 1,997 were
rural, 2,900 were urban, 2,730 were in a system and 1,472 were in a network.
2. Between 1993 and 2003, the population of the United States grew by 12 percent and
hospital admissions increased by 14 percent, yet emergency department visits rose by
more than 25 percent during this same period of time, from 90,300,000 visits in 1993 to
113,900,000 visits in 2003. The demand for emergency care in the United States
continues to grow at a rapid pace. In 2003, hospital emergency departments received
nearly 114,000,000 visits, which is more than 1 visit for every 3 people in the United
States; however, between 1993 and 2003, the number of emergency departments declined
by 425.
§324 Global Health
A.A distinction needs to be made between public and global health for statistical and
diplomatic reasons, therefore the term global health is used to refer to specialization in
the international study of epidemiology, response to outbreaks of disease and
comparative studies of national systems of health.
1.The UN General Assembly Resolution enhancing capacity building in public health of
8 February 2006 seeks to enhance the achievement of health related development goals,
noting with concern the deleterious impact on humankind of HIV/AIDS, tuberculosis,
malaria and other major infectious diseases and epidemics, and the heavy disease burden
borne by poor people, especially in developing countries, including the least developed
countries, as well as countries with economies in transition, and in this regard noting with
appreciation the work of the Joint United Nations Programme on HIV/AIDS, its co-
sponsoring agencies and the Global Fund to Fight AIDS, Tuberculosis and Malaria. New
and re-emerging diseases, such as the severe acute respiratory syndrome and a human
influenza pandemic arising from avian and swine influenza are also of concern. The
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serious damage and loss of life caused by natural disasters and their negative impact on
public health and health systems is also noted.
2. States have primary responsibility for strengthening their capacity-building in public
health to detect and respond rapidly to outbreaks of major infectious diseases, through the
establishment and improvement of effective public health mechanisms, while recognizing
that the magnitude of the necessary response may be beyond the capabilities of many
countries, in particular developing countries, as well as countries with economies in
transition.
3. Strengthening public health systems is critical to the development of all nations and
economic and social development are enhanced through measures that strengthen
capacity-building in public health, primarily through the establishment of competent
systems of epidemiological surveillance in the national government, including strategies
for training, recruitment and retention of sufficient public health personnel, systems of
prevention of and of immunization against infectious diseases, provision of adequate
medical supply and measures to eliminate discrimination in access to public health
iinformation and education for all people, especially for the most underserved and
vulnerable groups.
B. There were an estimated 6.6 billion people in the world with an average life
expectancy of 67.86 years in 2006. The longest life expectancy can be found in Andorra
where people live an average of 83.51 years, in Singapore people live 81.71 years, in
Hong Kong 81.5 years and in Japan 81.25 years. The US has an average life expectancy
of 77.85 years, 40th amongst 222 nations, and 14th amongst nations with populations over
a million. The world population showed a 1.15% average growth rate with a birth rate of
30.53 and 13.32 deaths per 1,000.
1. The lowest growth rate was in Bulgaria at –0.86% that like 26 other nations showed a
negative growth rate. In Eastern Europe this can be attributed to migration in pursuit of
better paying jobs. In Southern Africa population loss in some countries can be attributed
to people dying from HIV/AIDS that can be estimated to affect less than 1% of the world
population but up to 38.8% in Swaziland. The highest growth rate of 4.91% can be found
in Liberia as the result of high birth rates and returning refugees much like Burundi,
Kuwait and Montenegro where low mortality rates are fueling population growth.
2. The average infant mortality rate was 38.44 per 1,000 with a high of 185.36 in Angola
and low of 2.29 in Singapore.
3. The shortest life expectancies can be found in Sub Saharan Africa. In Swaziland,
where 38.8% of the population is infected with HIV/AIDS, the life expectancy is only
32.62 years. In Botswana, with HIV/AIDS infection rate of 37.3%, the life expectancy is
33.74 years and in Lesotho, with an HIV/AIDS infection rate of 28.9%, the life
expectancy is 34.4 years. Angola also has a low life expectancy of 38.82 years but with
an AIDS rate of only 3.9% this must be attributed to other chronic diseases and warfare.
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Fig. 9-3 15 Leading Causes of Death World Wide by Age 1998
Rank 0-4 years 5-14 years 15-44 years 45-59 years 60 years All ages
1 Perinatal Acute lower HIV/AIDS Ischaemic heart Ischaemic heart Ischaemic heart
conditions respiratory 1,629,726 disease disease disease
2,155,000 infections 887,146 6,239,562 7,375,408
213,429
2 Acute lower Malaria Road traffic Cerebrovascular Cerebrovascular Cerebrovascular
respiratory 209,109 injuries disease disease disease
infections 600,312 600,854 4,247,080 5,106,125
1,850,412
3 Diarrhoeal Road traffic Interpersonal Tuberculosis Chronic Acute lower
diseases injuries violence 407,737 obstructive respiratory
1,814,158 161,956 509,844 pulmonary disease infections
1,974,652 3,452,178
4 Measles Drowning Self-inflicted Trachea/bronchus Acute lower HIV/AIDS
887,671 157,573 injuries /lung cancers respiratory 2,285,229
508,621 305,982 infections
1,184,698
5 Malaria Diarrhoeal diseases Tuberculosis Cirrhosis of the Trachea/bronchus/ Chronic
793,368 133,883 427,314 liver lung cancers obstructive
264,117 889,873 pulmonary
disease
2,249,252
6 Congenital War injuries War injuries HIV/AIDS Tuberculosis Diarrhoeal
abnormalities 57,285 372,935 214,571 570,513 diseases
404,849 2,219,032
7 HIV/AIDS Nephritis/nephrosis Ischaemic heart Liver cancers Stomach cancers Perinatal
349,885 44,640 disease 205,394 561,527 conditions
244,556 2,155,000
8 Pertussis Congenital Cerebrovascular Stomach cancers Diabetes mellitus Tuberculosis
345,771 abnormalities disease 205,212 426,964 1,498,061
43,056 195,983
9 Tetanus Inflammatory Cirrhosis of the Chronic Colon/rectum Trachea/bronchus/
302,668 cardiac disease liver obstructive cancer lung cancers
40,802 142,445 pulmonary 424,463 1,244,407
disease
203,192
10 Protein−energy HIV/AIDS Drowning Self-inflicted Cirrhosis of the Road traffic
malnutrition 39,042 141,922 injuries liver injuries
214,717 178,478 355,615 1,170,694
11 Drowning Fires Fires Road traffic Nephritis/nephrosis Malaria
125,301 38,968 122,666 injuries 307,832 1,110,293
172,312
12 STDs Cerebrovascular Maternal Breast cancers Oesophaguscancers Self-inflicted
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excluding HIV disease haemorrhage 132,238 296,550 injuries
118,178 38,349 116,771 947,697
13 War injuries Tuberculosis Acute lower Oesophagus Liver cancers Measles
103,323 38,093 respiratory cancers 295,756 887,671
infections 117,352
115,100
14 Road traffic Interpersonal Rheumatic Diabetes mellitus Inflammatory Stomach cancers
injuries violence heart disease 104,855 cardiac disease 822,069
82,429 34,938 104,635 268,545
15 Meningitis Leukaemia Liver cancers Inflamatory Self-inflicted Cirrhosis of the
60,198 34,503 103,131 cardiac disease injuries liver
97,511 227,724 774,563
Dr. Kung. World Health Organization. Table 1. Leading Causes of Death, Both Sexes,
1998. WHO/HSC/PVI/99.11
4. It can be calculated from the CIA World Fact Book that 56,597,030 people died around
the world in 2004. In 1998 the WHO Report on Leading Causes of Death, Globally the
most deadly diseases were, for all ages, Ischemic hear disease claiming 7,375,408 lives,
Cerebrovascular disease claiming 5,106,125. Acute lower respiratory infections claiming
3,452,178. HIV/AIDS claiming 2,285,229. Chronic obstructive pulmonary disease
claiming 2,249,252. Diarrhoeal diseases claming 2,219,032. Perinatal conditions
claiming 2,155,000. Tuberculosis claiming 1,498,061. Trachea/bronchus/ lung cancers
claiming 1,244,407. Road traffic injuries claiming 1,170,694. Malaria claiming
1,110,293. Self-inflicted injuries claiming 947,697. Measles claiming 887,671.
Stomach cancers claiming 822,069. Cirrhosis of the liver claiming 774,563
5. WHO reports that in 2002 as a percentage of the GDP Equatorial Guinea had the
lowest per capita expenditure on health at 1.8% and the United States of America the
highest at 14.6% HA-30-7-05. In developing nations health investment is much needed
and public health concerns involving safe drinking water, sanitation, electrical power for
refrigeration and access to health care make the most effective use of limited funds to
provide maximum benefit for the lives of the people. In industrialized nations the health
insurance system is a mix of public and private insurance schemes that satisfy demand by
health care professionals but has the problem of representing its own financial interests
and policies must be shifted back and forth from public consolidation to private
diversification in order to combat corruption.
C. The World Health Report 2006 - Working together for health HA-14-4-06 contains an
expert assessment focusing on all stages of the health workers' career lifespan from entry
to health training, to job recruitment through to retirement, the report lays out a ten-year
action plan in which countries can build their health workforces, with the support of
global partners. WHO estimates there to be a total of 59.2 million full-time paid health
workers worldwide.
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1. Almost all countries suffer from mal-distribution characterized by urban concentration
and rural deficits, but these imbalances are perhaps most disturbing from a regional
perspective. The WHO Region of the Americas, with 10% of the global burden of
disease, has 37% of the world‘s health workers spending more than 50% of the world‘s
health financing, whereas the African Region has 24% of the burden but only 3% of
health workers commanding less than 1% of world health expenditure.
2. There is an estimated shortage of almost 4.3 million doctors, midwives, nurses and
support workers worldwide. The shortage is most severe in the poorest countries,
especially in sub-Saharan Africa, where health workers are most needed and the life
expectancy has actually reversed in the past two decades. 57 countries that fall below this
threshold and which fail to attain the 80% coverage level are defined as having a critical
shortage. Thirty-six of them are in sub-Saharan Africa.
3. There are currently 57 countries with critical shortages equivalent to a global deficit of
2.4 million doctors, nurses and midwives to achieve the Health related Millennium
Development Goals. This crisis has the potential to deepen in the coming years. Demand
for service providers will escalate markedly in all countries – rich and poor. Richer
countries face a future of low fertility and large populations of elderly people, which will
cause a shift towards chronic and degenerative diseases with high care demands. In
poorer countries, large cohorts of young people (1 billion adolescents) will join an
increasingly ageing population, both groups rapidly urbanizing. Many of these countries
are dealing with unfinished agendas of infectious disease and the rapid emergence of
chronic illness complicated by the magnitude of the HIV/AIDS epidemic. The
availability of effective vaccines and drugs to cope with these health threats imposes
huge practical and moral imperatives to respond effectively.
D. The United States has claimed criminal responsibility for the global HIV/AIDS
epidemic with the establishment of the DHHS in 1979 and the Court of International
Trade of the United States (CoITUS) in the Customs Court Act of 1980 whose names
remain to be changed to cease inciting genocide. The United States is also the only
nation to provide a large amount of private international assistance, much of it for health
promotion.
1.The United States has a duty to heighten their import and export control to prohibit the
export, and import, of biological weapons and classified laboratory toxins and vehicles
for toxin delivery.
2. The United States has a duty to heighten regulation of the private assistance through
private bills or some other process whereby this money can be accepted as Official
Development Assistance (ODA) by the United Nations and the United States could get
on track to providing 0.7% of the GNI, rather than 0.18%.
3. The United States has a lot to provide to the developing world in the way of
pharmaceutical and medical textbooks and knowledge but like medical care at home, it
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might be better if the United States did not de-liver health care, but provided for health
care as a part of humanitarian and social assistance.
§325 Privacy Rights
A.Privacy is extremely important in the conduct of health matters because of the
confidentiality of personally identifiable health information. There is no way to know
what could happen if personally identifying health information on a person‘s physical or
mental vulnerability to disease was known and the consequences of such information
falling in to the wrong hands could be as severe as death. Basic biographical information
regarding a person‘s name, address, social security number, and geneology must be
protected against random and unwise secondary transmission. To avoid government
secrecy in private matters the policy of confidentiality is used whereby all realeses of
information regarding a patient are the option of that patient, who must consent to any
release of information regarding their condition or their persona. Confidentiality and
informed consent are therefore the policy in regards to personal health care matters and
medical records.
1. The primary law protecting patient privacy is the Health Insurance Portability and
Accountability Act of August 21, 1996 P.L. 104-191. The Act amended the Internal
Revenue Code of 1986 to improve portability and continuity of health insurance coverage
in the group and individual markets, to combat waste, fraud, and abuse in health
insurance and health care delivery, to promote the use of medical savings accounts, to
improve access to long-term care services and coverage, to simplify the administration of
health insurance, and for other purposes. In Sec. 1177 it provides for penalties for a
person who knowingly and in violation of this part-- (1) uses or causes to be used a
unique health identifier; (2) obtains individually identifiable health information relating
to an individual; or (3) discloses individually identifiable health information to another
person, shall be punished (1) with a fine of not more than $50,000, imprisoned not more
than 1 year, or both; (2) if the offense is committed under false pretenses, be fined not
more than $100,000, imprisoned not more than 5 years, or both; and (3) if the offense is
committed with intent to sell, transfer, or use individually identifiable health information
for commercial advantage, personal gain, or malicious harm, be fined not more than
$250,000, imprisoned not more than 10 years, or both. The HHS Office of Civil Rights
enforces the compliance of this law and receives reports from consumers.
2. The Patient Safety and Quality Improvement Act of 2005 (PSQIA) was published on
November 21, 2008, and became effective on January 19, 2009 and is codified at 42
C.F.R. Part 3. The PSQIA establishes a voluntary reporting system to enhance the data
available to assess and resolve patient safety and health care quality issues. To encourage
the reporting and analysis of medical errors, PSQIA provides Federal privilege and
confidentiality protections for patient safety information called patient safety work
product. Patient safety work product includes information collected and created during
the reporting and analysis of patient safety events. The confidentiality provisions will
improve patient safety outcomes by creating an environment where providers may report
and examine patient safety events without fear of increased liability risk. Greater
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reporting and analysis of patient safety events will yield increased data and better
understanding of patient safety events.
B. The health information technology needed for a national database is being tested and
there is established the position of the National Health Information Technology
Coordinator Under Executive Order 13335 signed: April 27, 2004 on setting the stage for
a national database, Internet medical records are encouraged to be kept public unless a
specific request by the patient, who must be informed of this right, has been made for the
confidentiality of such records. Promoting the rapid adoption and widespread use of
individually owned, privacy protected electronic health records by fostering the
development of standards through a public-private collaboration to enable the rapid and
safe exchange of electronic patient information, including comments written by the
patient or their counsel and ethics committees, should be in place within the decade under
the Healthy America Act of 2005 S-4 . The American Recovery and Reinvestment Act of
2009 provided funding designated to modernize the health care system by promoting and
expanding the adoption of health information technology by 2014. Achieving this goal is
estimated to reduce health costs for the federal government by over $12 billion over the
next 10 years.
C. Consumer reports in the press are mostly positive in regards to computerized medical
records on the Internet. Patients with health insurance plans or providers who make
medical records available on the web report that it is easy to access and download
personal records and investigative journalists who tried to access other people‘s records
had difficulty. Confidentiality of medical records is however a serious concern. The
secret exchange of fraudulent and defamatory medical records between medical
providers, lawyers, health isurers and Medicare/Medicaid, with or without the coerced
consent to release records is however also disconcerting. There are certain provisions
that computerized medical records must provide.
1.The medical records are the property of the patient and can be published only with the
prior authorization of the patient who may rescind that authorization, at any time.
2. Medical providers would upload relevant documents to their patient‘s record that have
not been marked confidential by the patient, who must be informed of this right.
3. The patient may upload relevant documents they have authored themselves to their file
in order to better explain the details of their condition and pertinent research or to make
grievances pertaining to medical malpractice or other bio-hazards clear.
3. Except in emergency situations, where the patient is unconscious and the treating
physician requires medical records, the patient must authorize access to their records.
This would occur in writing, through a paper form, or a secure email form requesting to
view a person‘s medical records.
4. Government officials are not authorized to investigate a person‘s medical records
without the informed consent of that person, or a probable cause hearing where that
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person consciously refuses to consent to the disclosure of their records, or is dead, or
unconscious and in need of a review of their medical records to make treatment
decisions, and it is found that there is probable cause to review that person‘s medical
records.
D. Properly warranted epidemiologists may review medical records of a facility or
geographic location on the condition that these records are completely secret and are only
used for the purpose of compiling meaningful statistical data on the epidemiolog and
health outcomes pertaining to a geographical area, institution or practitioner.
Epidemiologists and scientists convicted of breeching the confidentiality of records shall
be immediately removed from their office of trust and may be fined under HIPPA.
1.Public health is different than patient health care in that public health is a statistical
study of health issues affecting a geographic area or the general public. Because of the
danger inherent in the unauthorized disclosure of personally identifying health
information it is important that there be a distinct separation of power between public
health, that we define as a statistical or scientific study of epidemiology, and private
health that we define as patient centered health care.
E. The privacy issue is central to criticism of the Public Health Service and the
obstruction of health insurance reform. To win the trust of the people and to secure
privacy and the best interest of the patient, to the fullest extent of the law, it is highly
recommended to change the name of the Centers for Medicare, Medicaid and SCHIP
(CMS) to National Health Insurance (NHI) and transfer the agency and other mandatory
benfit programs to the Social Security Administration (SSA). The rationale for this
reform is based in privacy rights and is four-fold – first, so as to cease to incite sexist
hatred and violence; second to create preconditions for the transfer of the confidential
government health insurance records; third, the NHI acronym is far superior in that the
right to refuse would be on the tip of the serpent‘s tongue thereby preventing a great deal
of militancy, spying and other unethical conspiratorial behavior as well as empowering
the patient to refuse to pay for defective, unethical, abusive, involuntary and/or
unnecessary treatment; fourth, so as to create a clear separation of confidential patient
medical records from the Public Health Service:
1.The CMS acronym, with its courtly reference to a woman‘s monthly period, is even
more tasteless, than the ethically discriminatory Health Care Financing Administration
(HCFA) it replaced in 2001. Under Art. 20(2) of the International Covenant on Civil and
Political Rights the propaganda that incites ethnic or religious hatred and violence must
be prohibited by law. This clearly extends to sexism, that because slightly more than half
of the population are women, is not only an incitement of hatred and violence, but an
invasion of privacy. Women are not all irritable, foul tempered and litigious, all of the
time, and such a theory should definitely not be written into the prima facie of a
government agency, particularly one that infiltrates deep into the private lives of
individual citizens.
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2. As a precondition of its transfer to SSA the CMS acronym must be changed to
National Health Insurance (NHI). As is the intention of the Social Security Acts, as
amended by the Disability, Medicare and Medicaid provisions, SSA is intended to be the
dominant institution, as it is representative of the rights of the patient and the
compensation of the patient for their injury, is the patient‘s best interest. By requiring the
name change SSA would be enforcing the correction of a grievous technical error and
demonstrating their dominance, so as not to be hostilely taken over by the interests of the
rich, powerful, greedy and very cruel medical establishment.
3. NHI would greatly improve the enforcement of the right to informed consent to
medical procedures and to participate in biological experiments such as corresponding
with government health insurance, health care treatment plans, or medical billers.
Informed consent is the fundamental principle of the Nuremburg Code pertaining to the
protection of bio-medical research subjects. Because of high levels of coercion, trickery
and corruption involved in illness and health care it is imperative that the right of the
patient to refuse a mode of treatment, and to refuse to pay for defective, unethical,
abusive, involuntary and/or unnecessary treatment, be fundamental to the government
health insurance strategy.
4. The primary justification for the transferring the government health insurance program
to the Social Security Administration (SSA) is to enforce a separation of powers between
the Public Health Service and the confidential medical records of private citizens
cooperating with the government health insurance program. The words confidential and
secret have entirely different meanings in the context of personal medical records and the
Public Health Service. In the context of individual records confidentiality ensures that an
individual‘s records are not disclosed to third parties without their informed consent. In
the context of the Public Health Service confidentiality is used to secure and protect the
exact same third parties that are most prohibited from abusing confidential medical
records. The very meaning of secrecy is opposite in the bureaucracy and the Public
Health Service. In the context of confidential medical records held by the bureaucracy,
secrecy is good; secrecy allows professional bureaucrats and researchers to perform
statistical epidemiologic and social studies without disturbing the confidentiality of
records. However in the context of the Public Health Service secrecy is bad, secrecy is
how conspiracies are created, secrecy is how leaking laboratories and torturers avoid the
forensic detection of their deadly and torturous pathogens. To eliminate the vast majority
of confusion regarding individual medical records the government health insurance
program should be transferred to the patient driven supervision SSA, as was the intention
of the Social Security Act.
Art. 2 Medical Ethics
§326 Ethical Review of Family Practice
A. To better respect the AMA Code of Medical Ethics 10.00-10.05 Opinions on the
Patient-Physician Relationship, Opinions 10.06-10.10 have been appended to espouse the
ideals of family medicine, caregiving, social work, family law and victim compensation.
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Family medicine is a medical specialty devoted to comprehensive health care for people
of all ages. It is a division of primary care that provides continuing and comprehensive
health care for the individual and family across all ages, sexes, diseases, and parts of the
body. It is based on knowledge of the patient in the context of the family and the
community, emphasizing disease prevention and health promotion. According to the
World Organization of Family Doctors (Wonca), the aim of family medicine is to provide
personal, comprehensive and continuing care for the individual in the context of the
family and the community. The American Academy of Family Practitioners (AAFP)
defines quality healthcare in family medicine as the achievement of optimal physical and
mental health through accessible, safe, cost-effective care that is based on best evidence,
responsive to the needs and preferences of patients and populations, and respectful of
patients‘ families, personal values, and beliefs. Until antibiotics are made available Over-
the-counter the role of the family physician, other than administering childhood vaccines,
shall be primarily to prescribe broad spectrum antibiotics, the best medicine of the 20th
century, and to evaluate and implement the best practice of specialties and discard the
endless symptom treating and unnecessary operations of high priced specialists.
1. The portion of the Hippocratic Oath (late 5th century B.C.) relevant to family practice
is: To consider dear to me, as my parents, those who taught me this art; to live in
common with them and, if necessary, to share my goods with them; To look upon the
children of others as my brothers, and to teach them this art. I will prescribe regimens for
the good of my patients according to my ability and my judgment and never do harm to
anyone. Family medicine has moved to the office, house calls are rare and hospital
visitations are performed by hospitalists rather than family physicians. This decadence is
reflected in the AAFP definition of personal medical home that is so immoral as to incite
homicide, a crime of genocide (18USC(50A)§1091(c)), and needs to be prohibited by
incorporating into the AAFP definition of personal medical home, the clause from the
Hippocratic Oath whereby, In every house where I come I will enter only for the benefit
of my patients, keeping myself far from all intentional ill-doing and seduction…
furthermore, the practice of sending medical bills to people‘s homes is frowned upon and
the practice of serving patients as a personal medical mailing address for hospital bills,
laboratory results, Internet pharmacy purchases and medicine related correspondence, is
encouraged.
2. Family medicine is the natural evolution of historical medical practice. The first
physicians were generalists. For thousands of years, generalists provided all of the
medical care available. They diagnosed and treated illnesses, performed surgery, and
delivered babies. Germ Theory developed in the 1600s by Dr. Girolamo Fracastoro was
proven with the application of the microscope to observe microscopic organisms by
Antoni van Leeuwenhoek in 1674. Sterilization advanced one step with Louis Pasteur
beginning in 1857 and took two steps back with the disgrace, wrongful imprisonment and
death in a psychiatric institution of hospital hygienist Dr. Ignaz Philipp Semmelweis in
1965. With World War II, despite the marketing of broad spectrum antibiotics,
discovered by Alexander Fleming in 1929, specialization began to flourish. In the two
decades following the war, the number of specialists and subspecialists increased at a
phenomenal rate, while the number of generalists declined dramatically. The concept of
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the generalist has been reborn and has yet to learn to walk to visit patients in hospitals
and their homes and make recommendation to ensure their living environment is
hygienic.
B. The fundamental understanding of health care is to prolong life, relieve pain and
suffering. When legislating, researching, litigating, practicing or seeking the assistance
of health care, it is important to realize what a dangerous field it is, and to be a master of
its discipline – medical ethics. Traditionally, health theology is the most effective
philosophy for preventing the hell fires from consuming the morality of health care, to
save lives from lies. Theology is however abstract and the specialized study of medical
ethics, and statutes and codes of related health professions, raises the art of detection of
err and prevention harm to scientific precision, and provides a system for the punishment
of misconduct by licensed proessionals. But the grievance boards are prone to conflict of
interest with both their due paying members and the due pay members of the Bar
Association and therefore not necessarily safe for the sick person to petition.
1.E-9.11 of the AMA Code of Medical Ethics provides for Ethics committees to be
established in all health care institutions. Generally, the function of the ethics committee
should be to consider and assist in resolving unusual, complicated ethical problems
involving issues that affect the care and treatment of patients within the health care
institution. A wide variety of background training is preferable, including such fields as
philosophy, religion, medicine, and law. Ethics consultation services, like social
services, should be financed by the institution. To prevent conflict of interest the
financing of ethics committees can be obligated by a government authority.
2.The goal of establishing Ethics Committees in all health institutions, medical campuses
and hospitals is wise and necessary. The humble stance of academic advisor to the health
institution is probably what is obstructing the actual establishment of any local ethics
committees. Ethics are far more important to medical practice, particularly in large
health institutions, hospitals and medical campuses, than business or the practice of law.
Ethics committees must be careful not to bully or dominate doctors in their professional
decisionmaking or to undermine the patient‘s confidence in their physicians. Ethics
committees should be available to confidentially hear the grievances of patients, allowed
to pay reasonable claims for redress of grievances, terminate bad bills, initiate
misconduct proceedings against any employee and render advice to health care
professionals to improve their medical practice. Ethics committees should probably be
created from the proceeds of lawsuits by former patients and/or ignored theologians,
philosophers, social scientists, scholars and lawyers, willing to forego the American
system of adversarial justice for an inquisitorial system that protects all people against
false arrest and torture. Ethics committees would be a form of alternate dispute
resolution by appointment of either a court, government or the corporate executive officer
of the health corporation. Ethics committees would use the AMA Code of Medical
Ethics as their basic document.
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C. In the US, not dissimilar to the rest of the world, in 2004 there were an estimated
250,000 deaths from what can loosely be construed as medical malpractice and product
liability.
12,000 -- unnecessary surgery
7,000 -- medication errors in hospitals
20,000 -- other errors in hospitals
80,000 -- infections in hospitals
106,000 -- non-error, negative effects of drugs
1.These estimates of death due to error are lower than those in a recent Institutes of
Medicine report, and if the higher estimates are used, the deaths due to iatrogenic
(hospital) causes would range from 230,000 to 284,000. Even at the lower estimate of
225,000 deaths per year, this constitutes the third leading cause of death in the US,
following heart disease and cancer. Doctors are the third leading cause of death
according to the Journal American Medical Association July 26, 2000;284(4):483-5.
There are other estimates that most people who ever received a poison medical bill would
believe, where medical malpractice is the absolute leading cause of death, taking over a
million lives annually, were the dirty linens in nursing homes to be taken figuratively and
the cause of most morbity and mortality. While doctors may be the third leading cause of
death the secret toxins of the medical campus research laboratories are theoretically the
absolute leading cause.
2.According to the Institute of Medicine over 18,000 people in the U.S. die each year due
to lack of access to medical treatment. However, studies of mortality where and when
doctors went on strike in Los Angeles and Israel indicate that mortality was lower when
there were no physicians. Medical attention might not be in the best interest of the
patient, but it is a right.
3. It should be forbidden for physicians to invoke the probate process to recover medical
bills and frowned upon to bill the estate for medical care that failed to save a person‘s
life. Physicians are encouraged, for the benefit of their private estate and the privae
estates of their patients, to avoid probate through Pay on Death (PoD) accounts, Transfer
on Death (ToD) securities, joint tenancy and signed guardianship agreements for minor
chidren and incapacitated persons.
4. Physicians and health care professionals need to be better spouses, parents and more
charitable and egalitarian members of their family and society. Their success often
comes at the cost of the success and health of their family. Health care professionals
need to provide better family counseling and social work to their patients. Physciians
should be charitable to the poor and disadvantaged in their family, and in others, and to
respect their dignity, privacy, health and right to an adequate standard of living, including
the right to social security of all people. The AMA Council on Ethical and Judicial
Affairs is strongly encouraged to adapt family law as a Chapter of their Code of Ethics.
Ethics Committees shall rely heavily on social work, the AMA Code of Medical Ethics
and the Social Security Administration.
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§326a Opinion 10.07 Caregiving for Children, Elders and the Disabled
A.The goals of caregiving are (1) to maintain a healthy lifestyle, (2) to promote
independent physical functioning to the highest level possible, (3) to promote
independent mental functioning to the highest level possible, (4) to promote a feeling of
self-worth, (5) to provide a safe environment, (6) to provide for privacy, (7) to provide
for social contact with friends and relatives, (8) to provide for a nurturing and caring
environment. These goals serve to emphasize and enhance the overall mission of
caregiving. Establishing specific plans to meet these general goals will do much to foster
the functioning and well-being of the person. Caregivers help the elderly, disabled, ill,
and mentally disabled to live in their own homes or in residential care facilities instead of
in health facilities. Most personal and home care aides work with elderly or physically or
mentally disabled clients who need more extensive personal and home care than family
or friends can provide. Caregivers are domestic partners, also called personal and home
care aides, homemakers, companions, and personal attendants, they provide house-
keeping and routine personal care services. Caregivers clean client's houses, do laundry,
change bed linens, plan meals (including special diets), shop for food, and cook, a vegan
diet is prescribed for longevity. Weekly manicures and pedicures are given and the
liberal use of antifungal foot powder is recommended for elders. When necessary
caregivers help clients get out of bed, bathe, toilet, groom, dress and eat. Caregivers
often accompany clients to doctors' appointments or on other errands and provide
instruction and physical education to their patients and may also advise families on
nutrition, exercise, cleanliness, contagious disease and household tasks.
1. Talking with understanding is fundamental to creating a nurturing and loving home
environment, particularly when dealing with dementia, where everyone is informed and
reminded of problems and opportunities, on a daily basis. Talking about health matters in
the home is of primary importance to healthy cohabitation. Caregivers, in consultation
with physician, should be able to diagnosis and treat the common cold (rotovirus) with
Vitamin C, influenza with Theraflu, pertussis and pneumonia with antibiotics to fend off
new infections. They say pneumonia is an elder‘s best friend and caregivers must always
be on the alert for contagious disease. Caregiving begins in utero when the mother
eschews vices, eats healthy food and consumes a folic acid multivitamin, in consultation
with a doctor. Births in America are usually performed under the supervision of an
obstetrician in a hospital however skilled midwives can perform home births. Nursing
mothers, famed for post-partum depression, do most of the caring for babies. As the
child develops the body grows, baby teeth come in, crawls, walks, talks, is weaned and
the father becomes more important. Vaccines are administered by pediatricians and
family physicians until age 7. Permanent teeth begin coming in around age five when
children start their formal schooling and the wisdom teeth arrive when it is over, around
age 18. Through this entire period of childhood parents, as caregivers, are expected to
provide a nurturing and loving home. Children of low income families are entitled to free
medical and dental care until age 18.
B. Persons with disabilities include those who have long-term physical, mental,
intellectual or sensory impairments which may hinder their full and effective
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participation in society on an equal basis with others. The family is the natural and
fundamental group unit of society and persons with disabilities and their family members,
are entitled to receive necessary protection and assistance by society and the State, to
enable families to contribute towards the full and equal enjoyment of the rights of persons
with disabilities. Persons with disabilities have the right to the enjoyment of the highest
attainable standard of health without discrimination on the basis of disability. State shall
take effective and appropriate measures, including through peer support, to enable
persons with disabilities to attain and maintain maximum independence, full physical,
mental, social and vocational ability, and full inclusion and participation in all aspects of
life. For the purposes of social security disability insurance, An individual shall be
determined to be under a disability only if his physical or mental impairment or
impairments are of such severity that he is not only unable to do his previous work but
cannot, considering his age, education, and work experience, engage in any other kind of
substantial gainful work which exists in the national economy under Sec 223(d)(1)(A) of
Title II of the Social Security Act 42USC(7)II§423(d)(1)(A)
C. The American Association of Homecare Code of Business Ethics assures the prompt and
reliable provision of homecare products and services, appropriate for each individual‘s needs,
health and safety for copay or deductible unless waived due to financial hardship‖. The National
Council on the Aging defines home health agency as "a company that provides many
professional health care services, in the home, under the direction of a physician‖. To
help home health care professionals receive federal funds the National Association for
Home Care and Hospice (NAHC) offers national certification for personal and home care
aides that requires the completion of a standard 75 hour course and written exam and are
evaluated on 17 different skills by a registered nurse. Physicians should not be reluctant
to certify hardworking caregivers under their supervision for government home health
care subsidies Sec. 1929 of Title XIX of the Social Security Act 42USC§1396t. Nearly
one third of persons with dementing illness exhibit signs of depression. Significantly,
caregivers display symptoms of depression in even higher percentages than do those with
dementia. Caregivers, mothers and domestic partners are notoriously economically
depressed must be treated well with respect and praise, improving wages, corporate
responsibility, companionship and physical exercise, because they must be in optimal
physical and mental health to heal their patient.
§326b Opinion 10.08 Social Work, the Psychiatric Inheritance
A.Social work is the mental health profession whose Code of Ethics states ―The primary
mission of the social work profession is to enhance human well-being and help meet the
basic human needs of all people, with particular attention the needs and empowerment of
people who are vulnerable, oppressed and living in poverty‖. Family law is religious
law that was usurped by lawyers during the Enlightenment and in the 20th century social
workers emerged to inherit responsibility for archiving the administration of social
welfare, probate, divorce, tenant-landlord relations, small claims, and mental health and
substance abuse cases. Social workers must become competent to write and archive well
written case law, confidentially and on the Internet. The Workforce Investment Act of
1998 defines literacy as "an individual's ability to read, write, speak in English, compute
and solve problems at levels of proficiency necessary to function on the job, in the family
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of the individual and in society." Social workers, as a class, are developmentally disabled
by (1) the need for a bachelor of the law equivalency as foundation for their graduate
degree in social work, and/or funeral direction for probate, to ensure they know how to
write a civil brief, that cites relevant statute, on just about any topic that might arise. E.g.
the Mental Health Bill of Rights 42USC((102)IV§9501 (2) the transfer of psychiatric
education from the medical campus to the college of social work, (3) abolition of civil
commitments and the termination of all psychiatric hospital licenses, (4) the need for a
comprehensive Social Work Administration (SWA) to administrate socially supervised
community mental health shelters and (5) definition of sado-masochism in the DMS-V.
B. The care of the mentally ill and poor has had a mixed record in the United States.
Colonial Americans utilized county almshouses to care for the poor, dispossessed and
mentally ill. In the 1840s Dorothea Dix went on an interstate psychiatric hospital
construction spree and almshouses were condemned as unsanitary. A brief resistance
provided supervised home care and art therapy in a rural environment for the mentally ill
regardless of ability to pay. After the Civil War the psychiatric hospitals became very
large and the charity curdled as relief organizations proudly promised that the poor would
not get one red cent as a condition for donations and grants to their non-profit
organization. After World War II the deinstitutionalization movement closed many
institutions in favor of community mental health care. The cruelty adapted into tortuous
antipsychotic and hypnotic drugs while the false arrests sped up so four times as many
people were hospitalized in half the beds. Zyprexa causes diabetes, particularly when
accidentally or intentionally mixed with alcohol. Antipsychotics, including Lithium,
cause potentially deadly extrapyramidal side effects that are easily cured with 1 g
Cogentin and the right to refuse antipsychotic treatment under 42USC((102)IV§9501
(1)(A)(i)(D)). Like Lithium, Prozac can cause birth defects; Prozac is otherwise a safe
and effective anti-depressant. Psychiatric hospitals have been condemned by the State
and World Health Organization and must terminate all inpatient psychiatric hospitals,
other than forensic, to reinvest in residential treatment that must be supervised by
licensed social workers employed by a Social Work Administration (SWA). The
psychiatric education shall be transferred to the College of Social Work and psychiatric
wishing to continue practicing shall be expected to apply for a social work license to
continue to be eligible for federal subsidies. In the interim first responders and
prospective patients are advised to boycott general hospitals with psychiatric hospitals,
until Psychiatric Emergency Services and civil commitments have been abolished.
C. Dr. Richard Cabot introduced a medical social services department at Massachusetts
General Hospital in 1905. Seven years later, a specialty in medical social work was
offered by the Boston School of Social Work. A number of hospitals, mainly in the
Northeast, established medical social work departments. In 1918, hospital social workers
formed the American Association of Hospital Social Workers. Mental institutes also
began to see the benefit of social services. Adolf Meyer, a prominent leader in the mental
hygiene movement, believed that psychiatry needed to focus more of its efforts outside
the asylum. He identified the social worker as a primary agent in providing a better
understanding of the patient's social environment. In 1920, leading Psychiatric social
workers formed the Psychiatric Social Workers Club. The International Federation of
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Social Workers is a successor to the International Permanent Secretariat of Social
Workers, which was founded in Paris in 1928 and was active until the outbreak of World
War II. After much preliminary work, the Federation was finally founded in 1956 at the
time of the meeting of the International Conference on Social Welfare in Munich,
Germany. The IFSW updated their previous definition of social work from 1982 in their
General Meeting in Montreal, Canada in July 2000 adopting the definition that ―The
social work profession promotes social change, problem solving in human relationships
and the empowerment and liberation of people to enhance well-being. Principles of
human rights and social justice are fundamental to social work‖.
D. Relationism practiced by social workers and human rights advocates, is a different
perspective on law that is more sympathetic to people‘s feelings as they relate to one
another, than either the adversarial or inquisitorial legal systems lawyers practice in.
Physicians who retain legal counsel, for any reason, are highly advised to employ a social
worker to ensure the richest of the rich capitalize upon the law to administrate wisely to
the poor. The parable of the Good Samaritan (Luke 10:30-37) is a powerful Biblical
inspiration for this idea of neighborly love. The essence of neighborliness is that the
Good Samaritan and the victim he helped did not know each other, and probably never
had a chance to become acquainted. The Good Samaritan does good, what he can see is
simply right to do, without seeking recompense or advantage for himself, and then goes
on his way. This kind of love is an essential component of a modern community. In Old
English, love is contrasted with lagu, law. The latter involves litigation, the former an
amicable settlement. The phrase under law and love in ancient Anglo-Saxon usage was
used to denote the position of being a member of a "frankpledge' which in turn was a
system of free engagement of neighbor for neighbor. Dignity of the human person is the
ethical foundation of a moral society. The measure of every institution is whether it
threatens or enhances the life and dignity of the human person. Social workers respect
the inherent dignity and worth of all individuals. Social workers treat each person in a
caring, respectful manner mindful of individual differences and cultural and ethnic
diversity. Social workers seek to promote the responsiveness of organizations,
communities and social institutions to individuals‘ needs and social problems. Social
workers act to prevent and eliminate domination of, exploitation of, and discrimination
against any person or group on any basis.
§326c Opinion 10.09 Family Law: Maiden Name, Support and Probate Avoidance
A.Health professionals shall never dispute a will or divorce. A physician who disputes a
will or divorce shall have their license suspended until they cease to burden the Court. A
physician is advised to avoid probate by never filing a will or destroying any previously
made will in favor of intro vivo transfers such as pay on death accounts, joint tenancy,
caregiving agreements, etc. whereas a wise person owns nothing when they die. A
practicing physician is responsible for making good faith support payments to any
immediate family member or caregiver of that family member, of theirs, living below the
family poverty line. To avoid infringing it is highly advised that a female (physician)
who gets divorced immediately fill out the paperwork to change the name of her medical
practice to use her Maiden name to avoid the semblance of contempt that occurred in
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Dickie v. Dickie [Canada] 1 S.C.R. 346, 2007 SCC 8. The struggle against the stigma of
illegitimacy and un-marriageability pertaining to the Agunah: Jewish chained wife, and
her children in Bruker v. Marcovitz, [Canada] 3 S.C.R. 607, 2007 SCC 54, is so much
more eloquent. Use of the Maiden name is the message of Good News pertaining to the
Virgin Mary in (Mathew 1:18-21) (Luke 1: 26-55) (Matthew 28), (Mark 16) and (Luke
24). Children inherit their name from their father, perhaps until such a day that mothers
are equally generous with their heritage. Female physicians are not obligated to use their
married name but may choose to. Physicians may not use their divorced name, if it is
other than their name of birth or current marriage. State Boards shall provide their
members, their member‘s spouses and family members, an alternate venue for the
amicable resolution of divorce and estate administration of physicians and learn to treat
patients like family, without residency requirements, by email.
B. A physician, with an above poverty line income, who is delinquent in their support
payments, or violently abuses their children or spouse in any way, stalks, defrauds or who
civilly commits any of their immediate family members to a psychiatric hospital against
their will, or subjects them to cruelty or fear of biological experimentation shall practice
medicine only if they pay reasonable compensation sufficient to be forgiven by the
victim, or the estate of the victim. A patient who has an ethical complaint with a
physician shall be treated like family by the State Board, by name and email and no
residency requirement shall be imposed on the email correspondence. Adultery is known
a deadly sin (Exodus 20:14) and (Deuteronomy 5:18) that may require avoidance of her
door (Proverbs 5:8). Jesus defined, everyone who divorces his wife and remarries
commits adultery, and he who marries a woman divorced from her husband commits
adultery. (Luke 16:18) (Mark 10:2-12). It would be irresponsible for the State Board to
discriminate against divorcees whose families were ruined, at least in part, as the result of
their ―membership‖ to a professional society. It would be unfair to appoint adulterers to
positions of oversight without the recommendation of their extended family, and
forbidden to positions of religious authority (1 Timothy 3:2). Health is not religion but
the concept of health theology is so intriguing as to demand religious law be liberally
applied to achieve the highest attainable degree of medical ethics, particularly at the
intersection of family medicine and family law.
C. The Old Age and Survivor Insurance (OASI) Trust Fund in Sec. 201 of the Social
Security Act 42USC(7)II§401 was begun with the original Social Security Act of 1935.
Survivor insurance provides for the spouse and dependent children should the beneficiary
die. One month after an insured person dies a sum of not less than $255 is made payable
to the widow or widower of the deceased. Should the deceased have been eligible or
receiving disability or old age insurance and the spouse was not eligible but dependent
upon the deceased income the surviving spouse and dependent children are eligible for
75% of normal benefits of the deceased. Divorced spouses, and those without sufficient
service, are often given, 50% of normal benefits. A person will not be eligible for full
benefits for such a time they have a monthly income above $2,500.00.
D. Probate avoidance is the primary purpose of estate planning. Blessed are the meek,
who avoid probate, for only they will inherit the earth (Matthew 5:5). Since probatable
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assets include only those assets owned at the time of death, the simplest way to reduce
their value is to give them all away while still alive. The most widely used strategy for
avoiding probate is joint ownership. Joint ownership applies to any type of property.
For a bank account it involves only the signing of a new Pay on Death (POD) signature
card. Transfer on death (ToD) securities registrations are used for stocks and bonds held
in a brokerage account. For real estate the preparation and recording of a new deed
recognizing joint ownership is best. There is a gift tax on up to half of the transferred
assets to joint ownership with people who did not contribute, other than a spouse,
depending on the length of the marriage. Like wills trust funds are vulnerable to state
laws mandating filing with probate and are therefore not the recommended method of
family administration – administrate a regular bank account in writing. Wills and
testamentary documentation can appoint a personal representative to balance the debts of
the decedent with the needs of the descendants. Never pay a student loan that failed to
employ or medical b(k)ill that failed to heal. Do not pre-appoint a lawyer or file a will
with probate. Respect the rights of the surviving personal representative. Do not hesitate
to dispose of the wardrobe and death bed, host a funeral for the family friends and
refurnish with the proceeds of an estate sale under 24USC(10)§420(a)(2)(A-E)(b)).
Credit cards often offer free life insurance to settle your debt if you die. So as not be
ensnared by the right of the creditors valued over $1,000 to file for probate collection, the
personal representative should explain their circumstances in writing to all creditors and
administrate a settlement that is fair. People who have been tortured into disclosing the
identity of their family to the will of the Probate Bar have only to revoke their will by
crossing out the signature. A beneficiary may opt disclaim an interest in an estate for
estate tax purposes under 26USC(B)(12)(B)§2518. State Medical Boards shall help the
intestate inheritors of the estates of physicians to avoid probate, with dignity, in the safety
and security of the state board, in writing.
§326d Opinion 10.10 Compensation for Torture, Biological Experimentation and
Work
A Compensation for victims of torture, biological experimentation and unpaid or
underpaid work is a fundamental responsibility of physicians-patient relationship. The
basic rights to compensation for false arrest and torture may be the only guiding rights
and the many rights to life, home, health, work and education, left the government for the
free market. Art. 7 of the International Covenant on Civil and Political Rights 1976
guarantees; No one shall be subjected to torture or to cruel, inhuman or degrading
treatment or punishment. In particular, no one shall be subjected without his free consent
to medical or scientific experimentation. Art. 14 of Convention against Torture, Cruel,
Inhuman and Degrading Punishment and Treatment (CAT) of 1985 requires Each State
Party shall ensure in its legal system that the victim of an act of torture obtains redress
and has an enforceable right to fair and adequate compensation including the means for
as full rehabilitation as possible. In the event of the death of the victim as a result of an
act of torture, his dependents shall be entitled to compensation. The International Ethical
Guidelines for Biomedical research Involving Human Subjects of 1993 codifies at
Guideline 19 the Right of injured subjects to treatment and compensation. Investigators
should ensure that research subjects who suffer injury as a result of their participation are
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entitled to free medical treatment for such injury and to such financial or other assistance
as would compensate them equitably for any resultant impairment, disability or handicap.
In the case of death as a result of their participation, their dependents are entitled to
compensation. Subjects must not be asked to waive the right to compensation.
B. The US has been ultra vires Arts. 2, 4 and 14 of the Convention against Torture (CAT)
since 2009, when the criminal penalties for torture were exempted for acts committed in
the geographic US, after a lengthy period without the exclusive remedy of the civil tort.
Physicians must oppose and must not participate in torture for any reason. Participation in
torture includes, but is not limited to, providing or withholding any services, substances,
or knowledge to facilitate the practice of torture. Physicians must not be present when
torture is used or threatened. Physicians may treat prisoners or detainees if doing so is in
their best interest, but physicians should not treat individuals to verify their health so that
torture can begin or continue. Physicians who treat torture victims should not be
persecuted. Physicians should help provide medical and financial support for victims of
torture and, whenever possible, strive to change situations in which torture is practiced or
the potential for torture is great (AMA Opinion on Torture 2.067). To prevent
interference with medical practice the medical community and all good citizens must
dissolves their association with the poison of their alma mater, nosocomial infections of
the hospital laboratory, the corruption of the Democratic and Republican (DR) two party
system, the nosocomial infections delivered by government health insurance. To foster
sovereign immunity health institutions must learn to respect, protect and fulfill the human
right of victims of torture and biological experimentation to compensation, as a self-
determinate institution, that employs those patients who turn in their written homework to
Ethics committees in health institutions under Opinion 9.11.
C. Medical malpractice is so common, and litigation over it so rare, that between three
and seven Americans die from proven medical errors for every-one who receives a
payment for any malpractice claim. Most victims of medical malpractice quietly find
another doctor or lose faith in the health and justice system entirely; leaving
malpracticing doctors and defective procedures in place for decades. The major problem
is that the money invested in malpractice insurance companies generates an interest to
prevent lawsuits, settlements, and most of all to avoid formal disciplinary action by the
State Medical Board, more than to improve patient safety. The medical malpractice
liability and insurance system needs to be improved, to better protect witnesses against
retaliation, to better protect society against the very real and present danger of medical
malpractice and to increase the utilization of State Medical Disciplinary Boards rather
than Courts. The medical establishment, for their part as a self-interested capitalist
system, is interested in increasing the number and severity of sick people by infecting
more people and providing ineffective treatment to profit from ―disease care‖ without
losing their license to practice. To end the domination of health care by conflict of
interest and begin to read consumer responses, impartially and effectively for the entire
25 percent of the hundred million patient care episodes with grievances or well-written
medical research, maybe 10 million of whom are due speedy compensation because of
their poverty. The primary purpose is to encourage the patient to do the medical library
and legal research needed for them and other like them to recover thereby reducing the
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burden on health care professionals struggling with their peculiar antibiotic resistant
nosocomial infection. Patient ownership of their medical records and applied research
papers should be redeemed as minimum wage work for the disabled. Institutional Ethics
Committees settle civil actions against employees under 42USC(6A)IA§233.
§327 Hippocratic Oath
A. The Hippocratic Oath is the foundation of medical ethics; it is sworn by most medical
students upon their graduation from medical school. Hippocrates of Cos (c.460-380
BCE) is considered to be the "Father of Medicine" little is known about him. It is
generally accepted that he was roughly a contemporary of Socrates and was a practicing
physician. It also seems likely that Hippocrates would have been an Asclepiad. The
Asclepiads were members of a guild of physicians which traced its origins to Asclepius,
the god of healing. Tradition also tells us that Hippocrates was the most famous physician
and teacher of medicine of his time, maybe of all-time.
1. Over 60 medical treatises that have traditionally been attributed to him. These treatises
are collectively referred to as the Hippocratic Corpus. Most of these treatises, however,
were not written by Hippocrates himself. In fact, several of the existent treatises were
written well after the life of Hippocrates. The treatises themselves were written over
about a two hundred year period and range in date from c.510-c.300 BCE, so clearly one
man could not have authored all of them. Although it is likely that Hippocrates did
compose some of the treatises, none of the 60 treatises can positively be attributed to
Hippocrates although they are similar in looking for natural explanations and treatments
of illness and rejecting sorcery and magic. Beyond the actual theories set forth by the
Presocratics, however, the early doctors were also influenced by the philosophers' use of
rational thought. Greek physicians influenced by the Presocratics began to make careful
observations of medical problems and to apply logic to medical treatments. Ultimately,
the influence of the Presocratics encouraged early physicians to employ reason in order to
progressively develop medical knowledge, rather than resorting to supernatural
explanations.
2. The Hippocratic Epidemics consists of seven books which record the observations
made by their doctor-authors during the course of their travels as itinerant physicians in
northern Greece -- Thessaly, Thrace, and the island of Thasos -- at the end of the fifth and
in the first half of the fourth centuries. In addition to the case histories, each book of the
Epidemics contains two other types of material: constitutions and generalizations
(aphorisms, prognostic indications, lists of things to consider, various notes). The
constitutions are summary accounts of the climatic conditions and the illnesses
encountered by the doctor in a particular locality over a specific period of time, usually a
year. The books of the Epidemics form a series that covers the period between 410 and
350 and that they have at least three different authors, and probably more. The earlier
books are more rigorously prognostic, with few indications of treatment and a strict
concentration on the description of symptoms. In the later books the course of the illness
is less often followed in detail and indications of treatment are more frequent.
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3. Hippokrates' summary definition of the art of medicine (De arte iii): "the deliverance
of the sick from pain and the reduction of diseases' violence, and the knowledge that
medical art is unavailing in some cases." Indeed it is often the case that where human
skill had been of no avail the patient turns to god.
B. The Iliad is attributed with being the historical foundations for the written philosophy
of medicine. The treatise chronicles part of the tenth and final year of the Trojan War.
Within the text of this poem, Homer mentions nearly 150 different wounds. Most of these
wounds are described with surprising anatomical accuracy. For instance,
1. In the Iliad, Harpalion, a prince allied with the Trojans, is struck from behind by an
enemy arrow. Homer explains that this was a fatal wound, for although the arrow entered
near the right buttock, it sliced through the body, missed the pelvic and pubic bones, and
hit the bladder. Wound after wound is described in a similar fashion in the Iliad. Spears
and arrows strike specific internal organs according to their point of entry and trajectory.
Homer also seems to have had an appreciation of which kinds of wounds were lethal. In
the Iliad, wounds to the arms and legs are painful but not deadly (the story of Achilles'
and his famous heel is not mentioned in the poem). On the other hand, all of the 31
different head wounds were lethal.
2. Beyond the description of wounds, to a lesser extent Homer also recorded the care
given to an injured warrior. Generally speaking, medical care focused on the comfort of
the wounded man and not on treating the wound itself. Among the warriors, however,
there were a few who were considered to be specialists in the art of healing through
means of herbal remedies and bandaging. One of these doctors was Machaon, the son of
the legendary healer Asclepius who later became deified. When Machaon was wounded
himself, however, he was treated by being given a cup of hot wine sprinkled with grated
goat cheese and barley. From these meager beginnings, Greek medicine rapidly
developed over the course of the next several centuries.
C. The codified translation by Heinrich Von Staden, "In a pure and holy way:" Personal
and Professional Conduct in the Hippocratic Oath," Journal of the History of Medicine
and Allied Sciences 51 (1996) 406-408 has been amended after reading that of NOVA so
that:
1. I swear by Apollo the Physician and by Asclepius and Hygieia and Panacea and all the
gods as well as goddesses, making them my witnesses,
a. I will fulfill according to my ability and judgment this oath and covenant
b. I will regard who has taught me this technique as equal to my parents,
c. I will share, in partnership, my livelihood and give a share when there is need,
d. I will regard the children of others as equal to my siblings and to teach them this art
should they desire to learn it, without fee and written covenant,
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e. I will give a share both of rules and of lectures, and of all the rest of learning, to my
children and the children of my teacher and to the pupils who have both made a written
contract and taken an oath according to the medical law, but no one else.
2. I will use remedies for the benefit of the ill in accordance with my ability and my
judgment and keep them from harm and injustice.
3. I will not give a drug that is deadly to anyone if asked for it,
a. Nor will I suggest the way to such a counsel.
b. Likewise I will not give a woman an abortive remedy.
c. And in a pure and holy way I will guard my life and teaching.
4. I will not use the knife, not even on sufferers from stone, but I will cede to those who
are practitioners of this activity.
5. Whatever houses I may visit, I will go for the benefit of the ill, remaining free of all
intentional injustice, mischief and sexual acts upon the free and the slaves.
6. Whatever I may see or hear in treatment, or even without treatment, in the life of
human beings – shall not be used to harm a person -- I will keep to myself, holding such
knowledge a secret.
a. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art,
being honored with fame for all time.
b. However if I transgress and purjure myself, may the opposite be my lot.
§328 International Code of Medical Ethics
A.The International Code of Medical Ethics was adopted by the 3rd General Assembly of
the World Medical Association, London, England, October 1949 and amended by the
22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th World
Medical Assembly Venice, Italy, October 1983 and the WMA General Assembly,
Pilanesberg, South Africa, October 2006. It provides:
1. Duties of Physicians in General
a. A physician shall always exercise his/her independent professional judgment and
maintain the highest standards of professional conduct.
b. A physician shall respect a patient‘s right to accept or refuse treatment.
c. A physician shall not allow his/her judgment to be influenced by personal profit or
unfair discrimination.
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d. A physician shall be dedicated to the providing the competent medical service in full
professional and moral independence, with compassion and respect for human dignity.
e. A physician shall deal honestly with patients and colleagues, and report to the
appropriate authorities those physicians who practice unethicaly or incompetently or who
engage in fraud or deception.
f. A physician shall no receive any financial benefits or other incentives soley for
referring patients or prescribing specific products.
g. A physician shall respect the rights and preferences of patients, colleagues, and other
health professionals.
h. A physician shall recognize his/her important role in educating the public but should
use due caution in divulging discoveries or new techniques or treatment through non-
professional channels.
i. A physician shall certify only that which he/she has personally verified.
j. A physician shall strive to use health care resources in the best way to benefit patients
and their community.
k. A physician shall seek appropriate care and attention if he/she suffers from mental or
physical illness.
l. A physician shall respect the local and national codes of ethics.
2. Duties of Physician to Patients
a. A physician shall always bear in mind the obligation to respect human life.
b. A physician shall act in the patient‘s best interest when providing medical care.
c. A physician shall owe his/her patients complete loyalty and all the scientific resources
available to him/her. Whenever an examination or treatment is beyond the physicians‘s
capacity, he/she should consult with or refer to another physician who has the necessary
ability.
d. A physician shall respect a patient‘s right to confidentiality. It is ethical to disclose
confidential information when the patient consents to it or when there is a real and
imminent threat of harm to the patient or to others and this threat can be only removed by
a breech of confidentiality.
e. A physician shall give emergency care as a humanitarian duty unless he/she is assured
that others are willing and able to give such care.
1330
f. A physician shall in situations when he/she is acting for a third party, ensure that the
patient has full knowledge of that situation.
g. A physician shall not enter into a sexual relationship with his/her current patient or into
any other abusive or exploitative relationship.
3. Duties of Physicians to Colleagues
a. A physician shall behave towards colleagues as he/she would have them behave
towards him/her.
b. A physician shall not undermine the patient-physician relationship of colleagues in
orer to attract patients.
c. A physician shall when medicaly necessary, communicate with colleagues who are
involved in the care of the same patient. This communication should respect patient
confidentialty and be confined to necessary information.
4. The Declaration of Geneva was adopted by the 2nd General Assembly of the World
Medical Association, Geneva, Switzerland, September 1948and amended by the 22nd
World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical
Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly,
Stockholm, Sweden, September 1994 and editorially revised at the 170th Council
Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-
les-Bains, France, May 2006. It states; At the time of being admitted as a member of the
medical profession:
a. I solemnly pledge to consecrate my life to the service of humanity;
b. I will give to my teachers the respect and gratitude that is their due;
c. I will practice my profession with conscience and dignity;
d. The health of my patient will be my first consideration;
e. I will respect the secrets that are confided in me, even after the patient has died;
f. I will maintain by all means in my power, the honour and the noble traditions of the
medical profession;
g. My colleagues will be my sisters and borthers;
h. I will not permit considerations of age, disease or disability, creed, ethnic origina,
gender, nationality, political affiliation, race, sexual orientation, social standing or any
other factor to intervent between my duty and my patient;
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i. I will maintain the utmost respect for human life.
j. I will not use my medical knowledge to violate human rights and civil liberties, even
under threat;
k. I make these promises solemnly, freely, and upon my honour.
§329 AMA Code of Medical Ethics
A. AMA Code of Medical Ethics states: The medical profession has long subscribed to a
body of ethical statements developed primarily for the benefit of the patient. As a
member of this profession, a physician must recognize responsibility to patients first and
foremost, as well as to society, to other health professionals, and to self. The following
Principles adopted by the American Medical Association are not laws, but standards of
conduct which define the essentials of honorable behavior for the physician.
I. A physician shall be dedicated to providing competent medical care, with compassion
and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all
professional interactions, and strive to report physicians deficient in character or
competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes
in those requirements which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health
professionals, and shall safeguard patient confidences and privacy within the constraints
of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge,
maintain a commitment to medical education, make relevant information available to
patients, colleagues, and the public, obtain consultation, and use the talents of other
health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies,
be free to choose whom to serve, with whom to associate, and the environment in which
to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to
the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as
paramount.
IX. A physician shall support access to medical care for all people.
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B. The AMA Code of Medical Ethics is the most exhaustive resource on the topic of
medical ethics and should be the core of health ethics curriculums that must prioritize the
prohibition of biological weapons, ban on torture, the independence of the practitoner
from spy networks, compensation for disability, injury and malpractice and human rights
in general.
§330 Patient Rights
A. The Patients' Bill of Rights and Responsibilities has three goals: (a) to strengthen
consumer confidence that the health care system is fair and responsive to consumer
needs; (b) to reaffirm the importance of a strong relationship between patients and their
health care providers; and (c) to reaffirm the critical role consumers play in safeguarding
their own health.
B. The Commission articulated seven sentences of rights and three of responsibilities:
1. Right to Information. Patients have the right to receive accurate, easily understood
information to assist them in making informed decisions about their health plans,
facilities and professionals so that they can make informed decisions about their
treatment and be assured the highest level of healthcare.
2. Right to Choose. Patients have the right to a choice of health care providers that is
sufficient to assure access to appropriate high-quality health care including giving women
access to qualified specialists such as obstetrician-gynecologists and giving patients with
serious medical conditions and chronic illnesses access to specialists.
3. Right to Access Emergency Services. Patients have the right to access emergency
health services when and where the need arises. Health plans should provide payment
when a patient presents himself/herself to any emergency department with acute
symptoms of sufficient severity "including severe pain" that a "prudent layperson" could
reasonably expect the absence of medical attention to result in placing that consumer's
health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction
of any bodily organ or part.
4. Right to Be a Full Partner in Health Care Decisions. Patients have the right to fully
participate in all decisions related to their health care. Consumers who are unable to fully
participate in treatment decisions have the right to be represented by parents, guardians,
family members, or other conservators. Additionally, provider contracts should not
contain any so-called "gag clauses" that restrict health professionals' ability to discuss and
advise patients on medically necessary treatment options.
5. Right to Care Without Discrimination. Patients have the right to considerate, respectful
care from all members of the health care industry at all times and under all
circumstances; patients must not be discriminated against in the marketing or enrollment
or in the provision of health care services, consistent with the benefits covered in their
policy and/or as required by law, based on race, ethnicity, national origin, religion, sex,
1333
age, current or anticipated mental or physical disability, sexual orientation, genetic
information, or source of payment.
6. Right to Privacy. Patients have the right to communicate with health care providers in
confidence and to have the confidentiality of their individually-identifiable health care
information protected patients also have the right to review and copy their own medical
records and request amendments to their records.
7. Right to Social Security. Patients have the right to a fair and efficient process for
resolving differences with their health plans, health care providers, and the institutions
that serve them through the administration of social security.
8. The Duty to Take on New Responsibilities. In a health care system that affords patients
rights and protections, patients must also take greater responsibility for maintaining good
health; the Patient must thoroughly research their health condition and co-operate with
their social health insurance provider to pay for their medical treatment. Families and
Physicians must ensure that their children are immunized.
9. The Responsibility to Provide for Annual Checkups. It is a shared responsibility of the
physicians and the patients to ensure that everybody has an annual medical and dental
check-up to uphold the highest standards of preventative medicine.
10. The Responsibility of the Taxpayer. Those patients living at or below the poverty
line may be written off by the family physician or health care provider as a tax deductible
contributions of their time and money if otherwise not reimbursed by Medicare or private
insurance; co-pays are negotiable and health care providers should earn enough through
co-pays of the gainfully employed to waive the fee for people living significantly below
the poverty line; Health care providers may claim credit for free goods and services for
the poor in their annual or quarterly tax returns under 26USC(A)(1)(F)I§501(c) and are
expected to uphold the same standards of record keeping and care as paying patients.
C. The term ''free clinic'' means a health care facility operated by a nonprofit private
entity meeting the following requirements: (i) The entity does not, in providing health
services through the facility, accept reimbursement from any third-party payor (including
reimbursement under any insurance policy or health plan, or under any Federal or State
health benefits program). (ii) The entity, in providing health services through the facility,
either does not impose charges on the individuals to whom the services are provided, or
imposes a charge according to the ability of the individual involved to pay the charge.
(iii) The entity is licensed or certified in accordance with applicable law regarding the
provision of health services.
§331 Rights of Persons with Disabilities
A. UN General Assembly Resolution Implementing the World Program of Action
concerning Disabled Persons of 26 January 2006; realizes the Millennium Development
Goals for persons with disabilities aware of the fact that there are at least 600 million
1334
persons with disabilities worldwide, of whom approximately 80 per cent live in
developing countries and recognizes that the important role of the World Programme of
Action is congruent with economic and social redistribution of resources and income to
improve the living standards of the population.
1. On 3 December 1982, the UN adopted the World Programme of Action concerning
Disabled Persons. The Millennium Declaration stressed the need to promote and protect
the full enjoyment of all human rights and fundamental freedoms by persons with
disabilities. The accessibility of both of the physical environment and of information and
communication is important in enabling persons with disabilities to enjoy fully their
human rights and to play an active part in the development of society.
2. Governments and intergovernmental and non-governmental organizations are urged to
promote effective measures, as elaborated in the World Programme of Action, for the
prevention of disability and the provision of appropriate habilitation and rehabilitation
services for persons with disabilities in a manner respectful of the dignity and integrity of
persons with disabilities for the full enjoyment of their human rights by non
discrimination and the intention to integrate persons with disabilities in technical
cooperation activities, both as beneficiaries and as decision makers.
B. The International Day of Disabled Persons is 3 December. The observance of the Day
aims to promote an understanding of disability issues and mobilize support for the
dignity, rights and well-being of persons with disabilities. It also seeks to increase
awareness of gains to be derived from the integration of persons with disabilities in every
aspect of political, social, economic and cultural life.
C. After years of work UN Enable finished drafting the Convention on the Rights of
Persons with Disabilities HA-19-10-06 that was opened for signature on 30 March 2007.
1. The term "disability" means, with respect to an individual, a physical or mental
impairment that substantially limits one or more of the major life activities of such
individual; a record of such an impairment; or being regarded as having such an
impairment. Persons with disabilities include those who have long-term physical, mental,
intellectual, or sensory impairments which in interaction with various barriers may hinder
their full and effective participation in society on an equal basis with others. The term
"qualified individual with a disability" means an individual with a disability who, with or
without reasonable accommodation, can perform the essential functions of the
employment position that such individual holds or desires.
2. The term ―discrimination on the basis of disability‖ means any distinction, exclusion or
restriction on the basis of disability which has the purpose or effect of impairing or
nullifying the recognition, enjoyment or exercise, on an equal basis with others, of all
human rights and fundamental freedoms in the political, economic, social, cultural, civil
or any other field. It includes all forms of discrimination, including denial of reasonable
accommodation, service or employment including limiting, segregating, or classifying a
1335
job applicant or employee in a way that adversely affects the opportunities or status of
such applicant or employee because of the disability of such applicant or employee.
D. The convention recognizes that discrimination against any person on the basis of
disability is a violation of the inherent dignity and worth of the human person, that there
is a diversity of people with disabilities and that there is a need to promote and protect the
human rights of all persons with disabilities, including those who require more intensive
support. People with disabilities must have the freedom to make their own choices and
be enabled to enjoy full access to the physical, social, economic and cultural
environment, to health and education and to information and communication, so as to
fully enjoy all their human rights and fundamental freedoms.
1. The right of persons with disabilities to an adequate standard of living for themselves
and their families, including adequate food, clothing and housing and to the continuous
improvement of living conditions is typically ensured by social security insurance.
Appropriate steps however need to be taken to safeguard and promote the realization of
this right without discrimination on the basis of disability. Social security insurance is
irrational in regards to poverty and the entire program for people under retirement age
discriminates upon the basis of disability.
2. The right of persons with disabilities to work, on an equal basis with others; includes
the right to the opportunity to gain a living by work freely chosen or accepted in a labour
market. A work environment should be open, inclusive and accessible to persons with
disabilities. Discrimination on the basis of disability with regard to all matters
concerning all forms of employment, including conditions of recruitment, hiring and
employment, continuance of employment, career advancement, and safe and healthy
working conditions are prohibited. The rights of persons with disabilities to just and
favorable conditions of work, shall be on an equal basis with others, including equal
opportunities, such as union membership and equal remuneration for work of equal value,
safe and healthy working conditions, including protection from harassment, and the
redressing of grievances. Disabled people shall be employed in both the public and
private sector. Disabled persons shall have access to vocational and professional
rehabilitation programs. State Parties shall ensure that persons with disabilities are not
held in slavery or in servitude, and are protected, on an equal basis with others, from
forced or compulsory labor.
3. The right of persons with disabilities to education shall be granted without
discrimination and on the basis of equal opportunity to an inclusive, education system at
all levels, and life-long learning. Education is important for the full development of the
human potential and sense of dignity and self worth, and the strengthening of respect for
human rights, fundamental freedoms and human diversity. The development by persons
with disabilities of their personality, talents and creativity, as well as their mental and
physical abilities, to their fullest potential requires access to a decent education that can
take into consideration any special needs they might have. States shall ensure that
persons with disabilities are not excluded from the general education system on the basis
of disability, and that children with disabilities are not excluded from free and
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compulsory primary and secondary education on the basis of disability. States shall take
appropriate measures to employ teachers, including those with disabilities, who are
qualified in sign language and Braille.
§332 Counsel Against Euthanasia and Abortion
A. The Hippocratic Oath varies somewhat according to the particular translation, but in
any translation the content is clear: "I will give no deadly medicine to anyone if asked,
nor suggest any such counsel; and in like manner I will not give to a woman a pessary to
produce abortion," or "I will neither give a deadly drug to anybody if asked for it, nor
will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive
remedy.‖ Contemporary medical ethics has however arrived at divergent opinions
regarding both right to life issues. For moral reasons, the religious right is adamantly
opposed to both abortion and euthanasia, but omits reference to the god like might of
malevolently used and secret laboratory supplies, creating a highly charged atmosphere
inspiring socio-paths from both sides of the debate, the scientific left and religious right,
commit random acts of violence.
1. Euthanasia and physician assisted suicide and any counsel to such effect are
condemned except when it involves the termination of life support for a person who can
reasonably be determined to never regain consciousness and is absolutely without any
moral support for their continuing life support. Abortion on the other hand is considered
the pregnant woman‘s right and so long as she aborts the child before it has developed to
the stage where it might live on its own in the third trimester when the woman must
justify that the abortion would save her life, is acceptable. Resistance to both suicide and
abortion is however widespread as anathema to the purpose of life and reproduction even
in the face of adversity.
2. Although abortion has been satisfactorially justified to be legal throughout the 50 state
euthanasia remains a prohibited and condemned practice the counsel for which is
considered mean, subversive and detrimental to the mental health of terminally ill
patients who need positive moral and medical support and care to live out their natural
life, in most states, with the exception of Oregon and few others who have passed Death
with Dignity Acts. Refraining from euthanasia and abortion is encouraged in the
Hippocratic Oath to protect the ―pure and holy way I will guard my life and teaching‖.
B. Euthanasia is the administration of a lethal agent by another person to a patient for the
purpose of relieving the patient‘s intolerable and incurable suffering. It is understandable,
though tragic, that some patients in extreme duress--such as those suffering from a
terminal, painful, debilitating illness--may come to decide that death is preferable to life.
However, permitting physicians to engage in euthanasia would ultimately cause more
harm than good. Euthanasia is fundamentally incompatible with the physician‘s role as
healer, would be difficult or impossible to control, and would pose serious societal risks.
1. The involvement of physicians in euthanasia heightens the significance of its ethical
prohibition. The physician who performs euthanasia assumes unique responsibility for
the act of ending the patient‘s life. Euthanasia could also readily be extended to
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incompetent patients and other vulnerable populations. Instead of engaging in euthanasia,
physicians must aggressively respond to the needs of patients at the end of life. Patients
should not be abandoned once it is determined that cure is impossible. Patients near the
end of life must continue to receive emotional support, comfort care, adequate pain
control, respect for patient autonomy, and good communication Opinion E-2.21 of the
AMA Code of Ethics.
2. Whereas the federal government is prohibited under 42USC§1395 from any sort of
interference with the medical profession the enforcement of medical ethics by the
government is limited to the termination of financing. The Assisted Suicide Funding
Restriction Act of 1997 finds that assisted suicide, euthanasia, and mercy killing have
been criminal offenses throughout the United States and, under current law, it would be
unlawful to provide services in support of such illegal activities wherefore some areas
might begin funding such activities Congress makes provisions to prohibit the furnishing
of assistance for these practices 42USC§14401.
C. The Principles of Medical Ethics of the AMA do not prohibit a physician from
performing an abortion in accordance with good medical practice and under
circumstances that do not violate the law Opiniion E-2.01 of the AMA Code of Ethics.
1. World Health Report of 2005 – Make every Mother and Child Count informs us that
68,000 women die every year from unsafe abortions and counsels for the legalization of
abortion to ensure their safety. At the time of the Persian Empire abortifacients were
known and that criminal abortions were severely punished. We are also told, however,
that abortion was practiced in Greek times as well as in the Roman Era, and that "it was
resorted to without scruple." The Ephesian, Soranos, often described as the greatest of the
ancient gynecologists, appears to have been generally opposed to Rome's prevailing free-
abortion practices. He found it necessary to think first of the life of the mother, and he
resorted to abortion when, upon this standard, he felt the procedure advisable.
2. The constitutional principles regarding the right to an abortion are articulated by the
Supreme Court in Roe v. Wade 410 US 113 (1973), and in keeping with the science and
values of medicine, the AMA recommends that abortions not be performed in the third
trimester except in cases of serious fetal anomalies incompatible with life H-5.982 Health
and Ethics Policies of the AMA House of Delegates.
3. Subsequently it was found to be important to protect professional organizations
involved in the training and licensing of physicians who don‘t advocate or educate their
pupils in abortion from discrimination under 42USC(6A)§238n.
D. Roe v. Wade 410 US 113 (1973) established criteria for legal abortion based upon the
development of the fetus as follows:
1. For the stage prior to approximately the end of the first trimester, the abortion decision
and its effectuation must be left to the medical judgment of the pregnant woman's
attending physician.
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2. For the stage subsequent to approximately the end of the first trimester, the State, in
promoting its interest in the health of the mother, may, if it chooses, regulate the abortion
procedure in ways that are reasonably related to maternal health.
3. For the stage subsequent to viability the State, in promoting its interest in the
potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion
except where necessary, in appropriate medical judgment, for the preservation of the life
or health of the mother.
§333 Prescription of Law
A. Ethical values and legal principles are usually closely related, but ethical obligations
typically exceed legal duties. In some cases, the law mandates unethical conduct. In
general, when physicians believe a law is unjust, they should work to change the law. In
exceptional circumstances of unjust laws, ethical responsibilities should supersede legal
obligations E1.02 The Relation of Law and Ethics AMA Code of Medical Ethics.
B. Art. 33 of Part 3 General Principles of Criminal Law of the Rome Statute of the
International Criminal Court relating Superior orders and prescriptions of law, states:
1. The fact that a crime within the jurisdiction…has been committed by a person pursuant
to an order of a Government, Court or of a superior, whether military or civilian, shall not
relieve that person of individual criminal responsibility unless:
a. The person was under a legal obligation to obey orders of the Government or the
superior in question;
b. The person did not know that the order was unlawful; and
c. The order was not manifestly unlawful.
2. For the purposes of this article, orders to commit genocide or crimes against humanity
are manifestly unlawful.
2. Art. 8(2)(ii) of Part 2 Jurisdiction, Admissability and Applicable Law of the Rome
Statute of the International Criminal Court relating to War Crimes warns of, ―Torture or
inhuman treatment, including biological experiments‖. When Congress passes acts of
war they also tend to pass acts to promote bioterrorism (genocide) and condone torture
because it is highly effective method of controlling the population through fear and
people are easily deterred from litigation and political activism by the spreading of minor
diseases and pain due to the ease with which such crimes can be adapted to cause death
or serious injury and the victims can be taken into medical custody for the purpose of
stifling the freedom of expression. This stereotypical war crime holds true in the war on
drugs which seems entirely motivated by the suffering that can be inflicted upon drug
addicts by forcing them to withdraw from their drugs of addiction when they aren‘t ready
1339
to do so by torturing them with false arrest, trial while they suffer from mental illness and
extended incarceration. Torture is also very common in psychiatric hospitals and all sorts
of penal institutions associated with the prosecutor‘s illegal demand for a conviction and
people who refuse to confess to a crime or to accept their mental illness are often
subjected to physical and mental pain to force them into compliance with a lie.
C. A health care professional shall always exercise his/her independent professional
judgment and maintain the highest standards of professional conduct under the
International Code of Medical Ethics. By independent professional judgment it is meant
that the decisionmaker is not blinded by greed, hatred or political status, is not affiliated
with, or make disclosure to any corrupt influences (the patient must be informed of and
consent to any disclosure to third parties) and does not recommend experimental
treatment until they have first hand knowledge that they have been proven effective and
are not unduly dangerous. A health care professional shall respect the law and also
recognize a responsibility to seek changes in those requirements which are contrary to the
best interests of the patient under the AMA Principles of Medical Ethics. There are
however good laws and bad laws just as there is good medicine and bad medicine and
while the health care professional must always beware of sacrificing their individual best
interest of the patient for socialist ideals of State sovereignty, political corruption,
academic science or corporate conflict of interest, they must also conform with the
evolving social standards of best practice, in the best interest of the patient, not the
shifting balance of power regarding the enforcement of the law.
1. In regards to the law and prescriptions of law when exercising their independent
professional judgment, the same rules apply to defending the practice of health and
medicine, as that of the practice of law. To be justified in revolting against popularly
passed legislation, bad laws must be overruled in their application to a specific case or as
a general rule whereby it should be advocated that the bad law be amended so that it is
acceptable or repealed. There are several theories for nullifying bad laws, federal
paramountcy, interjurisdictional immunity, constitutional supremacy and the human
rights or health case.
a. Federal paramount, federal law is superior the state and local law. When there is a
conflict between federal law and state or local law federal law wins.
b. Inter-jurisdictional immunity, for termporary periods of time a state or local authority
can plead inter-jurisdictional immunity while it gets into compliance with the federal
authority.
c. Constitutional supremacy, the Constitution is the supreme law and any law thereunder
can be deemded unconstitutional in its application or in general need of repeal if it does
not uphold the spirit of the Supreme law.
d. Human rights cases, the application of international human rights law or medical ethics
can supercede all domestic authority to the contrary, including the Constitution, if the
case sufficiently documents the commission of an internationally wrongful act.
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i. Of particular importance to health care, public health and torts of negligence in regards
their discipline by the Courts and Professional Review Boards are Arts. 2, 4 and 14 of the
Convention against Torture and Other Cruel, Inhuman and Degrading Treatment or
Punishment of 26 June 1987
ii. Each State Party shall take effective legislative, administrative, judicial or other
measures to prevent acts of torture in any territory under its jurisdiction. No exceptional
circumstances whatsoever, whether a state of war or a threat of war, internal political in
stability or any other public emergency, may be invoked as a justification of torture. An
order from a superior officer or a public authority may not be invoked as a justification of
torture. Each State Party shall ensure that all acts of torture are offences under its criminal
law. The same shall apply to an attempt to commit torture and to an act by any person
which constitutes complicity or participation in torture. Each State Party shall make these
offences punishable by appropriate penalties which take into account their grave nature.
iii. The civil tort is the most effective method of preventing and punishing the crime of
torture. Each State Party shall ensure in its legal system that the victim of an act of
torture obtains redress and has an enforceable right to fair and adequate compensation,
including the means for as full rehabilitation as possible. In the event of the death of the
victim as a result of an act of torture, his dependants shall be entitled to compensation. It
is very important that the enforcement of anti-torture statute represent the interests of the
patient to compensation and not merely fines that finance the exact same government that
sponsored to the torture.
iv. The mere fact that a State has failed to repress torture in their judgment or butchered
their laws to gut torture statute should be sufficient cause for the enactment of anti-torture
legislation whereas the absence of safeguards regarding torture make legal or health
advocacy very dangerous to the individual and population. A government failure to
prohibit torture generally means the government is hiring the torturers and criminals right
off of lawsuits against them and attempting to control society through the methodical use
of these malefactors to administer pain and torture to the righteous. Instead of individual
cases, public health statistics or their fraudulent nature should be used as the case to
prove State Responsibility for Internationally Wrongfull Act, needed to activate human
rights law. Anonymity and confidentiality must be defended in times of torture, advocates
must lie in wait for a trustworthy and responsible government official to confidentially
adjudicate civil torts, until confidence can be restored to the socio-economy.
§334 Malpractice Liability
A.Public Citizen‘s analysis of malpractice payments as reported in the National
Practitioner Data Bank Public Use File for the years 1990 to 2005 of January 2007
reports that medical malpractice payments were at or near record lows in 2008. The
decline almost certainly indicates that a lower percentage of injured patients received
compensation, not that health safety has improved. Medical malpractice is so common,
and litigation over it so rare, that between three and seven Americans die from proven
medical errors for every one who receives a payment for any malpractice claim. Most
1341
victims of medical malpractice quietly find another doctor or lose faith in the health and
justice system entirely; leaving malpracticing doctors and defective procedures in place
for decades. The medical malpractice liability and insurance system needs to be
improved, to better protect witnesses against retaliation, to better protect society against
the very real and present danger of medical malpractice and to increase the utilitization of
State Medical Disciplinary Boards rather than Courts. Mandatory ethics committees are
the most practical means of improving the distributive justice and reform of the health
system.
1. For the third straight year, 2008 saw the lowest number of medical malpractice
payments since the federal government's National Practitioner Data Bank began tracking
such data in 1990. The 11,037 malpratice payments made in 2008 were 30.7 percent
lower than the average number of payments recorded by the NPDB in all previous years.
2. The number of malpractice payments declined 15.4 percent between 1991 and 2005.
Adjusted for inflation, the average annual payment for verdicts declined 8 percent
between 1991 and 2005. Payments for million-dollar verdicts were less than 3 percent of
all payments in 2005. The number of payments per 100,000 people in the U.S. also fell
since 2001 – from 5.82 to 4.73 – a decline of 18.6 percent. Since 1991, the number of
payments per 100,000 people declined more than 10 percent.
3. The average payment for a medical malpractice verdict in 1991 was $284,896. In
2005, the average was $461,524. Adjusting for inflation, however, shows that the
average is actually declining. The 2005 average adjusted for inflation is only $260,890
— a decline of 8 percent since 1991.
4. The values of payments made to injured patients correspond appropriately to the
degree of harm suffered by the victims. Victims with a ―minor permanent injury‖
receive 55 percent less than those suffering a ―significant permanent injury.‖ The
highest payments go to the families of victims who died as a result of medical
malpractice and most of all to people who suffer quadripalegic paralysis or brain injury
necessitating a life of care.
5. In 1991, 9.7 percent of all payments were for obstetrics cases; in 2005, the figure
decreased to 9.0 percent. Surgical cases accounted for 26.0 percent of payments in
1991, and 26.2 percent of payments last year.
6. Several of the most common types of errors producing malpractice payments
significantly increased over time as a proportion of all errors. Meanwhile progress has
stalled in reducing the errors that are easiest to avoid. ―Failure to diagnose‖ cases, for
example, grew from 16 percent of payments in 1991 to 19 percent in 2005. ―Improper
Performance‖ cases grew from 10 percent to 15 percent of payments. ―Delay in
Diagnosis increased from 10 percent to 15 percent. ―Improper Management‖ on the other
hand declined from 10 percent to 6 percent. ―Wrong Diagnosis‖ declined from 5 to 3
percent. The number of payments for easily avoidable errors, such as leaving a foreign
object inside a patient, or operating on the wrong body part, fell from 874 in 1991 to 576
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in 1997, and then remained relatively constant until 2004, when incidents increased
dramatically. The most recent data reflect the highest number of such errors in 11 years.
B. The primary reason for this decline in malpractice settlements is that under
President Bush the rhetoric of the AMA and Chamber of Commerce was that medical
malpractice lawsuits send physicians‘ malpractice insurance premiums
―skyrocketing.‖ But reports reveal that medical malpractice insurers are making huge
profits. In Florida, alone, the 15 largest medical malpractice insurers profited $803
million in 2005. Since 2001, when CMS was created, the AMA has reported a ―crisis‖
in malpractice liability; however the real crisis seems to be regarding the patient‘s
freedom of expression to file a grievance and sue for health reform. In a recent article
in the New England Journal of Medicine, former Senators Hillary Clinton and Barack
Obama wrote that ―the [medical liability reform] discussion should center on a more
fundamental issue: the need to improve patient safety.‖
1. The cost of the medical malpractice liability system -- if measured broadly by adding
all malpractice insurance premiums -- fell to less than 0.6 percent of the $2.1 trillion in
total national health care costs in 2006, the most recent year for which the necessary data
to make such comparisons are available.
2. The cost of actual malpractice payments fell to 0.18 percent -- one-fifth of 1 percent --
of all health care costs in 2006. Annual malpractice payments have subsequently fallen
from $3.9 billion in 2006 to $3.6 billion in 2008.
C. Since the inception of the National Practitioner Data Base, only 18 percent of doctors
have been responsible for even a single malpractice payment. A serious problem is the
small percentage of doctors who paid multiple claims and who are responsible for much
of the malpractice in America. By strengthening patient safety and training while
disciplining repeat offenders, the amount of malpractice could be dramatically reduced.
1.The vast majority of doctors – 82 percent – have never had a medical malpractice
payment since the NPDB was created in 1990. Unfortunately, state medical boards and
health care institutions do not do enough to rein in those doctors who repeatedly make
medical errors and commit medical negligence. According to Public Citizen‘s analysis of
NPDB data, disciplinary actions such as license suspension or revocation are infrequent
for physicians whose negligence caused multiple malpractice payments.
a. Only 8.61 percent of doctors who made two or more malpractice payments were
disciplined by their state board.
b. Only 11.71 percent of doctors who made three or more malpractice payments were
disciplined by their state board.
c.Only 14.75 percent of doctors who made four or more malpractice payments were
disciplined by their state board.
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d.Only 33.26 percent of doctors who made 10 or more malpractice payments were
disciplined by their state board – meaning two-thirds of doctors in this group of egregious
repeat offenders were not disciplined at all.
Fig. 9-4 Number and Amounts of Medical Malpractice Payments
To Patients Paid on Behalf of Doctors, 1990-2005
Number of Percent/
Number of Total
Doctors Who Total Doctors
Payment Number of
Made
Reports Payments
Payments (777,859)*
All 140,008 223,617 18.00%
1 94,293 94,286** 12.12%
2 or more 45,715 129,331 5.88%
3 or more 17,596 73,325 2.26%
4 or more 8,144 45,106 1.05%
5 or more 4,091 28,989 0.53%
Percent of
Number Percent of
Total
of Total Value Total Amount
Number
Payment of of Payments
of
Reports Payments
Payments
All 100% 100% $50,807,346,000
1 41.27% 42.16% $20,966,431,500
2 or more 58.73% 57.84% $29,840,914,500
3 or more 33.09% 32.79% $16,809,942,400
4 or more 20.18% 20.17% $10,250,793,100
5 or more 12.93% 12.96% $6,570,145,650
Source: Figure 12: Public Citizen‘s analysis of malpractice payments as reported in the
National Practitioner Data Bank Public Use File for the years 1990 to 2005 of January
2007
2. The government as well as health care providers can and should take steps to reduce
preventable errors, protecting patients and doctors alike. A ―systems approach‖ to patient
safety advocated by the Institute of Medicine (IOM) and the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) is an important tool to protect the
health and safety of patients. As noted earlier, in the 1980s, anesthesiologists showed
that proactive measures to enhance patient safety are proven to save lives, reduce the
number of lawsuits and cut costs.
a. Twenty-five states currently have legislation or regulations establishing adverse event
reporting systems. Of these, 24 are mandatory.
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b. Medication errors are among the most common preventable mistakes. In July 2006,
the Institute of Medicine released a report concluding that there are at least 1.5 million
preventable medication errors that cost the U.S. over $3.5 billion. One of the
recommendations in the IOM report is to ―invest in technologies that have been
demonstrated to be effective, but are not yet widely implemented in most organizations,
such as computer physician order entry (CPOE)‖. CPOE is an electronic prescribing
system that intercepts errors where they most commonly occur – at the time medications
are ordered.
c. In 2003, the JCAHO published guidelines for preventing wrong site surgery that
include:A pre-operative verification process to ensure that all parties are fully informed
about the intended patient, procedure, and site; Visibly marking the operative site; and a
―time out‖ period immediately preceding the procedure to conduct a final verification of
the correct patient, procedure, and site.
d. In 2003, the Accreditation Council for Graduate Medical Education issued duty hour
standards for residents that limited residents to 80 hours on-duty per week, averaged over
four weeks. By averaging the number of hours per week over a four-week period,
residents can still be required to work in one session far longer than it is safe. Duty hours
for all physicians should be limited to 80 hours per week, not averaged over a month. By
legitimately limiting the number of consecutive work hours required of physicians,
fatigue-induced error could be considerably reduced.
e. In their 2000 report, To Err is Human, the Institute of Medicine noted that autopsies
―are an excellent way to refine clinical judgment and identify misdiagnosis.‖ A 2002
report published by the Department of Health and Human Service Agency for Healthcare
Research and Quality (AHRQ) concluded that ―the use of autopsy data to correct
inaccuracies in epidemiologic data would likely confer multiple benefits on the health
care system as a whole. Despite these benefits, the rate of autopsy in the U.S. has
declined significantly over the years. According to the AHRQ, ―in 1994, the last year for
which national U.S. data exist, the autopsy rate for all non-forensic deaths fell below 6
percent.‖
3. Physician oversight needs to be improved. Public Citizen recommends,
a. Information about doctor discipline, including state sanctions, hospital disciplinary
actions, and medical malpractice awards, is now contained in the National Practitioner
Data Bank (NPDB). While the Department of Health and Human Services, which
controls the NPDB, makes available a Public Use File for statistical research, the names
of the doctors are kept secret from the public. Congress should lift the veil of secrecy and
allow individuals access to the information they need to make the best and most informed
choice about which doctors they want to provide medical care for themselves and their
families.
b. Quality Improvement Organizations (QIOs) are a national network of 53 organizations
under the direction of the Center for Medicare & Medicaid Services (CMS) in the
1345
Department of Health and Human Services. QIOs are charged with ensuring that patients
receive timely, quality healthcare and investigating complaints about substandard care.
Unfortunately, the system has broken down. In March 2006, Senator Charles E. Grassley
(R-Iowa) wrote a letter to CMS stating that ―there is sparse evidence that QIOs are
effective.‖ Congress should instruct CMS to improve transparency and responsiveness in
the beneficiary process. QIO documents should be made subject to discovery in criminal,
civil, and administrative proceedings.
c. Too many state medical boards are unhelpfully dependent on professional medical
societies. These links result in a lack of meaningful oversight on the part of state medical
boards. To resolve this problem, medical boards (and separate disciplinary boards, where
present) should be appointed by the governor, and the governor‘s choice of appointees
should not be limited to a medical society‘s nominees. Furthermore, a minimum of 50
percent of the members of each state‘s medical board should be well-informed and well-
trained members of the public who have no ties to the health care industry, and,
preferably, are experienced patient advocates. Needless to say, medical boards‘ top
priority should always be protecting public health, not the careers of individual
physicians.
d. In order for state medical boards to properly function, they require improved funding
and staffing. State legislatures should permit medical boards to spend all of the revenue
from medical licensing fees, rather than forcing them to turn over a portion to the state
treasury. Boards should hire adequate staff to investigate all complaints within 30 days,
review all malpractice claims filed with the board, ensure compliance with reporting
requirements, and monitor and regularly visit doctors who have been disciplined to
ensure their compliance with imposed sanctions. State medical boards should also hire
investigators to review pharmacy records, consult with medical examiners, and perform
targeted office audits of doctors practicing alone and suspected of substandard
performance.
D. Using an analysis of data released by the Federation of State Medical Boards (FSMB)
on all disciplinary actions taken against doctors in 2008, Public Citizen calculated the rate
of serious disciplinary actions (revocations, surrenders, suspensions and probation/
restrictions) taken by state medical boards in 2008. This rate of serious actions per 1000
physicians continues to be significantly lower than the peak for the past nine years. (see
Figure below) . The rate in 2008—2.92 serious actions per 1000 physicians—is 21.5%
lower than the peak rate in 2004 of 3.72 serious actions per 1000 physicians.
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Source: Wolfe, Sidney M; Resnevic, Kate. Public Citizen‘s Health Research Group
Ranking of the Rate of State Medical Boards‘ Serious Disciplinary Actions, 2006-2008
(HRG Publication #1868) April 20, 2009
1.The most recent three-year average state disciplinary rates (2006-2008) ranged from
0.95 serious actions per 1,000 physicians (Minnesota) to 6.54 actions per 1,000
physicians (Alaska), a 6.9-fold difference between the best and worst state doctor
disciplinary boards. About three out of every 1,000 doctors were the targets of serious
disciplinary actions by state medical boards last year. An annual report out from the
watchdog group Public Citizen says the nationwide rate of serious actions, such as license
revocations and suspensions, was 2.92 per 1,000 doctors last year. That was unchanged
from the prior year — but remains below a peak of 3.72 in 2004.
a. States with the highest rates, averaged from 2006-2008: Rank State Serious actions per
1,000 doctors
1 Alaska 6.54
2 Kentucky 5.87
3 Ohio 5.33
4 Arizona 5.12
5 Oklahoma 5.02
b. States with the lowest rates:
Rank State Serious actions per 1,000 doctors
1 Minnesota 0.95
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2 S. Carolina 1.23
3 Wisconsin 1.64
4 Mississippi 1.87
5 Connecticut 1.97
2. There is considerable evidence that most boards are under-disciplining physicians. For
example, in a report on doctors disciplined for criminal activity that we published
recently, 67 percent of insurance fraud convictions and 36 percent of convictions related
to controlled substances were associated with only non-severe discipline by the board.
Boards are likely to be able to do a better job in disciplining physicians if the following
conditions are met:
a.Adequate funding (all money from license fees going to fund board activities instead of
going into the state treasury for general purposes)
b. Adequate staffing
c.Proactive investigations rather than only reacting to complaints
d.The use of all available/reliable data from other sources such as Medicare and Medicaid
sanctions, hospital sanctions, malpractice payouts, and the criminal justice system
e.Excellent leadership
f.Independence from state medical societies
g.Independence from other parts of the state government so that the board has the ability
to develop its own budgets and regulations
h.A reasonable legal standard for disciplining doctors (―preponderance of the evidence‖
rather than ―beyond a reasonable doubt‖ or ―clear and convincing evidence‖)
3. Most states are not living up to their obligations to protect patients from doctors who
are practicing medicine in a substandard manner. Serious attention must be given to
finding out which of the above bulleted variables are deficient in each state. Action
must then be taken, legislatively and through pressure on the medical boards
themselves, to increase the amount of discipline and, thus, the amount of patient
protection. Without adequate legislative oversight, many medical boards will continue
to perform poorly.
E. It is clear medical malpractice liability has fallen into disrepute in the United States
since CMS was creted in 2001. The medical malpractice liability and insurance system is
however flawed becaue it generates several competing interests, none of which is to
improve patient safety. The major problem is that the money invested in malpractice
insurance companies generates an interest to prevent lawsuits, settlements, and most of
all to avoid formal disciplinary action by the State Medical Board, more than to improve
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patient safety. The billions of dollars of profit made by malpractice insurance companies
enables them to set up a lobby with which to delude public officials with propaganda to
deter malpractice lawsuits and generally abuse their power to make the dangerous job of
suing the government for the redress of the health care system, even more dangerous. The
medical establishment, for their part as a self-interest capitalist system, is interested in
increasing the number and severity of sick people by infecting more people and providing
ineffective treatment to profit from ―disease care‖ without losing their license to practice.
To end the domination of health care by conflict of interest and begin to arbitrate medical
malpractice fairly, impartialy and effectively for the entire 25 percent of the hundred
million patient care episodes with grievances, the ultimate goal should be for the federal
government to completely nationalizes the health care workforce, including payroll and
responsibility for their malpractice liability. The federal government would share
responsibility for discipline with State Disciplinary Boards that are composed of 50
percent patient advocates and 50 percent licensed professionals and are appointed by the
Chief Executive. In the meanwhile Ethics Committees are needed in all health
institutions to assist patients with grievances to navigate the privacy and corruption.
1. The remedy against the United States for damage for personal injury, including death,
resulting from the performance of medical, surgical, dental, or related functions,
including the conduct of clinical studies or investigation, by any commissioned officer or
employee of the Public Health Service while acting within the scope of his office or
employment, whose act or omission gave rise to the tort claim under 42USC(6A)IA§233.
In reviewing tort claims for damages the investigator shall verify if the practitioner
a. Has implemented appropriate policies and procedures to reduce the risk of malpractice
and the risk of lawsuits arising out of any health or health-related functions performed by
the entity;
b. Has reviewed and verified the professional credentials, references, claims history,
fitness, professional review organization findings, and license status of its physicians and
other licensed or certified health care practitioners, and, where necessary, has obtained
the permission from these individuals to gain access to this information;
c. Has no history of claims having been filed against the United States. Upon a finding
that a physician or medical practitioner presents a threat of malpractice government
funding shall cease, for a period to be determined by the Secretary, to receive and to be
eligible to receive any Federal funds under titles XVIII or XIX of the Social Security Act
(42 U.S.C. 1395 et seq., 1396 et seq.).
d. There is an option for non-profit hospitals to be represented by the United States
government in determining malpractice liability.
§335 Product Liability
A. Health care professionals, consumers, society in general and the government, have a
responsibility to ensure health care and food products are not harmful to the health, of
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good quality and not adulterated. In the mid 19th century, the first century that the
pharmaceutical industry emerged as an important market sector, the pharmaceutical
industry functioned as a part of the chemical industry. In the 20th pharmaceutical
corporations gained a great deal of independence and advances in biopharmaceutical
research have led to expansion of the industry and market. After a century of fake patent
medicines, addictive products and defective remedies, in 1902, Congress passed the
Biologics Control Act, the gave the Marine Hosptital and Public Health Service
regulatory authority over the production and sale of vaccines, serums, and other
biological products that included the power to order a recall of unsafe products. The
Bureau of Chemistry, the modern era of the FDA dates to 1906 with the passage of the
Federal Food and Drugs Act. All biological products must be registered and can be
recalled under 42USC(6A)IIF§1262(d).
1. Pharmaceuticals, medical supplies and consumer products are big business. From
1997 to 2007, the number of prescriptions purchased increased 72% (from 2.2 billion to
3.8 billion), compared to a US population growth of 11%. Spending in the US for
prescription drugs was $216.7 billion in 2006, more than 5 times the $40.3 billion spent
in 1990. The Pharmaceutical Research and Manufacturing Association (PhRMA) reports
that the biopharmaceutical sector in 2003 was responsible for $63.9 billion in direct
output and employed over 406,000 people across the U.S. $23.6 billion in taxes are
attributed to the pharmaceutical industry, $6.4 billion of which were corporate taxes.
When the total impact of the market is calculated estimating every pharmaceutical job
creates 5.7 jobs in the community the pharmaceutical industry is directly responsible for
2.7 million jobs, 2.1% of the national economy, with an output of $172 billion. The
pharmaceutical industry is one of the most profitable sectors and the average employee
makes $72,000 and produces $157,000. The industry has the highest rate of investment
in research of any market sector at 15-20% of gross sales. Drug costs in the US are
much higher than in other countries. The global market for pharmaceuticals was worth
more than $693 billion in 2007. But Big Pharma is easily dwarfed by the global
chemistry industry, which lives somewhere in the $3 trillion-a-year-neighborhood.
2. Outpatient prescription drugs accounted for one tenth of overall health spending, 13%
of premium costs, an average cost of $32.45 per month to every privately insured
individual. The Medicare Drug Discount card released in 2004 saves consumers an
average of 17.5% on regular outpatient prescription costs although prescription drug cost
hikes have reduced savings to only an estimated 16.2%.
B.The FDA subjects new products to a pre-market approval process. Under
21USC(9)VA§360c(a) the sponsor of a new medical device need only demonstrate a
―reasonable assurance of safety and effectiveness‖, generally, in the production of a new
medical device only one clinical trial is necessary to prove its safety effectiveness. Under
21USC(9)VA§355(d) before a new drug can be marketed, the sponsor must show
―substantial evidence of safety and effectiveness‖, usually at least two clinical trials are
required to prove its safety and effectiveness. Products must be safe and effective and
their labeling must be accurate and not fraudulent in regards to its use, dosage, strength or
other quality. As the Food and Drug Act is written it is difficult for the government to
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recall pharmaceutical products after they have been approved and one must rely instead
upon the Public Health Service Act or the Courts.
1.A drug or device is deemed to be adulterated drugs or devices under 21USC(9)VA§351
if it has (a) been prepared, packed, or held under insanitary conditions whereby it may
have been contaminated with filth, or (b) it, or its container, is, in whole or in part, a
poisonous or deleterious substance, whereby it may have been rendered injurious to
health or (c) its strength, quality or purity differ from the compendium, or (d) it is not in
conformity with performance standards.
2. A drug or device is deemed to be misbranded under 21USC(9)VA§352(j) if it is
dangerous to health when used in the dosage or manner, or with the frequency or duration
prescribed, recommended, or suggested in the labeling thereof.
3. If a device presents substantial deception or an unreasonable and substantial risk of
illness or injury and such deception or health risk cannot be remedies in correspondence
with the company, such device may be banned under 21USC(9)VA§360f.
4. Upon a determination that a batch, lot, or other quantity of a product licensed under
42USC(6A)IIF§1262 presents an imminent or substantial hazard to the public health, the
Secretary shall issue an order immediately ordering the recall of that product and up to
$100,000 fine. The loopholes provided under 5USCI(5)II§554(a,1-6) are hereby
overruled.. Critera for biological product risk evaluation and mitigation strategies
elaborated under 21USC(9)VA§355-1 are;
a.The estimated size of the population likely to use the drug involved.
b. The seriousness of the disease or condition that is to be treated with the drug.
c. The expected benefit of the drug with respect to such disease or condition.
d. The expected or actual duration of treatment with the drug.
e. Whether the drug is a new molecular entity.
f. The seriousness of any known or potential adverse events that may be related to the
drug and the background incidence of such events in the population likely to use the drug.
The term ―adverse drug experience‖ means any adverse event associated with the use of a
drug in humans, whether or not considered drug related, including—
i. an adverse event occurring in the course of the use of the drug in professional practice;
ii. an adverse event occurring from an overdose of the drug, whether accidental or
intentional;
iii. an adverse event occurring from abuse of the drug;
iv. an adverse event occurring from withdrawal of the drug; and
v. any failure of expected pharmacological action of the drug.
The term ―serious adverse drug experience‖ is an adverse drug experience that results
in—
i. death;
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ii. an adverse drug experience that places the patient at immediate risk of death from the
adverse drug experience as it occurred (not including an adverse drug experience that
might have caused death had it occurred in a more severe form);
iii. inpatient hospitalization or prolongation of existing hospitalization;
iv. a persistent or significant incapacity or substantial disruption of the ability to conduct
normal life functions; or
v. a congenital anomaly or birth defect; or
vi. based on appropriate medical judgment, may jeopardize the patient and may require a
medical or surgical intervention to prevent an adverse outcome.
Improved information, professional training and certification and other methods that
render the product safe may be instituted, and if these countermeasure mitigate risk to
health and life sufficiently, keep the product on the market.
5. If the introduction, delivery or receipt for introduction into interstate commerce of any
food, drug, device, or cosmetic that is adulterated or misbranded or otherwise
noncompliant is prohibited under 21USC(9)III§331 that that product may be brought to
the US District Court for an injunction proceedings under 21USC(9)III§332 and held
liable for civil and criminal penalties under 21USC(9)III§333.
D. Medical products, particularly pharmaceuticals and vaccines, and viruses, toxins and
pathogens for laboratory research and biological product development are prone to
conflict of interest. As noted in paragraph B of this section the Food, Drug and Cosmetic
Act, does not, in its current form, provide for the recall of drugs, by any means other than
voluntarily on the part of the corporation or by injunction of the US District Court. The
FDA and Public Health Service are legally obstructed from effectively regulating
biological products after a product has been approved for market.
1. Unduly empowered, pharmaceutical companies are reported to (a) engage in conflicts
of interest with medical providers, bribing them with gifts and kickbacks to prescribe
their medication, (b) contribute heavily to Congressional campaigns to sustain their unfair
laws and arrange for subsidies and (c) conspire with the judiciary to conduct lucrative but
illegal coerced clinical drug trials on prisoners, interfere with government decionmaking,
intimidate and suppress people reporting adverse drug reactions.
a. Pharmaceutical companies invest an estimated $20 billion annually marketing directly
to doctors. For more than 65 years, the American Medical Association has been selling
pharmaceutical companies the Physician Masterfile, a database that contains information
on the prescribing practices and other characteristics of 900,000 practitioners, most of
whom are not AMA members, making $46 million in 2005 alone. Whoever directly or
indirectly, corruptly gives, offers or promises anything of value to any public official to
influence an official act, or commit or allow fraud or to omit an act that is the lawful duty
is guilty of bribing a public official or witness under 18USCI(11)§201. Taking into
consideration the state regulated license to practice medicine, the high salaries they
command, the life or death decisions they must make and the need to make informed
prescription decisions, as a professional doctors are for the intent of the law pertaining ot
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conflict of interest a public official, or a witness thereto, and it must therefore be
prohibited for the pharmaceutical and medical supply industry to give doctors any gifts.
b. The drug industry has invested a meager portion of their enormous profits on lobbying
government officials donating an estimated $800 million to state, federal and local
political campaigns between 2000 and 2007. In 2003 alone, the industry spent nearly
$116 million lobbying the government when the Medicare Modernization Act of 2003
was passed. In 2004, drug makers upped their reported expenditures on lobbyists to $123
million, a record amount for the industry. Of the 1,291 lobbyists who were listed that year
as representing pharmaceutical corporations and their trade groups, some 52 percent were
former federal officials. Between 1998 and 2004 the pharmaceutical industry disclosed
lobbying on 1,600 bills. While not patently illegal, campaign finance laws highly limit
the amount a corporation, particularly a for-profit corporation, can contribute.
Furthermore the immense size and power of the pharmaceutical lobby distorts the truth
and extra effort must be made to protect consumers, hear grievances and regulate the
market.
c. The case of Zyprexa Product Liability Litigation HA-12-2-07 presents a scenario that
would be expected from such negligent lawmaking, where a court abused their power to
issue an injunction, not against the popular anti-depressant drug that has given millions of
consumers diabetes and death, because of an adverse reaction with alcohol, for which a
$200 million lawsuit was settled in 2005, but against the researchers who had collected
millions of pages documenting adverse reactions with the drug, that also presents a high
risk of abuse secretly mixed with alcoholic beverages. The Court behaved atrociously
and the case was remanded to Congress for the FDA to consider recalling the drug.
2. Vaccine manufacturers need to eliminate from circulation the viruses that both cause
the diseases the vaccines are intended to prevent and are stockpiled in their laboratories to
produce the vaccines. Bio-medical research laboratories, particularly animal laboratories
that do research on the pathogens that cause deadly disease must be separated from the
interests of health care providers who would profit or gain political advantage from the
leaking of such pathogens Legal Consequences of Off-Season Flu Delivery HA-14-5-09.
a.The National Childhood Vaccine Injury Act of 1986 appropriates sufficient additional
funds to pay for all of the retrospective claim awards anticipated for this and future fiscal
years by the Division of Vaccine Injury Compensation (the potential shortfall for 2007
was estimated to be as high as $174 million) H-440.929 Health and Ethics Policies of the
AMA House of Delegates.
§336 Medical Education
A. Association of American Medical Colleges (AAMC) accredits university medical
programs and organizes their political union. Medical Education has been prioritized by
many Congresses and there are a large number health scholarships and research grants
listed in the Catalog of Federal Domestic Assistance.
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1. The American Board of Medical Specialties (ABMS) oversees board certification for
medical doctors (MD). For more than 70 years, ABMS‘ mission has been to maintain
and improve the quality of medical care by assisting its Member Boards in developing
and implementing educational and professional standards to evaluate and certify
physician specialists. ABMS is composed of 24 primary medical specialty boards.
2. To be a licensed practical nurse at least 1 to 2 years of study in a community college
are required. To be a registered nurse (RN) three to four years studying at a college of
nursing are required. Nurse board certification exams are overseen by the American
Nurses Credentialing Center and American Nurses Association (ANA).
B. In 2006 an estimated total of 51,380 masters and doctoral degrees were granted in the
health professions and related clinical sciences. The US National Center for Health
Statistics reports that in 1994, the last for which comprehensive statistics were provided,
as of 2006, there were a total of 1,501 schools issuing health care degrees. 125 medical
schools, 16 schools of osteopathy, more or less than 1,185 nursing schools offering
various nursing degrees from baccalaureate to associate to diploma to licensed practical
nursing, 54 schools of dentistry, 17 schools of optometry, and 75 schools of pharmacy.
There were a total of 270,228 professional health students in 1994.
1.There were 63,800 allopathic medical students, 17,121 in their first year, and 15,555
graduates with an MD. There were 7,822 students of natural remedy oriented osteopathy,
2,162 in their first year and 1,752 graduates with a DO.
2. There were 110,693 nursing students studying for their baccalaureate, 42,953 in their
first year and 94,870 graudates. There were 137,300 studying for an associates in
nursing, 77,343 in their first year and 58,839 graduates. There were 22,235 nursing
students studying for their diploma, 9,601 in their first year and 7,119 graduating. There
were 61,007 nursing students studying to be a licensed practical nurse, 60,632 in their
first year and 45,083 graduating.
3. There were 16,250 dental students, 4,100 in their first year and 3,875 graduating.
There were 5,201 optometry students, 1,351 in their first year and 1,125 graduating.
There were 27,143 pharmacy students, 8,970 in their first year and 7,504 graduating.
C. Formal education and training requirements for physicians are among the most
demanding of any occupation—4 years of undergraduate school, 4 years of medical
school, and 3 to 8 years of internship and residency, depending on the specialty selected.
1. Premedical students must complete undergraduate work in physics, biology,
mathematics, English, and inorganic and organic chemistry. To be a board eligible
Physician a medical doctor must pass the MCAT, graduate from medical school, choose a
specialty for a three year residency and pass the medical board exam.
2. Students spend most of the first 2 years of medical school in laboratories and
classrooms, taking courses such as anatomy, biochemistry, physiology, pharmacology,
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psychology, microbiology, pathology, medical ethics, and laws governing medicine.
They also learn to take medical histories, examine patients, and diagnose illnesses.
3. During their last 2 years, students work with patients under the supervision of
experienced physicians in hospitals and clinics, learning acute, chronic, preventive, and
rehabilitative care. Through rotations in internal medicine, family practice, obstetrics and
gynecology, pediatrics, psychiatry, and surgery, they gain experience in the diagnosis and
treatment of illness.
4. Following medical school, almost all M.D.s enter a residency—graduate medical
education in a specialty that takes the form of paid on-the-job training, usually in a
hospital. Doctors then continue the supervised study of medicine with Continuing
Medical Education (CME) courses.
D. There are four major problems with medical education and training. The first are the
extended hours residents are forced to work to the detriment of their and their patient‘s
health, safety and happiness. The second is conflict of interest between academic
medical professors and researchers and corporate and industrial clients. The third is the
slavery, homicidal judicial corruption and conspiracy of psychiatry seriously perverts
both the entire medical establishment and judiciary and due consideration should be
given to terminating the psychiatric specialty entirely in favor of social work and liberal
arts for the treatment of mental illness. The fourth is perhaps the most significant and
most omitted (censored) from literature and common knowledge, the stockpiling and
malevolent distribution of toxic laboratory supplies by primarily academic bio-medical
research laboratories is evidently, by far, the leading cause of death and disease. As the
core of medical knowledge, the medical campus must redress these issues as a duty to the
advancement of medical science, public health and the best interest of the patient.
1. In recent years, in most States, work requirements of medical residents have been
reduced to less than 60 hours a week, averaged over the course of the month. Studies
show that working long and irregular hours greatly increases the risk of getting into a car
accident on the way to and from work, greatly increases the risk of that the worker will
become ill and unable to work at all, greatly increases the chance the medical resident
will make a medical error or suffer an accident that will injure or inconvenience a patient
and for the most part is detrimental to the pursuit of health and happiness for everyone
concerned. Although it is probably a good idea for doctors to learn to work long hours in
emergency situations before they become a filthy rich jaded physicians with extensive
malpractice records, working a 2 hour work day, three or four days a week, spending
most of their time on the golf course or conspiring with their peers how to make people,
whose spirits have yet to be crushed, life a living hell. This Act shall specifically limit the
number of hours a medical resident must work to less than 60 per week.
2. While medical education and medical practice are inextricably interwined and it
would be countproductive to attempt to separate academia from hands on training,
academic institutions and health care providers must limit their financial relations to the
teaching hospital. Academics must declare any government grants or corporate sponsors
1355
to their institutional ethics committees. It is imperative that health care practitioners do
not moonlight in bio-medical research laboratories. The temptation to profit and corrupt
is too real to ignore the health corporation with unfettered access to chemical weapons.
Academic and practical medicine must be formally separated by formal written
declarations of scientific discovery and similar dissertations regarding the clinical
effectiveness of new treatments. The goal is two-fold. First, to prevent the malevolent
distribution of toxic laboratory supplies to entities financially interested in making
individuals or the general population sick and die. Second, secure the independence and
isolation of scientific research from outside interests so real progress can be achieved.
3. Psychiatry subverts the medical establishment and society. As a student of the political
concept of mental health and corrupt practitioner of judicial slavery in the Court of
Death, psychiatric ill will dominates the health system into inanity. The psychiatrist
seems to have been too squeamish to practice real medicine and not having the goodwill
to go into family practice, instead got involved in a medical slave trade designed to throw
the adjudicator of wills off the trail of the medical killer. A psychiatrist usurps the role of
the social worker as the primary mental health professional. Social workers are much
more likely to heal and be a benevolent influence upon the mentally ill than someone
who speaks only of lies and delusions, in Latin, pushes drugs and slaves. Psychiatric
hospitals subject a general hospital to seizure by anonymous estate lawyers. Both private
and public psychiatric hospitals are condemned to closure because community care is
more effective, affordable and humane. Medical campuses and establishments would
greatly benefit from terminating the psychiatric specialty entirely, referring the treatment
of mental illness to social work. By eliminating the psychiatric specialty and
incorporating the basic principles of social work, medical ethics and human rights into
medical training, medicine would become much less oppressive, public health and justice
would improve. Career psychiatrists could be retrained or continue to serve in prisons
and as social counselors, but, no lie, the academic goal is to chop the psychiatry down.
4. Most importantly both academic and corporate bio-medical research facilities must be
safe and secured. Institutional Review Boards (IRB) must be consulted regarding the
ethics of all bio-medical experiments. In general, experiments designed to make animals
ill are not good experiments, stockpiles of these poisons seem to be the whole problem.
The objective of bio-medical research is to discover cures for diseases.
a.The federal, state and local public health departemnts need to begin to track all toxins,
biological products and laboratory experiments using toxic chemicals, viruses and
pathogens. Laboratory scientists however need to be ever on the alert for corruption in
both the government and the alma mater of academia.
b. Toxic laboratory supplies and poisons must never leak out of the laboratory. Supplies
must be constantly monitored to detect any unwarranted use or disappearance. When
experiments are over, or there appears to be a leak, remaining poisons must be destroyed.
Government officials, law enforcement officers, or the institution of higher education,
should not be allowed to seize any toxic chemicals, viruses or pathogens. If the
government or academia chooses to frown on an experiment using toxins, terminate the
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experiment and document the destruction of the pathogens for the benefit of the
investigators.
c. It is in fact in detecting and destroying the poisons and toxins that bio-medical
researchers will make the most progress in finding cures for diseases. For medical
science to make progress against cancer and heart disease and other killers, like penicillin
after World War I, or the polio vaccine after WWII, academia, the scientific and military
communities must not only patent a forensic test for all pathogens and a cure for the
disease it causes, but must eliminate all disease pathogens from the planet.
Art. 4 Laboratory Security
§396 The Crime of Bioterrorism
A.Bio-terrorism can be defined as ―the use, or threatened use of biological agents to
promote or spread fear or intimidation upon an individual, a specific group, or the
population as a whole for religious, political, ideological, financial, or personal
purposes‖. The Executive Board of the World Health Organization urges Member States
to treat any deliberate use of biological and chemical agents or radionuclear material as a
threat to global public health and to share expertise, supplies and resources in order
rapidly to contain the event and mitigate its effects.
1.The master tactician Solon used the purgative herb hellebore [skunk cabbage] to poison
the water supply during his siege of Krissa in 600 BC. Armies in the ancient times,
tainted water supplies of entire cities with herbs and fungi that induced fatal diarrhoea
and hallucinations. According to the Bible a series of biological calamities were inflicted
on the Egyptians to convince an obstinate pharaoh to liberae the ancient Hebrews. An
assessment of the World Health Organization in 1970, concluded that a dissemination of
50 kg of Yersinia pestis over a city of five million might result in 150 000 cases of
pneumonic plague and 36 000 deaths. Another estimate showed that 100 Kg of anthrax
over a large city on a clear night could kill 1-3 million people.
2.During the French and Indian War, Sir Jeffrey Amherst suggested deliberate infection
with smallpox to reduce American Indian populations. On June 24, 1763, one of
Amherst's subordinates gave blankets and a handkerchief from the smallpox hospital to
the American Indians. An outbreak of smallpox spread throughout the tribes of
American Indians. During World War I, biological warfare programs developed covert
operations to infect livestock and livestock feed. During World War II, prisoners were
infected with pathogens and treated to study investigational vaccine and drugs.
Biological weapons research was also conducted on prisoners who were infected with
pathogens such as Bacillus anthracis and Yersinia pestis. Many prisoners died as a
result from the experimentation. Malicious attacks also included contamination of water
and food supplies with Bacillus anthracis, Salmonella, Shigella, and Yersinia pestis. In
the United States, an offensive biological program was developed in 1942, under the War
Reserve Service, a civilian agency. Experiments were conducted using biological
materials including Bacillus anthracis and Brucella suis. A program to develop
countermeasures, including antisera, vaccines, and therapeutic agents was established in
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1953 to protect troops against possible bioterror attacks. Under the presidency of Richard
Nixon, the United States biological weapons program was terminated in 1969. This
mandated the termination of biological research for offensive attacks and destruction of
the biological arsenal.
3. In the 20th century almost 420 terrorist attacks occurred in which 135 were of
biological nature. Most countries subscribe to international conventions banning
biological and chemical weapons however, incidents such as anthrax-tainted letters being
sent through the united states postal system in 2001 and the release of sarin (the sole
purpose of which is as a nerve gas) on the Tokyo subway in 1995 remind us that although
chemical and biological attacks are rare, there are individuals and groups who are ready
to use this brand of terrorism.
4. This Chapter dramatically expands the definition of the term biological agents to
include the unlisted and mysterious viruses, toxic substances and pathogens intended for
use, or used, in bio-medical research to make laboratory animals or humans sick. This
new definition incorporates all intentional malevolent distribution or transmission, of any
virus, toxin, pathogen or poison that causes disease and/or death in humans or animals.
5. By expanding this definition to include all intentional malevolent leaks of dangerous
pathogens from bio-medical research laboratories, the number of bio-terrorist attacks, one
time or continuing leaks of dangerous pathogens from individual laboratories, affecting
or ending the lives of from one to millions of people, numbers in the millions, over the
course of the 20th century. In the United States there are probably 10,000 academic,
corporate and government research laboratories malevolently leaking licensed biological
products into the general populace, at any given time, in flagrant violation of the
regulation of biological products under 42USC(6A)(2)(F)(1)§262.
6. To enhance control of dangerous biological agents and toxins under
42USC(6A)(2)(F)(1)§262a the Secretary must publish a list of these biological agents
and toxins that has the threat to pose a serious risk to society, and update this list
biannually. The Secretary shall thereby regulate the activities of public health service
laboratories and grantees as well as license and inspect all bio-medical research
laboratories using, possessing or stockpiling dangerous toxic substances and laboratory
supply companies distributing these toxins to laboratories and when a licensed biological
product is determined to present an imminent hazard shall recall such batch, lot or other
quantity up to all, from the market and ultimately from existence under
42USC(6A)(2)(F)(1)§262(d).
B. As the Public Health Service, the prohibition of biological weapons is the fundamental
duty of the Department of Health and Human Services. To make this clear the criteria for
the graduation of the haplessly named DHHS to the highest attainable degree of Public
Health Department (PHD) is contingent upon the creation of an Education Division (ED)
in the Agency for Toxic Substances and Disease Registry (ATSDR) to list and explain
toxic substances used in academic bio-medical research that can cause disease or death in
human and animals and to actively prohibit these substances in the Controlled Substances
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Act (CSA). The definition of biological weapons is set forth in 18USC(10)§178 as
follows:
1. the term ''biological agent'' means any microorganism (including, but not limited to,
bacteria, viruses, fungi, rickettsiae or protozoa), or infectious substance, or any naturally
occurring, bioengineered or synthesized component of any such microorganism or
infectious substance, capable of causing -
a. death, disease, or other biological malfunction in a human, an animal, a plant, or
another living organism;
b. deterioration of food, water, equipment, supplies, or material of any kind; or
c. deleterious alteration of the environment;
2. the term ''toxin'' means the toxic material or product of plants, animals,
microorganisms (including, but not limited to, bacteria, viruses, fungi, rickettsiae or
protozoa), or infebctious substances, or a recombinant or synthesized molecule, whatever
their origin and method of production, and includes -
a. any poisonous substance or biological product that may be engineered as a result of
biotechnology produced by a living organism; or
b. any poisonous isomer or biological product, homolog, or derivative of such a
substance;
3. the term ''delivery system'' means -
a. any apparatus, equipment, device, or means of delivery specifically designed to deliver
or disseminate a biological agent, toxin, or vector; or
b. any vector;
c. the term ''vector'' means a living organism, or molecule, including a recombinant or
synthesized molecule, capable of carrying a biological agent or toxin to a host;
3. Prohibitions with respect to biological weapons at 18USC(10)I§175, states;
a. In General. - Whoever knowingly develops, produces, stockpiles, transfers, acquires,
retains, or possesses any biological agent, toxin, or delivery system for use as a weapon,
or knowingly assists a foreign state or any organization to do so, or attempts, threatens, or
conspires to do the same, shall be fined under this title or imprisoned for life or any term
of years, or both. There is extraterritorial Federal jurisdiction over an offense under this
section committed by or against a national of the United States.
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b. Additional Offense. - Whoever knowingly possesses any biological agent, toxin, or
delivery system of a type or in a quantity that, under the circumstances, is not reasonably
justified by a prophylactic, protective, bona fide research, or other peaceful purpose, shall
be fined under this title, imprisoned not more than 10 years, or both. In this subsection,
the terms ''biological agent'' and ''toxin'' do not encompass any biological agent or toxin
that is in its naturally occurring environment, if the biological agent or toxin has not been
cultivated, collected, or otherwise extracted from its natural source.
c. Definition. - For purposes of this section, the term ''for use as a weapon'' includes the
development, production, transfer, acquisition, retention, or possession of any biological
agent, toxin, or delivery system for other than prophylactic, protective, bona fide
research, or other peaceful purposes.
C. To resolve a situation civilly 18USCI(10)176 provides for seizure, forfeiture, and
destruction of biological agents and directs the Attorney General to consider as not bona
fide any research that involves development, production, transfer, acquisition, retention,
or possession of any biological agent, toxin, or delivery system for other than
prophylactic, protective, bona fide research, or other peaceful purposes.
1.The judiciary and Attorney General must be very careful to destroy any toxic
substances they come into possession of. Ideally the scientists would document the
destruction of the substances for the benefit of investigators, so as not to endanger the
fairness of the trial. The scientific and technical goal is to patent devices that can detect
toxic laboratory supplies in clothing, food, environment and in the body. It is a serious
offense for the judiciary to possess, stockpile or deliver biological agents. It is a serious
offense to the judiciary to tolerate or abet any scientific, academic or Health Corporation
improperly engaged in the possession, stockpile and delivery toxic biological agents.
D. The BWC, Convention on the Prohibition of the Development, Production and
Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction
that was opened in 1972 and entered into force in 1975 recognizes that an agreement on
the prohibition of bacteriological (biological) and toxin weapons represents a first
possible step towards the achievement of agreement on effective measures also for the
prohibition of the development, production and stockpiling of chemical weapons, and
determined to continue negotiations to that end, determined for the sake of all mankind,
to exclude completely the possibility of bacteriological (biological) agents and toxins
being used as weapons, to mitigate the horrors of war.
E. The Convention on the Prohibition of the Development, Production, Stockpiling, and
Use of Chemical Weapons and on their Destruction CWC was opened in Paris in 1993
and entered into force in 1997 is more exhaustive and prohibits all development,
production, acquisition, stockpiling, transfer, and use of chemical weapons. It establishes
an Organization for the Prohbition of Chemical Weapons (OPCW) in the Hague. It
requires each State Party to destroy chemical weapons and chemical weapons production
facilities it possesses, as well as any chemical weapons it may have abandoned on the
territory of another State Party. The verification provisions of the CWC not only affect
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the military sector but also the civilian chemical industry, world-wide, through certain
restrictions and obligations regarding the production, processing and consumption of pre-
cursor chemicals. The Organization plans to expand the Prohibition to cover biological
agents of concern to the pharmaceutical and bio-medical community. The Convention
must insert the word ―disease‖ into their condemnation of devices and toxic substances
causing death or other harm or incapacity, and be integrated into the international system
of patent protection as the Search Office for toxins, viruses and pathogens, to really
reduce human suffering on the planet.
§338 Biosecurity and Biosafety
A.The key principles for securing biological agents, in research laboratories and
biomedical facilities, where loss, theft, release or intentional misuse of the agent, might
have significant public health or economic consequences, are found in the following
definitions. ‗
1.Biosafety: Development and implementation of administrative policies, work practices,
facility design, and safety equipment to prevent transmission of biologic agents to
workers, other persons, and the environment.
2. Biosecurity: Protection of high-consequence microbial agents and toxins, or critical
relevant information, against theft or diversion by those who intend to pursue intentional
misuse.
3. Biologic Terrorism: Use of biologic agents or toxins (e.g., pathogenic organisms that
affect humans, animals, or plants) for terrorist purposes.
Home
4. Bioterrorism Leads to the Need for Increased Biosecurity: Intentional or threatened use
of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in
humans, animals, or plants.
5. Responsible official: A facility official who has been designated the responsibility and
authority to ensure that the requirements of Title 42, CFR, Part 73, are met.
6. Risk: A measure of the potential loss of a specific biologic agent of concern, on the
basis of the probability of occurrence of an adversary event, effectiveness of protection,
and consequence of loss.
7. Select agent: Specifically regulated pathogens and toxins as defined in Title 42, CFR,
Part 73, including pathogens and toxins regulated by both DHHS and USDA (i.e.,
overlapping agents or toxins).
8. Threat: The capability of an adversary, coupled with intentions, to undertake
malevolent actions.
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9. Threat assessment: A judgment, based on available information, of the actual or
potential threat of malevolent action.
B. In recent years, concern has increased regarding use of biologic materials as agents of
terrorism, but these same agents are often necessary tools in clinical and research
microbiology laboratories. Traditional biosafety guidelines for laboratories have
emphasized use of optimal work practices, appropriate containment equipment, well-
designed facilities, and administrative controls to minimize risk of worker injury and to
ensure safeguards against laboratory contamination. Risk assessments should include
systematic, site-specific reviews of 1) physical security; 2) security of data and electronic
technology systems; 3) employee security; 4) access controls to laboratory and animal
areas; 5) procedures for agent inventory and accountability; 6) shipping/transfer and
receiving of select agents; 7) unintentional incident and injury policies; 8) emergency
response plans; and 9) policies that address breaches in security.
C. The Public Health Security and Bioterrorism Preparedness and Response Act of 2002
(Public Law 107-188; June 12, 2002) requires that the United States improve its ability to
prevent, prepare for, and respond to acts of bioterrorism and other public health
emergencies that could threaten either public health and safety or American Agriculture.
It necessitates that individuals possessing, using, or transferring agents or toxins deemed
a severe threat to public, animal or plant health, or to animal or plant products notify
either the Secretary of the Department of Health and Human Services (HHS) or the
Secretary of the Department of Agriculture (USDA). In accordance with the Act,
implementing regulations detailing the requirements for possession, use, and transfer for
select agents and toxins were published by HHS (42 CFR part 73) and by USDA (9 CFR
part 121 and 7 CFR part 331) .
1.The list of select toxins and agents is woefully inadequate to inform the vast majority of
afflicted people of the cause of their chronic health condition, despite public information
requirements for agency rules, opinion, orders, records and proceedings under
5USCI(5)II§552.
2. In determining whether to include an agent or toxin on the list of select agents and
toxins the Secretary and USDA shall consider.
a. the effect of exposure to the agent or toxin on animal or plant health, and on the
production and marketability of animal or plant products;
b. the pathogenicity of the agent or the toxicity of the toxin and the methods by which the
agent or toxin is transferred to animals or plants;
c. the availability and effectiveness of pharmacotherapies and prophylaxis to treat and
prevent any illness caused by the agent or toxin; and
d. any other criteria that the Secretary considers appropriate to protect animal or plant
health, or animal or plant products; and
e. consult with appropriate Federal departments and agencies and with scientific experts
to effectively represent appropriate academic and professional groups.
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3. A database is being developed to prevent unauthorized access to listed agents and
toxins that will register possession and transfer of listed agents and toxins. The database
shall not disclose the identity of a specific registered person or discloses the identity or
location of a specific registered person.
4. Registration of an entity requires that an ―Application for Laboratory Registration for
Possession, Use, and Transfer of Select Agents and Toxins‖ (APHIS/CDC Form 1)
should be completed and submitted to either HHS Centers for Disease Control (CDC) or
to USDA Animal Plant Health Inspection Service (APHIS). Registration also requires
that the U.S. Department of Justice (DOJ) complete a security risk assessment (SRA) for
the facility, its owners, and the designated responsible official. Before registration is
granted, the facility must also meet biosafety requirements that are commensurate with
the risk that the select agent or toxin poses and must establish security measures that
provide graded protection in accordance with the threat that the agent or toxin poses. An
entity that needs to register in order to possess, use, or transfer a select agent or toxin
must submit its registration information to either APHIS or CDC, but is not required to
submit the application to both APHIS and CDC.
5. The Secretary shall by regulation provide for the establishment and enforcement of
safety procedures for the transfer of listed agents and toxins, including measures to
ensure:
a. proper training and appropriate skills to handle such agents and toxins; and
b. proper laboratory facilities to contain and dispose of such agents and toxins;
c. the establishment and enforcement of safeguard and security measures to prevent
access to such agents and toxins for use in domestic or international terrorism or for any
other criminal purpose;
d. the establishment of procedures to protect animal and plant health, and animal and
plant products, in the event of a transfer or potential transfer of such an agent or toxin in
violation of the safety procedures established under paragraph
e. appropriate availability of biological agents and toxins for research, education, and
other legitimate purposes.
f. the recall and removal from the market and existence of certain pathogens that pose a
serious risk to human health and safety.
6. The registered person will be briefed on bio-security enhancements for their facility
that may include, but shall not be limited to the following:
a. the purchase and installation of equipment for detection of intruders;
b. the purchase and installation of fencing, gating, lighting, or security cameras;
c. the tamper-proofing of manhole covers, fire hydrants, and valve boxes;
d. the rekeying of doors and locks;
e. improvements to electronic, computer, or other automated systems and remote security
systems;
f. participation in training programs, and the purchase of training manuals and guidance
materials, relating to security against terrorist attacks;
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g. improvements in the use, storage, or handling of various chemicals; and
h. security screening of employees or contractor support services.
7. In the event a listed agent or toxin leaks outside of the biocontainment area of a facility
the registered person will notify the Secretary of Health and Human Services. If the
Secretary finds that the release poses a threat to public health or safety, the Secretary,
shall take appropriate action to notify relevant State and local public health, other
relevant Federal authorities and, if necessary, the public.
D. For their part laboratories, hazardous material disposal agencies, institutions
associated with laboratories or vulnerable to conflicts of interests thereto, eg. Health
corporations, institutions of higher education, the judiciary, the general public and most
importantly people with chronic health conditions must implement biosafety in their
social, administrative and health policy. Corruption in regards to bio-hazardous, toxic
and pathogenic materials is a constant danger. Bio-hazardous materials must be properly
disposed of. Laboratories and institutions must not leak of their own accord and must be
sure that the agencies and corporations they contract with to dispose of their toxic
laboratory supplies are actually destroying the substance and not putting their toxic waste
it into circulation contaminating the public. Individuals must identify associates who are
delivering the pathogens that are making them sick, terminate corrupt relationships, make
sure associates are able to communicate honestly on this critical issue, throw away
contaminated clothing, bedding, beds and food and take the necessary security
precautions against the malevolent delivery of pathogens in the future, eg. securely
locking office and/or bedroom door, private refrigerator, all new clothes and bed. If
surveillance and breaking and entering defeats security measures take on a new identity,
sever all ties, move to new location and keep on moving until a safe situation is found.
§339 Nuremburg Code
A. The 20th century system of social control by secret and unethical biological
experiments is best explained in and regulated by the Nuremburg Code as reprinted from
Trials of War Criminals before the Nuremberg Military Tribunals under Control Council
Law No. 10, Vol. 2, pp. 181-182.. Washington, D.C.: U.S. Government Printing Office,
1949. It provides:
1.The voluntary consent of the human subject is absolutely essential. This means that the
person involved should have legal capacity to give consent; should be so situated as to be
able to exercise free power of choice, without the intervention of any element of force,
fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and
should have sufficient knowledge and comprehension of the elements of the subject
matter involved as to enable him to make an understanding and enlightened decision.
This latter element requires that before the acceptance of an affirmative decision by the
experimental subject there should be made known to him the nature, duration, and
purpose of the experiment; the method and means by which it is to be conducted; all
inconveniences and hazards reasonable to be expected; and the effects upon his health or
person which may possibly come from his participation in the experiment.
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2. The duty and responsibility for ascertaining the quality of the consent rests upon each
individual who initiates, directs or engages in the experiment. It is a personal duty and
responsibility which may not be delegated to another with impunity.
3.The experiment should be such as to yield fruitful results for the good of society,
unprocurable by other methods or means of study, and not random and unnecessary in
nature.
4.The experiment should be so designed and based on the results of animal
experimentation and a knowledge of the natural history of the disease or other problem
under study that the anticipated results will justify the performance of the experiment.
5. The experiment should be so conducted as to avoid all unnecessary physical and
mental suffering and injury.
6.No experiment should be conducted where there is an a priori reason to believe that
death or disabling injury will occur; except, perhaps, in those experiments where the
experimental physicians also serve as subjects.
7.The degree of risk to be taken should never exceed that determined by the humanitarian
importance of the problem to be solved by the experiment.
8.Proper preparations should be made and adequate facilities provided to protect the
experimental subject against even remote possibilities of injury, disability, or death.
9.The experiment should be conducted only by scientifically qualified persons. The
highest degree of skill and care should be required through all stages of the experiment of
those who conduct or engage in the experiment.
10.During the course of the experiment the human subject should be at liberty to bring
the experiment to an end if he has reached the physical or mental state where
continuation of the experiment seems to him to be impossible.
11.During the course of the experiment the scientist in charge must be prepared to
terminate the experiment at any stage, if he has probable cause to believe, in the exercise
of the good faith, superior skill and careful judgment required of him that a continuation
of the experiment is likely to result in injury, disability, or death to the experimental
subject.
B. The Doctors' Trial (officially United States of America v. Karl Brandt, et al.) was the
first of 12 trials for war crimes that the United States authorities held in their occupation
zone in Nuremberg, Germany after the end of World War II. These trials were held
before U.S. military courts, not before the International Military Tribunal, but took place
in the same rooms at the Palace of Justice. The trials are collectively known as the
"Subsequent Nuremberg Trials", formally the "Trials of War Criminals before the
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Nuremberg Military Tribunals" (NMT). 20 of the 23 defendants were medical doctors
(Brack, Rudolf Brandt, and Sievers being Nazi officials) and all were accused of having
been involved in Nazi human experimentation. Josef Mengele, one of the leading Nazi
doctors, had evaded capture.
1. The primary chages against the accused were war crimes: performing medical
experiments, without the subjects' consent, on prisoners of war and civilians of occupied
countries, in the course of which experiments the defendants committed murders,
brutalities, cruelties, tortures, atrocities, and other inhuman acts. Also planning and
performing the mass murder of prisoners of war and civilians of occupied countries,
stigmatized as aged, insane, incurably ill, deformed, and so on, by gas, lethal injections,
and diverse other means in nursing homes, hospitals, and asylums during the Euthanasia
Program and participating in the mass murder of concentration camp inmates.
2. 7 were sentenced to death, 6 were acquitted, 5 were sentenced to life in prison and
released early after 15-20, 4 were sentenced to 15 to 20 years and released after 10.
§340 Institutional Ethics Committee
A.The Office for Human Research Protection (OHRP) provides leadership in the
protection of the rights, welfare, and wellbeing of subjects involved in research
conducted or supported by the U.S. Department of Health and Human Services (HHS).
OHRP helps ensure this by providing clarification and guidance, developing educational
programs and materials, maintaining regulatory oversight, and providing advice on
ethical and regulatory issues in biomedical and behavioral research.
1.The annual National Science Foundation report on Research and Development
Expenditures in Universities 2007 reports that overall, universities and colleges reported
S&E R&D expenditures of $49.4 billion in FY 2007, 3.5% more than in the previous year
($47.7 billion). When adjusted for inflation, academic R&D rose by 0.8% in FY 2007.
The federal government is the largest source of academic R&D funding, accounting for
more than 60% of total R&D expenditures, more than half of that from the National
Institutes of Health (NIH). As an indicator of how much R&D within medical schools
contributes to the total R&D reported, only 2 institutions within the top 20, do not have a
medical school within their institution. Return on the investment is marginal, and a
survey of 68 research universities revealed that for every increase of $1 million in federal
research funding (1996$) to a university results in 10 more articles and 0.2 more patents.
As a first approximation, increasing federal research funding on the margin results in
more, but not necessarily higher quality, research output.
2. Biomedical research in the life sciences is a major problem for academia and society in
general. The poisons and toxins leaked from these laboratories, with and without official
government cover, are the probable cause for the vast majority of the modern burden of
illness and death, and the way ingnorant dictators maintain their dominance in academica
and government. Institutional ethics committees need to eliminate these risks to society
and scholarly research and prohibit corrupt finance, conflicts of interests and toxic agents.
Funding for bio-medical research, in general, probably needs to be dramatically reduced,
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in favor of relatively low cost epidemiologic research. In all cases of bio-medical
research, an independent epimiologic study must be commissioned to publicize
information and risks posed by the toxicology and its theoretical statistical impact on
public health. E.g. any proposed research into plaques causing alzheimers disease cannot
be approved without an independent epidemiologic study of the international, national,
state, county and local incidence of the disease, the risk posed by authorizing laboratory
pathogens, or conducting official research into the field, why the therapeutic benefits of
the study outweigh the risk, ie. looking for a drug to dissolve plaques or a test to detect
the presence of laboratory toxins in the environment, and if the study is approved,
regularly and confidentially monitor the incidences of the disease in the local community,
and in the families and associates of laboratory staff, to ensure there is no malevalent use
of the toxic agent.
3.This Act requires that all bio-medical research using living subjects, whether they be
human or animal, be subjected to regulation controlling any toxic chemicals, substances
or viruses, they may possess and ensuring adequate informed consent and protection of
human subjects against harm and epidemiologic safeguards are in place to monitor the
affects on the community of any secret leaking of the research. As the result of the high
risk of bio-terrorism posed by bio-medical research, the ethical review of bio-medical
research shall be separate from the ethical review of all other forms of research, however
other ethical review panels can cross examine and condemn bio-medical research projects
they feel pose a threat, or continuing threat to society, health and welfare.
Fig. 9-6: "Take a Bite Out of Poison" $49.4
billion Higher Education R&D Expenditure
by Field, FY 2007, in Millions of Dollars
2,577
8,088
Science
8,934
Life Sciences
Engineering
28,802 Liberal Arts
Source: National Science Foundation. R&D Expenditures at Colleges and Universities
2007
B.Under the National Research Act of July 12, 1974. Title II, Public Law 93-348 the
Protection of Human Research Subjects in all research using human subjects, conducted,
supported or regulated by the federal government must uphold 45 CFR 46. Although
most educational and administrative agency research remains exempt from the
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regulations, bio-medical research is not isolated for special protection, as should have
been done, with greater focus upon the control of toxic substances, the primary function
of this law is to mandate all federally funded and regulated research be reviewed by
Institutional Review Boards (IRB) or Institutional Ethics Committees (IEC). Under the
National Research Act;
a. Research means a systematic investigation, including research development, testing
and evaluation, designed to develop or contribute to generalizable knowledge.
b. Research subject to regulation, and similar terms are intended to encompass those
research activities for which a federal department or agency has specific responsibility for
regulating as a research activity, (for example, Investigational New Drug requirements
administered by the Food and Drug Administration). It does not include research
activities which are incidentally regulated by a federal department or agency solely as
part of the department's or agency's broader responsibility to regulate certain types of
activities whether research or non-research in nature (for example, Wage and Hour
requirements administered by the Department of Labor).
c.Human Subject means a living individual about whom an investigator (professional or
student) conducting research obtains (1) date through intervention or interaction with the
individual and (2) identifiable private information.
d. IRB approval means the determination of the IRB that the research has been reviewed
and may be conducted at an institution within the constraints set forth by the IRB and by
other institutional and federal requirements.
2. In order to approve research covered by this policy the IRB shall determine (1) Risks
to subjects are minimized: (i) By using procedures which are consistent with sound
research design and which do not unnecessarily expose subjects to risk, and (ii) whenever
appropriate, by using procedures already being performed on the subjects for diagnostic
or treatment purposes. In evaluating risks and benefits, the IRB should consider only
those risks and benefits that may result from the research (as distinguished from risks and
benefits of therapies subjects would receive even if not participating in the research).
Selection of subjects must equitable. In making this assessment the IRB should take into
account the purposes of the research and the setting in which the research will be
conducted and should be particularly cognizant of the special problems of research
involving vulnerable populations, such as children, prisoners, pregnant women, mentally
disabled persons, or economically or educationally disadvantaged persons.Informed
consent will be sought from each prospective subject or the subject's legally authorized
representative, in accordance with, and to the extent required by §46.116. Informed
consent will be appropriately documented, in accordance with, and to the extent required
by §46.117. When appropriate, the research plan makes adequate provision for
monitoring the data collected to ensure the safety and privacy of subjects and to maintain
the confidentiality of data.
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3. Research covered by this policy that has been approved by an IRB may be subject to
further appropriate review and approval or disapproval by officials of the institution.
However, those officials may not approve the research if it has not been approved by an
IRB. An IRB shall have authority to suspend or terminate approval of research that is not
being conducted in accordance with the IRB's requirements or that has been associated
with unexpected serious harm to subjects. Any suspension or termination of approval
shall include a statement of the reasons for the IRB's action and shall be reported
promptly to the investigator, appropriate institutional officials, and the department or
agency head.
4. Basic elements of informed consent shall be provided to each subject:
(a) A statement that the study involves research, an explanation of the purposes of the
research and the expected duration of the subject's participation, a description of the
procedures to be followed, and identification of any procedures which are experimental;
(b) A description of any reasonably foreseeable risks or discomforts to the subject;
(c) A description of any benefits to the subject or to others which may reasonably be
expected from the research;
(d) A disclosure of appropriate alternative procedures or courses of treatment, if any, that
might be advantageous to the subject;
(e) A statement describing the extent, if any, to which confidentiality of records
identifying the subject will be maintained;
(f) For research involving more than minimal risk, an explanation as to whether any
compensation and an explanation as to whether any medical treatments are available if
injury occurs and, if so, what they consist of, or where further information may be
obtained;
(g) An explanation of whom to contact for answers to pertinent questions about the
research and research subjects' rights, and whom to contact in the event of a research-
related injury to the subject; and
(h) A statement that participation is voluntary, refusal to participate will involve no
penalty or loss of benefits to which the subject is otherwise entitled, and the subject may
discontinue participation at any time without penalty or loss of benefits to which the
subject is otherwise entitled.
5. Besides not isolating the regulation of bio-medical research the name IRB is offensive
to the Controlled Substances Act that mistakenly lists marijuana as a Schedule I most
dangerous substance. The explanation for this gross criminal negligence can be found at
45CFR46.111(a)(2) that orders, ―the IRB should not consider possible long-range effects
of applying knowledge gained in the research (for example, the possible effects of the
research on public policy) as among those research risks that fall within the purview of its
responsibility‖. Although it enforces informed consent, the National Research Act is so
offensive that it should undergo massive repeal.
6. Bio-medical research and health policy must be subjected to serious consideration as to
whether or not the political risk of the torture they are studying constitutes or might
constitute the crime of genocide when politicized, as defined in the Convention on the
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Prevention and Punishment of the Crime of Genocide and Art. 6 of the International
Covenant on Civil and Political Rights.
a. The misnomer IRB, ostensibly does incite genocide because it derogates the Controlled
Substances Act under which harmless marijuana consumers and dealers are slaved but
totally fails to control the handlers of toxic animal laboratory supplies, whose names are
censured from peer reviewed literature and when unleashed upon society by unethical
political parties, corporations and academic institutions.
b. Animal laboratory research has particularly disturbing long term consequences the
American Journal of Physiology Guiding Principles in the Care and Use of Animals does
little to correct. The problem with animal laboratory research is that animals are
subjected to experiments whose whole purpose is often to cause illness or death. The
long term consequences of this are that there are suppliers of illicit toxic substances that
cause disease of concern to human. The policy and political ramification of animal
laboratory research is that ―quasi-political party animals‖ routinely weaponize the secret
toxins and commit genocide in their families and communities and animal laboratory
experiments in torture are therefore high risk experiments.
C. The World Medical Association Helsinki Declaration of June 1964, that was amended
for an eighth time on October 2008, provides, ―It is the mission of the physician to
safeguard the health of the people…The purpose of biomedical research involving human
subjects must be to improve diagnostic, therapeutic and prophylactic procedures, and the
understanding of the aetiology and pathogenesis of disease. In current medical practice,
most diagnostic, therapeutic or prophylactic procedures involve hazards. This applies
especially to biomedical research‖. According to the American Medical Association
explains, fails to differentiate between good and bad research, in the Ethical
Considerations in International Research adopted by the AMA June 2001.
D. The Council for International Organizations of Medical Sciences (CIOMS) in
collaboration with the World Health Organization International Ethical Guidelines for
Biomedical research Involving Human Subjects of 1993 drew up comprehensive ethical
guidelines in response to the need to produce drugs to treat the AIDS epidemic and
swiftly produced the first anti-retroviral drugs. Its general principles are that all research
involving human subjects should be conducted in accordance with three basic ethical
principles, namely respect for persons, beneficence and justice. Human test subjects
should be compensated, especially if they are harmed.
§341 Pathogen Patent Protection
A.The patent system is hypothetically the most scientific method to control toxic
substances, like Influenza A-C subtypes, HIV and the secret pathogens and carcinogens
used to cause heart disease and cancer, that promises to eliminate human error while
communicating the non-communicable results of bio-chemical-medical research to
forensic science before the pathogens are officially removed from circulation. In general,
every patent shall contain a short title of the invention and a grant to the patentee of the
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right to exclude others from making, using, offering for sale, or selling the
invention,,,and, if the invention is a process, of the right to exclude others from using,
offering for sale or selling… importing…or exporting…products made by that process,
referring to the specification for the particulars thereof the Content and Term of Patent,
Provisional Right under 35USCII(14)§154(a)(1). In regards to the patent of toxic
substances it is in the public interest that the patentee themself be excluded from use of
the invention, without proper authorization by the appropriate government agency.
1. There is no law in either the US Code nor the Patent Co-operation Treaty referring
directly to the control of toxic chemical substances. In Apotex Inc. v. Sanofi‑Synthelabo
Canada Inc., 2008 SCC 61 on November 6, 2008, the Canadian Supreme Court held that,
"In the field of chemical patents, originating or genus patents are based on the discovery
of a new invention, namely, a reaction or compound, while selection patents are for
compounds chosen from the compounds described in the originating patent. Selection
patents do not differ in nature from any other patent, but in order to be valid, the selected
compound must be novel and possess a substantial advantage to be secured or
disadvantage to be avoided". It is in particular the disadvantages of toxic substances,
viruses and genes that is in the public interest to protect society against by totally
eliminating, prohibiting, the entire existence of such malevolent substances, noxious and
deadly to human and animal life. Securing the enforcement of such controlled substances
patents is however both a story of betrayal and failure and one of progressive
development of a scientific inspection regime against the myths of the medical
establishment.
2. The 21st century, not much different than the Hague Conventions prohibiting the use of
biological and chemical weapons in war, at the dawn of the 20th century, is definitely a
time when human progress and development require the prohibition of toxic chemical
agents that cause disease. While vaccine and pharmaceutical drugs have helped to
eliminate many diseases the time has come when society must come to grips with the
toxic byproducts of medical research and eliminate the toxin weapons used in the
settlement of disputes by subversives. The difference between this movement to patent
toxic substances now and in the beginning of the 20th century is that instead of military
law the prohibition of toxic substances shall be done under medical law. It is hoped, that
much like the Geneva Conventions helped to greatly reduce the number of casualties of
war in the latter half of the 20th century, toxic substance patent laws shall greatly reduce
incidences of disease and death around the world.
B. Both US Trademark and Patent Office and Patent Co-operation Treaty (PCT) need to
incorporate a special classification for toxic chemical substances that cause disease into
their system of patent classification in order to control and eliminate these disease
vectors. The irony is that the Strasbourg Agreement Concerning International Patent
Classification of March 24, 1971 was ratified in the same town where the Strasbourg
Agreement of 1675 between France and the Holy Roman Empire was the first treaty to
ban the use of chemical weapons. The Strasbourg Agreement of 1971, and the Patent
Cooperation Treaty for that matter, totally omits mention of the special category of toxic
substances.
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1. WHO drafted a Working Paper on Patent Issues related to Influenza Viruses and their
Genes and Annex on November 17, 2007, revealing that in their attempts to patent
Influenza HA and NA genes and gene products that specifically claim or may encompass
H5N1 sequences they were forced to choose from 6 patent families, vectors or cells
containing influenza genes and vaccines containing influenza products 18 patent families
and siRNA and antisense directed to H5N1, also oligonucelotides having H5N1 sequence
12 patent families. These families of medically useful knowledge and control of toxic
substances are located in neither Section A(61) Human Necessities: Medical or
Veterinary Science; Hygiene nor Section C(07-08) Chemistry; Metallurgy: Organic
Compounds. The Strasbourg Agreements to do not agree.
2. The PCT must adopt a special classification for toxic substances used or prepared in
laboratories, including toxins, viruses, genes that cause disease in humans and animals. It
is okay to list these substances as Section A Human Necessities whereas their eradication
is, but they should be comprehensively listed so that toxicology agencies such as the
Office for the Prohibition of Chemical Weapons could cooperate.
3. The PCT was not the only law to so boldly fail to prohibit toxic substances in the early
1970s. The UN Single Convention on Narcotic Drugs of 1961 as amended by the 1972
Protocol led to the even more hypocritical US Controlled Substances Act (CSA) of 1971
that declares at 21USC(13)§801, ―The illegal importation, manufacture, distribution, and
possession and improper use of controlled substances have a substantial and detrimental
effect on the health and general welfare of the American people‖ but in formulating the
schedules at 21USC(13)§812 made the mistake of using the word drug as if it were the
definition of controlled substance when in fact it is the malevolent illegal torturous and
homicidal distribution of toxic laboratory supplies which is really in need of the same sort
of ―control‖ as weapons of mass destruction. To completely destroy the scientific validity
of Schedules of both the Single Convention and Controlled Substances Act Marijuana is
listed in Schedule I drug in both lists as if there is a lack of accepted safety for use of the
drug or other substance under medical supervision, although by all reports it is safer than
alcohol.
4. Both the Strasbourg Agreement for International Patent Cooperation and Controlled
Substances Act of 1971 mocked the prohibition of biological and chemical weapons and
served to confuse law enforcement by heightening scientific scrutiny of everything but
the trade secrets of mad science - disease, mass murder and genocide - we actually wish
to limit.
B. Make no mistake, the law clearly prohibits the development, production, acquisition,
possession, or use of biological and chemical weapons as a crime.
1.Whoever knowingly possesses any biological agent, toxin, or delivery system of a type
or in a quantity that, under the circumstances, is not reasonably justified by a
prophylactic, protective, bona fide research, or other peaceful purpose, shall be fined,
imprisoned not more than 10 years, or both. Whoever knowingly develops, produces,
stockpiles, transfers, acquires, retains, or possesses any biological agent, toxin, or
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delivery system for use as a weapon, or knowingly assists a foreign state or any
organization to do so, or attempts, threatens, or conspires to do the same, shall be fined or
imprisoned for life or any term of years, or both under 18USC(10)§175
2. Under 18USC Chapter 11B, just after Child Support (11A), §229 it shall be unlawful
for any person knowingly— to develop, produce, otherwise acquire, transfer directly or
indirectly, receive, stockpile, retain, own, possess, or use, or threaten to use, any chemical
weapon; or to assist or induce, or conspire, in any way, with any person to commit such
violation…Shall be fined under this title, or imprisoned for any term of years, or both and
by whose action the death of another person is the result shall be punished by death or
imprisoned for life and/or the Attorney General may impose a civil fine of $100,000
under 18USC(11B)§229A
C. It is a crime of conspiracy against health that these scientific laboratory supplies and
experimental chemicals and bio-toxins cannot be controlled by the international scientific
community under the PCT and CWC and are immediately referred to the criminal justice
system. For their part law enforcement officers, judicial officers and politicians de-liver,
there is simply too much community wealth and power to oppose the toxic chemical
conspiracy of corruption, disability and death without agreement between the science and
the law regarding what is a controlled substance. Because these toxic chemicals and
viruses are not properly identified, detected and controlled tens of millions of people
needlessly die every year and billions suffer, while the scientists who kill and torture
them get rich and are awarded prizes for their fabulous advances in medical research and
their institutions of higher education take in millions of dollars of grant funding.
1.As the International Military Tribunal said in 1946, ―crimes against international law
are committed by men, not by abstract entities, and only by punishing individuals who
commit such crimes can the provisions of international law be enforced‖. The Rome
Statute of the International Criminal Court likewise establishes jurisdiction over the
―most serious crimes of concern to the international community as a whole‖ (preamble),
but limits this jurisdiction to ―natural persons‖ (art. 25, para. 1). The same article
specifies that no provision of the Statute ―relating to individual criminal responsibility
shall affect the responsibility of States under international law‖ (para. 4). Orders and
prescriptions of law to commit genocide or crimes against humanity are manifestly
unlawful (art. 33). The manufacture and delivery of toxic substances is patently
genocide, (a) Killing members of the group; (b) Causing serious bodily or mental harm to
members of the group; (c) Deliberately inflicting on the group conditions of life
calculated to bring about its physical destruction in whole or in part; (d) Imposing
measures intended to prevent births within the group; (e) Forcibly transferring children of
the group to another group. A war crime of Torture or inhuman treatment, including
biological experiments and employing poison and poison weapons (art. 8 (2)(a)(ii) &
(b)(xvii)).
2.A good proposal for a civil settlement is demonstrated in the Order of 30 May 2008,
whereby the International Court of Justice allowed Ecuador to requests the Court ―to
adjudge and declare that: (a) Colombia has violated its obligations under international
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law by causing or allowing the deposit on the territory of Ecuador of toxic herbicides that
have caused damage to human health, property and the environment; (b) Colombia shall
indemnify Ecuador for any loss or damage caused by its internationally unlawful acts,
namely the use of herbicides, including by aerial dispersion, and in particular: (i) death or
injury to the health of any person or persons arising from the use of such herbicides; and
(ii) any loss of or damage to the property or livelihood or human rights of such persons;
and (iii) environmental damage or the depletion of natural resources; and (iv) the costs of
monitoring to identify and assess future risks to public health, human rights and the
environment resulting from Colombia‘s use of herbicides; and (v) any other loss or
damage; and(c) Colombia shall: (i) respect the sovereignty and territorial integrity of
Ecuador; and (ii) forthwith, take all steps necessary to prevent, on any part of its territory,
the use of any toxic herbicides in such a way that they could be deposited onto the
territory of Ecuador; and (iii) prohibit the use, by means of aerial dispersion, of such
herbicides in Ecuador, or on or near any part of its border with Ecuador.‖
D. To properly legislate patent protection for disease pathogens these pathogen patents
would be isolated and treated differently from all other patents. The discoverer would be
protected and rewarded as a witness to, rather than owner of, the intellectual property.
There would be a special application for for pathogen patents. The discoverer would have
to select the Search Office they wish to use from a list supplied by the Patent Office.
1.For international patents under the Patent Co-operation Treaty the search office would
be exclusively the Office for the Prohibition of Chemical Weapons who has declared an
interest in expanding their schedule to prohibit disease pathogens used in bio-medical and
pharmaceutical research.
2. For national patent applications filed with the US Patent and Trademark Office
(USPTO) the application will be forwarded to either the US Chemical Weapons
Convention Implementation Assistance Program (CWCIAP) for hazardous industrial
chemicals or the US Agency for Toxic Substance and Disease Registry (ATSDR) for bio-
hazardous medical research.
Art. 4 Epidemics
§342 Epidemiology
A.Epidemiology is the study of factors affecting the health and illness of populations, and
serves as the foundation, logic and control of interventions made in the interest of public
health and preventive medicine. Epidemiology is considered a cornerstone methodology
of public health research. In the study of communicable and non-communicable diseases,
the work of epidemiologists ranges from outbreak investigation to study design, data
collection and analysis including the development of statistical models to test hypotheses
and the documentation of results for submission to peer-reviewed journals. In the first
half of the 20th century, mostly with the help of penicillin, medical science achieved great
success against infectious diseases, but non-infectious diseases remain unchecked.
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Infectious organisms belong to a wide range of classes and vary in size from the 2-nm
poliovirus to 10-m tapeworms. Chemical pollutants and radioactivity also cause disease.
1. New thinking, free of academic, corporate and government conflict of interest, is
needed to topple the oligarchy of bio-medical science and higher education to begin to
control and eliminate the viruses and pathogens that cause such deadly diseases as
influenza, HIV/AIDS, heart disease and cancer as well as a host of disabling and painful
conditions. Epidemiologists need to begin to recognize, monitor and terminate corrupt
bio-medical research and health care practices. Health is much like law and democracy
whose fundamental principle is the negative power of ―freedom‖. The ―do no harm‖
doctrine must be understood so that bio-medical researchers and associations respect
themselves as ―infectious biological agents‖ so as to limit new ―interventions‖ into
society and instead study old interventions in pusuit of terminating the harmful biological
invasions that give rise to epidemics of disease and domestic violence.
2. As a public health discipline, epidemiologic evidence is often used to advocate both
personal measures like diet change and corporate measures like removal of junk food
advertising, termination of dangerous biological experiments and laboratory leaks, with
study findings disseminated to the general public in order to help people to make
informed decisions about their health. Population-based health management
encompasses the ability to; a. Assess the health states and health needs of a target
population; b. Implement and evaluate interventions that are designed to improve the
health of that population; c. efficiently and effectively provide care for members of that
population and d. discipline the medical and scientific community to minimize the public
health risk posed by pathogens and misconduct.
3. The general trend over the 20th century was one of great success against infectious
diseases, thanks to new products such penicillin that greatly reduced mortality from
diarheal diseases such as cholera and dysentery as well as infection and the polio vaccine
erradicted polio. Life expectancy has therefore increased from 50 to nearly 80 years
industrialized nations. Death from non-infectious diseases such as cancer and heart
disease, have however remained the same or increased in frequency, so that what killed
16% of the population in 1900 now kills 66%. The intervention of HIV/AIDS into the
world scene caused an increase in mortalities due to infectious diseases that went down
after anti-retroviral treatment was developed. To begin to make progress against these
diseases we must not only rely on effective treatment but must eliminate the
environmental, scientific and social causes of disease so no one gets sick in the first
place. Bio-medical science must reveal the names of the pathogens they use to cause
heart disease and cancer in lab rats, so they may be controlled and eliminated Influenza
and other respiratory ailments must stop senselessly developing vaccines and eliminate
stockpiles of viruses and germs.
4. Infectious disease mortality declined during the first 8 decades of the 20th century from
797 deaths per 100 000 in 1900 to 36 deaths per 100 000 in 1980. From 1981 to 1995, the
mortality rate increased to a peak of 63 deaths per 100 000 in 1995 and declined to 59
deaths per 100 000 in 1996. The decline was interrupted only by a sharp spike in
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mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was
particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza
were responsible for the largest number of infectious disease deaths throughout the
century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in
the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease
mortality increased in the 1980s and early 1990s in persons aged 25 years and older and
was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in
25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza
deaths among persons aged 65 years and older.
Source: National Intelligence Estimate. The Global Infectious Disease Threat and Its
Implications for the United States. NIE-99-17D January 2000
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B. The historical development of the study of epidemiology is mostly attributed to the
Greek physician Hippocrates is sometimes said to be the father of epidemiology. He is
the first person known to have examined the relationships between the occurrence of
disease and environmental influences. He coined the terms endemic (for diseases usually
found in some places but not in others) and epidemic (for disease that are seen at some
times but not others. One of the earliest theories on the origin of disease was that it was
primarily the fault of human luxury. This was expressed by philosophers such as
Rousseau who pointed out that although one could rant and rave about quackery societies
with developed medical systems tended to live longer and be healthier.
1. In the medieval Islamic world, physicians discovered the contagious nature of
infectious disease. In particular, the Persian physician Avicenna, considered a "father of
modern medicine," in The Canon of Medicine (1020s), discovered the contagious nature
of tuberculosis and sexually transmitted disease, and the distribution of disease through
water and soil. He introduced the method of quarantine as a means of limiting the spread
of contagious disease. He also used the method of risk factor analysis, and proposed the
idea of a syndrome in the diagnosis of specific diseases.
2. In the middle of the 16th century, a famous Italian doctor from Verona named
Girolamo Fracastoro was the first to propose a theory that these very small, unseeable,
particles that cause disease were alive. They were considered to be able to spread by air,
multiply by themselves and to be destroyable by fire. Germ theory was a concept that
took many years to congeal. The whole idea of little germs that were too small to see
causing disease was hard for people to swallow.
3. Germ theory was actually born in the 1670‘s when the Dutch researcher Antoni van
Leeuwenhoek built a simple microscope and discovered a whole world of
microorganisms, in addition to red blood cells and spermatozoa. He observed germs from
canal water, from ginger, from the dirt between his toes -- from almost everywhere he
looked. Yet, his discovery was disregarded until the 1830‘s when other scientists finally
began to catch on that the microscope was a legitimate tool.
4. In 1707, a French scientist demonstrated that microorganisms did not develop in a
water/manure mixture that had been boiled and then sealed. There were versions of this
experiment repeated for over 150 years, and by the 1830‘s, the principles of antiseptic
surgery should have been in place. Resistance to germ theory however marched on. In
1846, a young Austrian-Hungarian doctor named Igaz Semmelweis investigated a
notorious maternity ward in which nearly all of the inpatients contracted a fatal case of
―childbed fever‖. What he noticed was that women who came into the ward after giving
birth were not likely to become ill. When a professor cut his finger in the middle of an
autopsy in that same hospital died of identical symptoms, Semmelweis began making his
students disinfect their hands before delivering babies, and the number of childbed fever
cases dropped. Of course, no good deed goes unpunished. Semmelweis was labeled
―insane‖ by his colleagues for having the audacity to suggest that they should wash their
hands between deliveries, and they fired him. He tried to continue his research but was
ostracized by the medical community. His own mental health eventually deteriorated,
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leading to his death in an insane asylum. In 1860 a famed doctor was scheduled to speak
at a conference to thoroughly denounce Semmelweis‘s ideas. Before the speech began, he
was interrupted by a man who proceeded to tell the audience that he had discovered the
bacterium responsible for childbed fever. That man was Louis Pasteur, and the rest is
history. Lack of proper hand washing continues to be the primary reason why MRSA and
other superbugs are spread in hospitals today.
5. In 1865, a Glasgow surgeon named Joseph Lister used antiseptic for the first time in
surgery. The results were dramatic: his post-amputation death rate fell from 45 to 15
percent. For the first time, there were surgical procedures from which patients had a
moderate chance of recovery. Germ theory took a few more steps forward in 1872 when a
growth of penicillium glaucum killed off bacteria in one of Lister‘s liquid cultures. In
1884, he treated a patient with penicillium and cured him of an infected wound.
However, Lister ―lacked the energy or the resources to promote penicillium, partly
because he was still struggling to win acceptance of antiseptic surgery‖. Penicillin was
not introduced until 1941.
C. To date, few universities offer epidemiology as a course of study at the undergraduate
level. Many epidemiologists are physicians, or hold other postgraduate degrees including
a Master of Public Health (MPH), Master of Science or Epidemiology (MSc.). Doctorates
include the Doctor of Public Health (DrPH). Epidemiological studies are aimed, where
possible, at revealing unbiased relationships between exposures such as alcohol or
smoking, biological agents, stress, or chemicals to mortality or morbidity. "Correlation
does not imply causation" is a common theme for much of the epidemiological literature.
For epidemiologists, the key is in the term inference. Epidemiologists use gathered data
and a broad range of biomedical and psychosocial theories in an iterative way to generate
or expand theory, to test hypotheses, and to make educated, informed assertions about
which relationships are causal, and about exactly how they are causal. Epidemiologists
Rothman and Greenland emphasize that the "one cause - one effect" understanding is a
simplistic mis-belief. Most outcomes whether disease or death, are caused by a chain or
web, consisting of many component causes. Types of study are,
1. Cases series: qualititative study of the experience of a single patient, or small group of
patients with a similar diagnosis, or to a statistical technique comparing periods during
which patients are exposed to some factor with the potential to produce illness with
periods when they are unexposed. It is important for epidemiologists to know how to
counsel and treat the victims of outbreaks of disease and is how to do the theoretical
science of epidemiology justice. Confidentiality is important.
2. Case control: studies select subjects based on their disease status. A group of
individuals that are disease positive (the "case" group) is compared with a group of
disease negative individuals (the "control" group). The control group should ideally come
from the same population that gave rise to the cases. The case control study looks back
through time at potential exposures that both groups (cases and controls) may have
encountered. A 2x2 table is constructed, displaying exposed cases (A), exposed controls
(B), unexposed cases (C) and unexposed controls (D). The statistic generated to measure
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association is the odds ratio (OR), which is the ratio of the odds of exposure in the cases
(A/C) to the odds of exposure in the controls (B/D), i.e. OR = (A/C) / (B/D). Because
these studies look backward to determine why some people get a disease and others do
not, they are not very dangerous.
3. Cohort studies: Selects subjects based on their exposure status. The study subjects
should be at risk of the outcome under investigation at the beginning of the cohort study;
this usually means that they should be disease free when the cohort study starts. The
cohort is followed through time to assess their later outcome status. An example of a
cohort study would be the investigation of a cohort of smokers and non-smokers over
time to estimate the incidence of lung cancer. The same 2x2 table is constructed as with
the case control study. However, the point estimate generated is the Relative Risk (RR),
which is the probability of disease for a person in the exposed group, Pe = A / (A+B) over
the probability of disease for a person in the unexposed group, Pu = C / (C+D), i.e.
RR = Pe / P. These studies are extremely dangerous because subjects run the risk of
being exposed to the biological agents that cause the diseases the researchers want to
prove their study or achieve a secret political agenda or become seized by the laboratory
leak it turns out they are studying. Cohort studies are important to determine the general
safety of lists such as health and welfare rolls, and alumni associations and the affects of
discriminatory actions that identify a percentage of the group.
D. Cutting edge research into epidemiology mostly involves the detection and recall of
pathogenic substances such as trans-fats. In United States law, epidemiology alone
cannot prove that a causal association does not exist in general. Conversely, it can be
taken by US courts, in an individual case, to justify an inference that a causal association
does exist, based upon a balance of probability. Epidemiology is concerned with the
incidence of disease in populations and does not address the question of the cause of an
individual‘s disease. This question, sometimes referred to as specific causation, is beyond
the domain of the science of epidemiology. Epidemiology has its limits at the point where
an inference is made that the relationship between an agent and a disease is causal
(general causation) and where the magnitude of excess risk attributed to the agent has
been determined; that is, epidemiology addresses whether an agent can cause a disease,
not whether an agent did cause a specific plaintiff‘s disease. To do justice, scientific
tests, that do not bring the pathogen itself to market, need to be developed to detect all
pathogens, in the human body and environment, used to cause disease in bio-medical
research laboratories, whereby the victim would know how to protect themselves and
could be compensated and the perpetrators could be convicted of their crime against
humanity.
1.Confidence in national epidemiologic and death statistics has been damaged by the
concurrence of corruption with the release of death statistsics. In 2008 the death statistics
were released in concurrence with the FISA Re-authorization. In 2009 the death statistics
were released in concurrence with the financing of Internet medical records. In both of
these instances the credibility of the rosy statistics in in doubt. To respond to this
evidence of corruption the national statistical study of disease and death in the United
States need to be protected against interference and improved.
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a.National, state and county morbidity and mortality statistics need to be subjected to
rigorous cross-examination by independent agencies and universities. Major
discrepencies will be reported to the public and the government will review their statistics
and make revisions based upon their judgment.
b. National, state and county morbidity and mortality statistics need to be up to date,
rather than two years out of date, and state and local health statistics need to be made
available by the federal government, in easy to use databases, and by local public health
departments, for cross-examination by the public to be informed of and to redress
endemic problems.
§343 Mental Health
A. Mental illness is the most common ailment affecting 25% of the US population, who
are extremely reliant upon this discrimination for the relief of poverty and 5% suffer
severe mental illness in any given year. More than 50% of the population suffers mental
illness at least once in their lifetime, and the other 50% are probably covering up the
general acceptance of their sadistic oppressiveness. Philosophically mental health is
nearly as effective an approach to understanding the epidemiology of illness as health
theology, it will however keep a person fooled by university culture for years, what in the
absence of doubt could take forever, but in the presence of the truth pertaining to the evil
nature of health, development and democracy, dissolves swiftly with social work. In
practice the treatment of mental illness is the core corruption in society whereby the local
psychiatric establishment has corrupted a medical campus, a general hospital or three and
the judge responsible for the adjudication of the wills of deceased, thereby complicating
the discovery, prevention and punishment of unethical medical behavior and products,
with the absolute corruption of slavery, many people and governments are prone to.
1.The World Health Organization Report on Mental Health of November of 2001,
estimates that mental illness and psychological disorders stemming from substance abuse
affect a combined total of 450 million people, 7.3%, of the 6,137,000,000 global
population. WHO recommends that in the future, ―governments take responsibility for
providing treatment for mental disorders within primary care; ensuring that psychotropic
drugs are available; replacing large custodial mental hospitals with community care
facilities backed by general hospital psychiatric beds and home care support.‖
2. The Surgeon General‘s Report on Mental Health of 1999 stated that 55% of Americans
suffered from mental illness at some time in their life and 1 in 5 Americans experience a
diagnosable mental disorder in any given year. Mental illness is the second leading cause
of disability, after stroke paralysis, costing disability insurance an estimated $24 billion
and medical insurance $65 billion annually.
3. In 2000 at the Conference on the Report of the Surgeon General, then Ohio Director of
Mental Health Mike Hogan Phd, promised to, ―close all state mental institutions and
private psychiatric hospitals to provide unimpeded access to community mental health.‖
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The WHO Report recommends that in the future, ―governments take responsibility for
providing treatment for mental disorders within primary care; ensuring that psychotropic
drugs are available; replacing large custodial mental hospitals with community care
facilities backed by general hospital psychiatric beds and home care support.‖
B. The most prevalent diagnosis of Mental Diseases are;
1. ―Major depressive disorder‖ is the most common mental disorder affecting 9.9 million
people or 5% of the U.S. population every year;
2. ― Bi-polar disorder‖ is a mental disorder affecting 2.3 million U.S. adults or 1.2 % of
the U.S. population;
3. ‗Schizophrenia‖ is a mental disorder affecting 2.2 million U.S. adults about 1.1% of
the U.S. population;
4. ―Anxiety disorders‖ are a category of mental disorder affecting 19.1 million U.S.
adults;
5. ―Panic disorder‖ is an anxiety disorder that affects 2.4 million U.S. adults,
6. ―Generalized Anxiety Disorder‖ is an anxiety disorder affecting 4.0 million or 2.8% of
the populace,
7. ―Social Phobia‖ is an anxiety disorder affecting 5.3 million or 2.8% of the populace.
8. ―Agoraphobia and specific phobia‖ are anxiety disorder affecting 9.5 million people.
9. ―Attention Deficit Hyperactivity Disorder‖ is a disorder that affects 4.6% of school age
juveniles.
10. ―Alzheimer‘s disease‖ is a disorder that affects an estimated 4 million senior citizens
or 10% of the people 65 or older.
C. Mental illness is the leading cause of disability. The demand for treatment has never
been higher, the rate of mental illness in the United States is estimated at 20.1% of the
population causing 11% of Global Burden of Disease and if trends continue will cause
15% of all days missed from work. Community care and community housing need to be
readily accessible for people who need housing and psychiatric counseling must be
provided for those who wish to undergo a psychiatric evaluation or are alleged mentally
ill and do not have the means to support themselves.
1. Although Neurological disorders account for only 1% of the world‘s deaths mental
illness accounts for 11% of the Global Burden of Disease and if trends continue will
account for 15% by the year 2020. In the USA 12% of all absences from work were due
to mental disorders. The total cost of mental illness in the U.S. was estimated at $153.5
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billion, in 1990 it is however difficult to come up with a dollar figure for the damages
caused by mental illness. Incidences of mental illness are reported to be twice as
common among the poor than the wealthy. The total expenditure on the treatment of
mental illness in 1988 was only $23 billion yet the majority of cases of mental illness
remain untreated. Accessibility to psychiatric medication, counseling and welfare are
considered important for the economic recovery of individuals and our nation.
2. Suicide is 3rd leading cause of death among 15 – 24 year olds. In 1997 30,535 people
died from suicide in the U.S. It was the 11th leading cause of death in 2000. The highest
suicide rates are found in white men over the age of 85. More than 90% of people who
kill themselves have a diagnosable mental disorder. Four times as many men as women
commit suicide although women attempt to commit suicide 2-3 times more often. Major
depressive disorder is the leading cause of suicide, heightened by substance abuse and
conduct disorder. Suicide is the leading cause of violent death, outnumbering homicide
or war related deaths.
3. Joseph Parks of the Missouri Department of Mental Health reports that people with
serious mental illness die at age 51, on average, compared with 76 for Americans
overall. Their odds of dying from the following causes, compared with the general
population. 3.4 times more likely to die of heart disease. 3.4 times more likely to die of
diabetes. 3.8 times more likely to die of accidents. 5 times more likely to die of
respiratory ailments. 6.6 times more likely to die of pneumonia or influenza. Adults with
serious mental illness treated in public systems die about 25 years earlier than Americans
overall, a gap that's widened since the early '90s when major mental disorders cut life
spans by 10 to 15 years.
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Source: Census Bureau, Department of Health and Human Services and Bureau of Justice
Statistics; Harcourt, Bernard E. The Mentally Ill Behind Bars. New York Times. January
15, 2007
D. Psychotropic drugs and psychiatric hospitalization are a story of big money and
medical slavery. The numbers show that de-institutionalization policies between 1970
and 1998 have been successful in reducing the supply of totally government funded
psychiatric beds by a total of 376,704. State and county mental institutions having
reduced their number of inpatient beds from 413,066 in 1970 to 63,525 in 1998.
Likewise VA medical center psychiatric beds went down from 50,688 in 1970 to 13,301
in 1998. To compensate private psychiatric hospitals, non-federal general hospital and
residential centers for emotionally disturbed children that are funded 68% by private
clients‘ HMO have increased 51,348 beds. Between 1970 and 1998 Private psychiatric
hospitals have increased in patient population from 14,295 to 33,635, Non-federal general
hospital psychiatric wards have increased from 22,394 to 54,266, residential treatment
centers for emotionally disturbed children increased from 15,129 to 33,483. The total
number inpatient beds of all ―mental institutions‖ declined from 515,572 in 1970 to
198,195 in 1998. However the reduction in psychiatric hospitalization was followed by
an even greater increase in penal incarceration, largely the result of drug slavery policies
of the hypocritical Drug Enforcement Agency (DEA) whose purpose seems only to mock
the barbaric practice of judge enforced psychiatric medication and prevent any
meaningful regulation of drugs and dangerous laboratory supplies.
1.Psychiatric drugs fuel a $330-billion psychiatric industry, without a single cure, kill an
estimated 36,000 people every year, more than illegal drugs, with the death toll rising.
Drug treatment is the newest torture. Since the Enlightenment the spinning chair,
copious bloodletting, removal of possibly infected viscera, extraction of teeth, electric
shock, forcible restraint, for days or weeks, wrapping in cold blankets, slicing through
the brain with an ice pick, sterilization, female genital mutilation have been used to treat
the "mad". Even the most grotesque treatments have often been introduced as humane
alternatives to existing options.
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2.In the 1950s, the chemical lobotomy, or "hibernation therapy" was introduced.
Patients were given a drug that rendered them immobile and semiconscious for days,
on the assumption that they would emerge improved. The drug was called a
"neuroleptic", or brain restrainer - Chlorpromazine. Since marketed as an antipsychotic,
it is used, in lower doses, today. So too are a host of related drugs for depression,
anxiety and other mentall illnesses. Many doctors, and some patients, swear by them
(other patients swear at them). These drugs helped to get people out of the psychiatric
hospital but maybe only as an appeasement to allow the psychiatrists, whose slaves
were freed, to torture even larger numbers of people in the community.
2. Antipsychotics and psychiatric drugs are, at times, cruel drugs and anti-depressants
addictive because they are pleasurable. Anti-psychotics however need special attention
because they are designed to reduce pleasure and they are generally developed to appease
the torture doctors of institutions in questionable drug experiments on prisoners coerced
or ignored, officially deprived of all respect for their intelligence. Some cause shaking,
salivation, restlessness, infertility, stiff ness, agitation, and frail bones; others cause
obesity, somnolence, and increase the risk of heart attack, diabetes, and stroke.
Antidepressants also have side- effects, although theirs are typically less dramatic:
sickness, sexual dysfunction, a feeling of being numbed, or losing one's personality, and
acutely increased risk of suicide. But side-effects, when they occur, seem justified, since
mental illness is extremelyunpleasant; and evidence indicates that the drugs work.
Because the danger is evident but there is demand is extremely important that the drugs
be consumed voluntarily and defective or adulterated drugs removed from the market.
3. Taking to heart those mind altering substances that alter a person‘s personality are
noted in torture statute 18USC(113C)§2340(2)(b&D) toxic substances like involuntarily
administered LSD must not be overlooked as a cause of mental illness that in times of
social stress can lead to suicide. In nearly every case, taking into consideration the
individual nature of morality, the proper mental health professional is not a psychiatrist
but a social worker. A psychiatrist is not a moral professional and must be barred from
taking on social responsibilities such as Ethics Committees or employment training, that
might be corrupted by the death cult. Likewise, psychiatric medication is not the cure, it
is not even advertised as a cure but a regular expense with the threat of withdrawal, but
meditation is. Visual meditation is an excellent way to stifle auditory and visual
hallucinations until regaining mastery of the mind. Excersize, socialization and success
help with depression and anxiety. The understanding of mental illness, de-
institutionalization and the fallibility of the mind is however so important it should be
taught in junior high school. People with reasonable expectations for themselves and
others are more likely to enjoy their lives in peace with others and not be deluded to
serious mental illness or hatred by a minor mental quirck or reaction to social stress.
§344 Genetic Disease
A.The study of genetic disease has been complicated by the human tendency for families
to commit genocide, when infringed upon by a public official or professional in abuse of
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honor, defined in the Convention on the Prevention and Punishment of Genocide of 9
December 1948 ―as any of a number of acts committed with the intent to destroy (a
family), in whole or in part, a national, ethnic, racial or religious (family) group: killing
members of the (family) group; causing serious bodily or mental harm to members of the
(family) group; deliberately inflicting on the (family) group conditions of life calculated
to bring about its physical destruction in whole or in (individual) part; imposing measures
intended to prevent births within the (family) group, and forcibly transferring children of
the (family) group to another group‖. Under the Rome Statute for the International
Criminal Court apartheid is a crime of genocide.
1.The Genetic Information Nondiscrimination Act of 2008 P.L. 110-223 prohibits
discrimination in insurance or employment on the basis of genetic information and recalls
the eugenics movement that plagued the early science of genetics with theories of genetic
superiority that inspired Nazi Aryanism and concentration camp genocide and became
the basis of State laws that provided for the sterilization of persons having presumed
genetic `defects' such as mental retardation, mental disease, epilepsy, blindness, and
hearing loss, among other conditions. The first sterilization law was enacted in the State
of Indiana in 1907 and soon a majority of States had adopted sterilization laws to `correct'
apparent genetic traits or tendencies. Many of these State laws have since been repealed.
Once again, State legislatures began to enact discriminatory laws in the early 1970s
mandating genetic screening of all African Americans for sickle cell anemia, leading
Congress in 1972 to pass the National Sickle Cell Anemia Control Act, which withholds
Federal funding from States unless sickle cell testing is voluntary.
2. Since the decoding of the human genome in 2000 the current explosion in the science
of genetics, requires control of the study and exchange of information to prevent a
resurgence of the crime of genocide on either the national scale or the neglected family of
willful killers calling accusations of poison a psychiatric disorder. It is imperative that
the study of genetics continue to be a laboratory science and clinical counsesl and not a
social or psychiatric study as advocated by the National Institutes of Mental Health in
2007 that admitted to conducting genetic research on the gray area of mental illness
where anyone paid by the State is lying and the black market of slavery and death makes
billions of dollars annually.
B. Genetic disease has long stalked humanity. Retrospective diagnosis has suggested that
George III, the English king whose principal claim to fame is to have lost the American
colonies in the Revolutionary War, suffered from an inherited disease, porphyria, which
causes periodic bouts of madness, which some historians have attributed his loss of the
colonies on. Most genetic diseases have no such geopolitical impact, they nevertheless
have brutal consequences for the afflicted families, sometimes for many generations. The
drooping Hapsburg lower lip was passed down for at least twenty-three generations that
was aggravated by intermarrying. Although arranged marriages between different
branches of the Hapsburg clan may have made political sense it was not astute in genetic
terms. Inbreeding can result in genetic disease. Charles II, the last of the Hapsburg
monarchs in Spain, not only had the family lip but could not chew his own food and was
a complete invalid, incapable, despite two marriages, of producing any children.
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1.Queen Victoria provides a famous example of sex-linkage. On one of her X
chromosomes, she had a mutated gene for hemophilia, the ―bleeding disease‖ in whose
victims proper blood clotting fails to occur. Although she herself did not have the
disease, she was a carrier. Her daughters did not have the disease either, however each
evidently possess at least one copy of the normal version. Victoria‘s sons were not so
lucky, they had a 50/50 chance of inheriting the disease from their mother‘s mutated
chromosome. Prince Leopold drew the short straw and he developed hemophilia and
died at thirty one, bleeding to death from a minor fall. Princess Alice and Beatrice, were
carriers, having inherited the mutated gene from their mother. They each produced
carrier daughters and cons with hemophilia. Alice‘s grandson Alexis, heir to the Russian
throne, had hemophilia, and would doubtless have died young had the Bolsheviks not
gotten to him first. Understanding genetics is not just about why we look like our parents,
it is also about coming to grips with some of humankind‘s oldest enemies: the flaws in
our genes that cause genetic disease.
2. Generations of careful selection- breeding to domesticate appropriate species and then
breeding only from the most productive cows and from the trees with the largest fruit –
resulted in animals and plants tailor made for human purposes. The rule of thumb is that
the most productive cows will produce highly productive offspring and from the seeds of
trees with large fruit large fruited trees will grow. It wasn‘t until 1909 that British
biologist William Bateson gave the science of inheritance a name, genetics, the
application of genetics to human well being was carried out eons ago by anonymous
ancient farmers. Almost everything we eat – cereals, fruit, meat, dairy products – is the
legacy of that earliest and most far reaching application of genetic manipulations to
human problems.
3.Gregor Mendel (1822-1884) published his famous paper on the subject of heredity in
1866 that was ignored by the scientific community for another thirty four years. The
failure of early biologists to distinguish between two fundamentally different processes –
heredity and development was the most important distinction clarified by Mendel. Today
we understand that a fertilized egg contains the genetic information, contributed by both
parents, that determines whether someone will be afflicted with a genetic disease.
Development on the other hand involved the development of a new individual from the
humble starting point of a single cell, the fertilized egg. Mendel published his results
shortly after Darwin‘s Origin of Species in 1859 and it was Mendel who got it right, who
despite chronically failing professional and priestly exams, was an effective teacher of
heredity who was later elected abbot of the monastery. Mendel realized there are specific
factors, later to be called ―genes‖ that are passed from parent to offspring in pairs, one
from each parent. The theory of dominant and recessive genes became apparent in the
famous experiment with green and yellow peas whereby yellow peas can result both from
YY and YG combinations. Characteristics that are transmitted with a high probability
(50%) from generation to generation are dominant. Other characteristics that appear in
family trees much more sporadically, often skipping generation, may be recessive. When
a gene is recessive an individual has to have two copies of it for the corresponding trait to
be expressed.
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4. The chromosome was discovered around the time of Mendel‘s death in 1884 however
it was not until 1902 that Mendel‘s work on heredity and chromosomes came together.
Walter Sutton, a medical student at Columbia University, noted while studying
grasshopper chromosomes that, normal cells have a pair of chromosomes however sex
cells have only one chromosome. It became clear that ―genes‖ were chromosomes. In
Germany Theodor Boveri independently came to the same conclusion and the biological
revolution they precipitated came to be called the Sutton-Boveri chromosome theory of
inheritance. Genes suddenly became real, they were on chromosomes and you could
actually see chromosomes through microscopes.
5. Hunt Morgan, also of Columbia University, looking down a microscope did not
believe that stringy chromosomes fully explained changes and mutations that occur from
one generation to the next. He turned to the fruit fly Drosophila melanogaster to isolate
some distinct characteristics to track through the generations. He was looking for genetic
novelties, random variations. What he noticed was that white-eyed flies were typically
male. It was known that the sex of the fruit fly, or human, is determined chromosomally:
females have two copies of the X chromosome, whereas males have one copy of the X
and one copy of the much smaller Y. The white-eye result made sense: the eye-color
gene is located on the X chromosome and the white-eye mutation. Through this
experiment Morgan, despite his initial reservations, effectively proved the Sutton-Boveri
as well as introducing the concept of sex linkage in which a particular characteristic is
disproportionately represented in one sex. During the course of their experiment Morgan
and his students discovered that chromosomes actually break apart and re-form during the
production of sperm and egg cells, ―recombination‖ whereby gene copies are shuffled
between members of a chromosome pair of each donor. Recombination permitted
Morgan and his students to map out the positions of particular genes along a given
chromosome. Recombination involves breaking and re-forming chromosomes because
genes are arranged like beads along a chromosome string. Genes that are far away from
each other are more likely to break away than genes that are close together. This basic
principle of ―recombination‖ underlies all of genetic mapping that has been one of the
primary tools of scientists involved in modern genetic research.
6. James Watson began his work figuring out the structure of a then little known
molecule called deoxyribonucleic acid – DNA – working with Francis Crick in
Cavendish laboratory at Cambridge University. At the time it was already known that
DNA molecules consist of multiples copies of a single basic unit, the nucleotide, which
come in four forms: adenine (A), thymine (T), guanine (G), and cytosine (C). Watson
discovered that A fitted neatly with T and G with C. Crick realized straightaway that the
pairing idea implied a double-helix structure with the two molecular chains running in
opposite directions. The way the molecule was organized immediately suggested
solutions to two of biology‘s oldest mysteries: how hereditary information is stored and
how it is replicated. Charles Darwin‘s theory of evolution, which showed how all of life
is interrelated, was a major advance in our understanding of the world in materialistic,
physicochemical terms. The breakthrough of biologists Theodor Schwann and Louis
Pasteur during the second half of the nineteenth century were also an important step
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forward. Rotting meat did not spontaneously yield maggots, rather, familiar biological
agents and processes were responsible, in this case egg laying flies thereby discrediting
the idea of spontaneous generation. Many biologists were reluctant to accept natural
selection as the sole determinant of the fate of evolutionary lineages and physicists found
the messy complexity of biology bewildering. That is why the double helix was so
important. It brought the Enlightenment‘s revolution in materialistic thinking to the cell
that the double helix is an elegant structure, but its message is prosaic: life is a matter of
chemistry.
7. The double helix proved to be the key to molecular biology, a new science whose
progress over the subsequent fifty years has been astounding. Not only has it yielded a
stunning array of insights into fundamental biological processes, but it is now having an
ever more profound impact upon medicine, on agriculture, and on the law. DNA is no
longer a matter of interest only to white-coated scientists in obscure university
laboratories, it affects all of us. By the mid-sixties the basic mechanics of the cell had
been worked out and how the four letter alphabet of DNA sequence is translated into the
twenty letter alphabet of the proteins.
8. In the 1970‘s techniques were introduced for manipulating DNA and reading its
sequence of base pairs. Extraordinary new scientific vistas opened up and we could
come to grips with genetic diseases from cystic fibrosis to cancer and revolutionize the
criminal justice system with genetic fingerprinting. We could also profoundly revise
ideas about human origins by using DNA based approaches to prehistory and we could
improve agriculturally important species with an effectiveness we had previously only
dreamed of. The climax of the first fifty years of the DNA revolution came on Monday
June 26, 2000 when US President Bill Clinton announced the completion of the rough
draft sequence of the human genome stating, ―Today, we are learning the language in
which God created life. With this profound new knowledge, humankind is on the verge
of gaining immense new power to heal.‖
C. Genetic diseases are usually grouped into singlegene disorders (haemoglobinopathies,
cystic fibrosis and haemophilia) and chromosomal disorders (Down syndrome, among
others). These conditions are described as genetic diseases because a defect in one or
more genes or chromosomes leads to a pathological condition according to WHO‘s
Control of Genetic Disease EB116/3
1. Multifactorial disorders, on the other hand, where genetic and environmental factors
interact, have not traditionally been considered to be genetic diseases. Multifactorial
disorders are usually categorized as
a. congenital malformations, such as neural tube defect, cleft lip and palate, or
b. diseases with a genetic predisposition, such as some chronic, noncommunicable
diseases.
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2. Congenital malformations are often associated with genetic diseases because they both
tend to present during pregnancy, at birth or in early childhood.
3. Clinical genetics services provide care for people with both categories of disease, and
registries of birth defects collect information about genetic diseases and congenital
malformations.
4. Some genetic diseases, such as haemophilia, are carried on the X-chromosome (these
X-linked disorders occur mainly in men). Others can arise from the presence of an
abnormal gene in any autosome: if the gene is dominant, it results always in what is
called a dominant condition, whereas if it is recessive many of these diseases appear only
when the gene is inherited from both parents (and are thus called recessive conditions).
5. Genetic diseases can vary in severity, from being fatal before birth to requiring
continuous management; their onset covers all life stages from infancy to old age. Those
presenting at birth are particularly burdensome, however, as they may cause early death
or life-long chronic morbidity.
6. Globally, at least 7.6 million children are born annually with severe genetic or
congenital malformations; 90% of these infants are born in mid- and low-income
countries.
7. All people are at risk of diseases due to genetic mutations. The higher prevalence of
genetic diseases in particular communities may, however, be due to some social or
cultural factors. Such factors include a tradition of consanguineous marriage, which
results in a higher rate of autosomal recessive conditions including congenital
malformations, stillbirths, or mental retardation. Furthermore, maternal age greater than
35 years is associated with higher frequencies of chromosomal abnormalities in the
offspring.
8. The control of genetic diseases should be based on an integrated and comprehensive
strategy combining best possible treatment and prevention through community education,
population screening, genetic counselling and the availability of early diagnosis.
9. Some of the most common genetic diseases (thalassaemias, cystic fibrosis,
haemophilia and phenylketonuria) can be managed with considerable success. Effective
treatment is beneficial in terms of not only increased life expectancy but also improved
quality of life.
D. The decoding of the human genome has been disappointing in producing medicine.
Other than its use in detecting a few chronic noncommunicable or infectious diseases
(such as familial adenomatous polyposis and leishmaniasis), the main medical application
of DNA technology is diagnosis of genetic disorders and identification of mutations
causing or caused by chronic diseases. The danger of genetics is that it facilitates the
glossing over of the real problem, genocide of the family, studied by geneologists. The
beauty of genetic research is that the results can be easily disseminated to counsel
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millions of sick people in their struggle with genocide of the family and society. It is
important that genetics be isolated as a laboratory science.
§345 Virology
A.Viruses are the smallest infectious agents. Outside living cells, viruses are wholly
inert. Their sole activity is to invade the cells of other organisms, which they takeover to
make copies of themselves, using genetic information. Viral infections range from warts,
the common cold and other minor respiratory tract infections and hepatitis, to extremely
serious diseases, such as rabies, AIDS, and at least 18% of all types of cancer. Highly
effective vaccines prevent poliomyelitis, measles, mumps, rubella, hepatitis, yellow
fever, human papilloma, rotavirus and post-exposure rabies. AIDS drugs have reduced
HIV infection and mortality worldwide. The rotavirus vaccine (2006) reduced childhood
ER visits for gastroenteritis by 85%. LigoCyte is beginning phase II trials of an
intranasal norovirus vaccine. Teva Pharm is authorized to manufacture the adenovirus
vaccine, discontinued in 1996, after epidemics took 5 lives. The FDA removed 600 cold
and flu remedies and approved Allegra OTC. Corticosteroid inhalers discontinued for
fluorocarbon concerns can substitute Flovent. Acyclovir, topical and pegylated interferon
alpha-2B, Foscarnet sodium and Immune Globulin IV treat a broad spectrum of the viral
vectors of chronic disease surveyed in Antiviral Medicine for the Treatment of Chronic
Disease HA-24-4-11.
1.Infectious organisms belong to a wide range of classes and vary in size from the 2-nm
poliovirus to 10-m tapeworms. Viruses are the smallest known types of infectious agent.
Viral pathogens account for a major share of all human infections. The number of
different kinds of virus probably exceeds the number of types of all other organisms.
Viruses are about one half to one hundredth the size of the smallest bacteria. Viruses are
smaller than cells, ranging in size from 0.02 µm to 0.3 µm. A common unit of measure
for viruses is the nanometer, which is 1000 times smaller than 1 µm and one million
times smaller than 1 mm. Smallpox virus, one of the largest, is about 200 nm in
diameter, polio virus, one of the smallest, is only 28 nm in diameter. Viruses that cause
human disease are grouped into more than 20 large families.
Fig. 9-9 Viral Families
Family Disease Family Disease
Papovaviruses Warts Orthomyxoviruses Influenza
Adenoviruses Respiratory and Paramyxoviruses Mumps,
eye infections, measles,
diarrhea rubella
Herpesviruses Cold, sores, Coronaviruses Common cold
genital herpes,
chickenpox,
herpes zoster
(shingles),
glandular fever,
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congenital
abnormalities
(cytomegalovirus)
Poxviruses Cowpox, smallpox Arenaviruses Lassa fever
(eradicated),
molluscum
contagiosum
Picornaviruses Poliomyelitis, viral Rhabdoviruses Rabies
hepatitis types A
and B, respiratory
infections,
myocarditis
Togaviruses Yellow fever, Retroviruses AIDS,
dengue, degenerative
encephalitis brain disease
and (possibly)
various kinds
of cancer
Calcivirus Norwalk (Ohio)
virus
Source: Sanders, Tony J. Table 1 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
2. Not all viruses cause disease, but many do. Viral infections range from the trivial and
harmless, such as warts, the common cold and other minor respiratory tract infections and
hepatitis, to extremely serious diseases, such as rabies, AIDS, and some types of cancer.
It is debatable whether viruses are truly living organisms or just collections of large
molecules capable of self-replication under very specific favorable conditions. Their sole
activity is to invade the cells of other organisms, which they takeover to make copies of
themselves. Outside living cells, viruses are wholly inert. They are incapable of
activities typical of life, such as metabolism. Unlike bacteria, viruses cannot be grown in
a suitable culture medium; they can multiply only within living cells. Therefore, viruses
must be grown in cultures of cells, which can be any of many types of animal or human
cell that are easily made to multiply in test tubes.
B. The study of virology involves the isolation and identification of viruses to diagnose
specific viral infections. To achieve this, a tissue or fluid sample (such as a specimen of
feces, sputum, blister fluid, blood, urine, cerebrospinal fluid, or even brain biopsy
specimen, depending on the suspected virus, is needed. The specimen is exposed to a
cellular culture and the cells are then observed for distinctive changes that occur when
they are infected with viruses. Alternatively, virus particles must first be made to clump
together by adding an antiserum (antibodies obtained from the blood of someone who has
had the viral infection, and which will bind to the virus particles). Immunoassay
techniques, in which ―labeled‖ antibodies are added to the specimens and detected if they
have bound to virus cell components, are another possibility. Another method of
diagnosing viral infections is to look for antibodies produced by the immune system to
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combat the viruses. A rapidly rising level of antibodies to a particular virus can prove
good evidence of infection Antibodies can be detected by types of immunoassay and
other laboratory techniques.
Fig. 9-10 Some laboratory procedures in diagnostic virology
Condition Possible viral cause Samples to obtain Inoculation
Procedure
Upper respiratory Rhinovirus Nasopharyngeal Human fibroblast
infection Coronavirus fluid or tracheal culture
Adenovirus fluid (aspirate)
Pneumonia Influenza Nasopharyngeal Human fibroblast
fluid or swab cultures or
embryonated eggs;
Monkey kidney cells
Human fibroblast
culture; Look for
characteristic virus
particles with the
electron microscope
Measles Measles virus Nasopharyngeal Human fibroblast or
Vesicular rash Herpes simplex fluid or swab; monkey kidney
Diarrhea Rotavirus (infants) Vesicular fluid by cultures
Norwalk agent aspiration;
(adults) Feces or rectal swab
Nonbacterial Enterovirus Spinal fluid
meningitis Mumps
Herpes Symplex
Source: Sanders, Tony J. Table 2 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
1.Various serological techniques are extremely useful in the diagnosis of infectious
diseases. If a person has been exposed to a particular infectious organism, antibodies
(proteins with a role in immunity) directed specifically against the organism appear in
that person‘s serum some days after exposure. Their presence or absence in the blood
can be detected by such laboratory techniques as immunoassay, including the ELISA test
and radioimmunoassay. In other cases, serological techniques are used to identify parts
of infectious organisms (antigens) by studying the reaction between the antigens
(obtained by culture of a specimen taken from a patient) and serum samples known to
contain certain antibodies. A series of tests may be carried out in which the unknown
antigen is added to carious antiserums (preparations containing specific antibodies) in test
tubes; a positive reaction is sometimes revealed by a color change. In addition to
devising and carrying out such diagnostic tests, serologists may be involved in
developing antiserums for passive immunization.
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C. A virus is a non-cellular genetic element that enlists a cell for its own replication, and
is characterized by also having an extracellular state. In this extracellular state, the virus
particle is metabolically inert and does not carry out respiratory or biosynthetic functions.
A single virus particle (virion) consists simply of an inner core of nucleic acid surrounded
by one or two protective shells (capsids) made of protein. These capsids are built from a
number of identical protein subunits arranged in a highly symmetrical form, usually
either as a 20-faced solid (an icosahedron) or as a spiral tube. Surrounding the outer
capsid may be another layer called the viral envelope. This layer also consists primarily
of protein. In many cases, the viral envelop is lost when the virus invades a cell. The
nucleic acid at the core is called the genome, it consists of a string of genes that contain
coded instructions for making copies of the virus. Depending on the type of virus, the
nucleic acid may be either DNA, in which there are two complementary intertwined
strands of nucleic acid (the double helix) or RNA, consisting of a single strand.
1.Viroids are circular single-stranded RNA molecules that encode no proteins and are
completely dependent on host-encoded enzymes. They are the smallest known pathogens
ranging from Coconut cadang-cadang viroid which is 246 nucelotides in size to Citrus
exocortis viroid which is 375 nucleotides, and cause a number of very important crop
diseases. Unlike viruses, their extracellular form is the same as their intracellular form
and they have no protein coat. Prions have an extracellular form that does contain
protein, but it does not contain the nucleic acid that encodes that protein. The gene that
encodes the prion protein is found in the host cell and the prion somehow modifies this
protein product. Prion protein particles and various prions are known to cause a variety
of diseases in animals, such as scrapie in sheep, bovine spongiform encephalopathy in
cattle, and kuru and Creutzfeldt-Jakob disease in humans. Although they are very simple
elements, life viruses, both prions and viroids are infective and are reproduced inside
cells.
D. When a virus genome is introduced into a cell and reproduces, the process is called
infection. The cell that a virus can infect and in which it can replicate is called a host.
Viruses can have varied effects on cells. Lytic infection results in the destruction of the
host cell. However, there are several other possible effects following viral infection of
animal cells. In the case of enveloped viruses, release of virions, which occurs by a kind
of budding process, may be slow and the host cell may not be lysed. The cell may remain
alive and continue to produce virus over a long period of time. Such infections are
referred to as persistent infections. Viruses may also cause latent infection of a host. In a
latent infection, there is a delay between infection by the virus and the appearance of
symptoms. Fever blisters (cold sores), caused by the herpes simplex virus, result from a
latent viral infection; the symptoms reappear sporadically as the virus emerges from
latency.
1. Viruses gain access to the body by all possible entry routes. They are inhaled in
droplets; swallowed in food and fluids; and passed through the punctured skin in the
saliva of feeding insects or rabid dogs or accidentally on the needles of tattooists, those
who pierce ears, or even physicians. Many viruses begin to invade cells and multiply
near their site of entry. Some enter the lymphatic vessels and may spread to the lymph
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nodes, where many are engulfed by white blood cells, such as lymphocytes. Many pass
from the lymphatic to the blood and within a few minutes are spread to every part of the
body. They may then invade and start multiplying within specific target organs such as
the skin, brain, liver, or lungs. Other viruses travel along nerve fibers to their target
organs.
2. Viruses cause disease in a variety of ways. First, they may destroy or severely disrupt
the activities of the cells they invade, possibly causing serious disease if vital organs are
affected. Second, the response of the body‘s immune system to viral infection may lead
to symptoms, such as fever and fatigue, or to a disease process. In particular, antibodies
produced by the immune system may attach to viral particles and circulate as immune
complexes in the bloodstream. The antibodies may then be deposited in various parts of
the body and cause inflammation and severe tissue damage. Third, by interacting with
the chromosomes of their host cells, viruses may cause cancer. Fourth, a virus may cause
disease by weakening the cell-mediated arm of the immune system (i.e. the activity of T-
lymphocytes). This is how HIV works, invading and disrupting one type of T-
lymphocyte so that the normal defenses to a wide range of infections are lost.
3. The immune system deals fairly rapidly with most viruses. Each mechanism of the
immune system may be involved in resisting a viral attack – including white cells
(macrophages) that engulf the viral particles, and lymphocytes that produce antibodies
against the virus or attack virally infected cells. This leads to recovery from most viral
infections within a few days to weeks. Furthermore, the immune system is often
sufficiently sensitized by the infection to make a second illness form the same virus rare
(as is the case with measles). With some viruses, however, the speed of the attack is such
that serious damage or even death may occur before the immune system can adequately
respond (as is the case with rabies and some cases of poliomyelitis). In other cases, a
virus is able to dodge or hide from the immune system, so the infection becomes chronic
or recurrent. This is common with many herpes virus infections (such as genital herpes
and shingles) and with viral hepatitis B. Finally, the AIDS virus, by weakening the
immune system, leaves the body open to many opportunistic infections.
E. Viruses are more difficult than bacteria to combat with drugs because it is difficult to
design drugs that will kill viruses without also killing the cells they parasitize.
Nevertheless, there has been remarkable progress in the development of antiviral agents,
especially against the herpes group of viruses. Such drugs may work by helping to
prevent viruses from entering cells or by interfering with their replication in cells.
Interferon refers to a group of natural substances, produced by virus-infected cells, that
protects uninfected cells. Some interferons can now be produced artificially and have
been tried in the treatment of various viral infections, including the common cold and
viral hepatitis B. Otherwise, treatment of viral infections depends largely on alleviating
the patient‘s symptoms and trusting the body‘s immune defenses to brings about a cure.
A much more fruitful area in the fight against viruses is immunization. One viral disease,
smallpox, has already been eradicated worldwide through a coordinated vaccination
program. Highly effective vaccines are also now available to prevent many others,
including poliomyelitis, measles, mumps, rubella, hepatitis B, yellow fever and rabies.
1394
§345a HIV/AIDS
A.AIDS is a chronic, life-threatening condition caused by the human immunodeficiency
virus (HIV). HIV/AIDS was first detected in the US in a Haitian immigrant in 1981,
random retests of African blood samples dating back to 1959 have tested positive. HIV is
transmitted through the exchange of blood during sexual intercourse, needle sharing or
blood transfusion. HIV interferes with the body's ability to fight off viruses, bacteria and
fungi that cause diseases such as pneumonia and meningitis, by damaging the immune
system. The virus and the infection itself are known as HIV. HIV tests detect antibodies.
Acquired immune-deficiency syndrome (AIDS) is the name given to the later stages of an
HIV infection. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of
blood if the number is less than 200 CD4 cells or if the CD4 percentage is less than 14%,
the person has AIDS. A person‘s viral load is also considered important in determining
the danger of infection posed by AIDS. Since the development anti-retroviral drugs in
1993 AIDS mortalities and new infections have gone down.
1.The mythology surrounding the invention and introduction of HIV into the population
is that HIV was isolated so unethically in government laboratories in the late 1970s that
the Department of Health and Health Services (HHS) laboratories dropped out of, or were
expelled from, the Department of Health, Education and Welfare (HEW) and in a
declaration of ―Third World Whore‖ Congress created the Court of Internatioanl Trade of
the United States (CoITUS) in the Customs Court Act of 1980 to smuggle the virus. The
primary target of the pandemic were the black South Africans who won their decades
long struggle for equal suffrage in 1986 when the aphartheid regime (of can-sir and
angina) was overthrown, to steal from the people the joy of victory with a never ending
pandemic of a new infectious and communicable disease. The homosexual and IV drug
using communities in the US were also affected as were many people receiving blood
transfusion, before safeguards were put into place.
2. People have defended themselves by a number of methods. Practicing safe sex and
abstinence and adopting needle exchange programs so IV drug users are not forced by
necessity to share needles. Blood donation outfits now test all donated blood for HIV
infection to prevent transmitting the virus in a blood transfusion. People who have tested
HIV+ must heed the caution regarding the spy network written into HIV/AIDS as must
all people with chronic diseases and defend themselves against an evil insectlike
conspiracy of HIV bearing biological attackers in the housing or community and the
deadly home invasion by a trusted aid, family members, lover, landlady or visitor who
infects the food supply, war-drobe, or most deadly, the bed. Although reported to be
incurable there are personal reports of newly infected people who manage to completely
recover by evading capture by bad medicine. Two Haitian doctors have managed to
control the epidemic in the nation through border controls, testing and anti-viral drugs, so
that the national number of HIV infected people has declined from 3% to 2%.
1395
3. Unknown a quarter of a century ago, HIV/AIDS is now the leading cause of death and
lost years of productive life for adults aged 15–59 years worldwide. Official
development assistance and other forms of global health investment are on the rise. Most
of the increased spending is for HIV/AIDS. The Global Funds also gives countries the
chance to derive extra public health benefits from the new funds. The opportunity exists
to invest these resources so as to save millions of threatened lives through treatment,
reinforce comprehensive HIV/AIDS control and strengthen some of the world‘s most
fragile health systems. The objective of treating 3 million people in developing countries
with antiretroviral drugs by the end of 2005 is a step on the way to the goal of universal
access to antiretroviral therapy and HIV/AIDS care for all who need it.
B. Vital registration systems, national censuses, demographic surveys and demographic
surveillance systems have provided information on mortality trends. The advent of the
HIV/AIDS pandemic has reversed the gains in life expectancy made in sub-Saharan
Africa, which reached a peak of 49.2 years during the late 1980s and which is projected
to drop to just under 46 years in the period 2000–2005. Overall, life expectancy at birth in
the African Region was 48 years in 2002; it would have been 54 years in the absence of
HIV/AIDS. In the countries of southern Africa life expectancy would have been 56 years
instead of 43 years.
1. The HIV/AIDS epidemic is reported by the World Health Organization Report of 2004
to have killed more than 20 million people. Today, an estimated 34–46 million others are
living with HIV/AIDS. Two-thirds of the total live in Africa, where about one in 12
adults is infected, most of those in southern Africa where as many as 40 percent of the
population is infected, and one-fifth in Asia. Totaling CIA world fact book vital statistics
reveals a total of 26.5 million HIV infected Africans with 2.3 million fatalities in 2004.
Globally in 2003, 3 million people died and 5 million others became infected. Almost 6
million people need treatment. Four million children have been infected since the virus
first appeared. Of the 5 million people who became infected with the virus in 2003, 700
000 were children, almost entirely as the result of transmission during pregnancy and
childbirth, or from breastfeeding.
2. The first cases of what would later become known as AIDS were reported in the
United States in June of 1981. Since then, 1.7 million people in the U.S. are estimated to
have been infected with HIV, including more than 580,000 who have already died and
more than 1.1 million estimated to be living with the disease today. There were an
estimated 56,300 new HIV infections in the U.S. in 2006. In 2009 it was reported by
D.C. health officals that at least 3 percent of the people living in the nation‘s capital are
infected. The report says that the number of HIV and AIDS cases in D.C. jumped 22
percent from the nearly 12,500 reported in 2006. Almost 1 in 10 residents between ages
40 and 49 are living with HIV, and black men had the highest infection rate at almost 7
percent. The report says that the virus is most often transmitted by men having sex with
men, followed by heterosexual transmission and injection drug use. Subsequently that
number has risen as high as 5%.
1396
3. Globally, unprotected sexual intercourse between men and women is the predominant
mode of transmission of the virus. Other important modes of transmission include
unprotected penetrative sex between men, injecting drug use, and unsafe injections and
blood transfusions. The most explosive growth of the epidemic occurred in the mid-
1990s, especially in Africa. The trends in HIV prevalence among pregnant women
attending the same antenatal clinics since 1997 show that the epidemics in the countries
of southern Africa are much larger than elsewhere in sub-Saharan Africa – and that the
gaps appear to be widening. In eastern Africa HIV prevalence is now less than half that
reported in southern Africa and there is evidence of a modest decline. In western Africa
prevalence is now roughly one-fifth of that in southern Africa and no rapid growth is
occurring. The most dramatic effect of the HIV/AIDS epidemic has been on adult
mortality (18). In the worst-affected countries of eastern and southern Africa, the
probability of a 15-year-old dying before reaching 60 years of age has risen sharply –
from 10–30% in the mid-1980s to 30–60% at the start of the new millennium. In
community-based studies in eastern Africa, mortality among adults infected with HIV
was 10–20 times higher than in non-infected individuals.
E. A WHO study found that a combination of universal voluntary HIV testing and
immediate antiretroviral treatment (ART) following diagnosis of HIV infection could
reduce HIV cases in a severe generalized epidemic by 95 percent within 10 years. To
combat the disease WHO and its partners have established the following objectives:
1. Counselling and condom distribution for the people tested as part of the programme;
2. Pre-sex medical exams for both partners;
3. Antiretroviral drugs (first-line drugs for all people identified in late-stage disease and
second-line drugs for treatment failures);
4. Antiretroviral drugs to prevent mother-to-child transmission for women testing
positive in antenatal care clinics and who are in early clinical stages of disease;
5. Treatment and prophylaxis of opportunistic infections;
6. Palliative care;
7. Laboratory tests for toxicity for those showing signs of toxicity and switches of
individual drugs in case of confirmed toxicity.
8. To track HIV drug resistance and assess its geographical and temporal trend.
a. In low-income developing countries, which generally do not have extensive insurance
mechanisms, most personal health services are financed by a mix of taxation and user
fees in the public sector. With the exceptions of Botswana and Brazil (both middle-
income countries which have decided to meet the cost from public sources), developing
country governments have not been greatly involved in financing antiretroviral therapy,
probably because of its high unit cost. Private providers have been financing
antiretroviral therapy through user fees for some time; international nongovernmental
organizations and research-funded sites have received substantial external funds and have
been able to provide either free or heavily subsidized treatment.
b. Private-sector employers have provided free access to antiretroviral therapy, either
directly through occupational health services or indirectly through private insurance
1397
intermediaries. A mixture of public and private financing is desirable, but only if it
ensures equal access. Thus, scaling up the provision of antiretroviral therapy with greater
public provider involvement presents a considerable challenge to governments. Under
Art. 16 of the African Charter on Human and Peoples‘ Rights adopted 27 June 1981.
Every individual shall have the right to enjoy the best attainable state of physical and
mental health. 2. States parties to the present Charter shall take the necessary measures to
protect the health of their people and to ensure that they receive medical attention when
they are sick. In Thailand the production of generic AIDS drugs made costs affordable.
F. The HIV/AIDS pandemic threatens to compromise the economic, social, and
democratic gains made in Africa in recent decades, and $15 billion in new funds made by
the US under the Global AIDS and Tuberculosis Relief Act of 2000 22USC(76)IIA§6831
were matched by other nations for an estimated $25 billion. The Secretary-General of the
UN has however asked for another $8-10 billion a year to fight AIDS.
1. The ONE Campaign wrote, ―Without our help, the Global Fund may have to cut
programs that have already begun to have a real impact, delivering prevention, care and
treatment to millions of people around the world. Remember, AIDS kills 8,500 people
every day, TB kills 5,000 and malaria kills over 3,000 in Africa alone - every day.
Together, we can help fight back against these killer diseases. We also have an
unprecedented opportunity to wipe poliomyelitus from the world through the
immunization of affected countries as has been done in the Americas however the
program needs $250 million through 2006‖.
2. The Kaiser Foundation wrote, ―The Senate approved 98-1 a $31.8 billion fiscal year
2006 foreign aid appropriations bill (HR 3057) that includes nearly $3 billion to fight
global HIV/AIDS, tuberculosis and malaria, as well as about $1.8 billion for the
Millennium Challenge Account, which is meant to encourage economic and political
reform in developing countries. The Senate by a voice vote added $100 million to the
bill's appropriation for the Global Fund To Fight AIDS, Tuberculosis and Malaria U.S.
Senators Dick Durbin (D-IL) and Rick Santorum (R-PA) applauded the passage of their
amendment to increase the United States' contribution to the Global Fund to Fight AIDS,
Tuberculosis, and Malaria to $866 million in fiscal year 2007.
3. The evident culpability of the US government in the invention of the HIV epidemic is
disturbing and great caution must be taken that public and private US foreign assistance
for HIV/AIDS and other tropical diseases to ensure that it is spent on unadulterated anti-
retrovirals and other drugs and is not used to finance bio-terrorism or any form of
government oppression. In conversation with a naturalized US citizen from South Africa
who dropped out of medical school to serve as information officer in the South African
Embassy to the United States in the critical years (1980-1985) when the virus was
theoretically smuggled, adamantly claims, ―AIDS comes from bush meat‖. This is not a
satisfactory explanation but does raise genuine concern for the safety of bloody meats
purchased in stores. More explanation was prevented by protection of the Extradition
Treaty between the Government of the United States of America and the Government of
the Republic of South Africa, signed at Washington on September 16, 1999 that prohibits
1398
rendition to the International Criminal Court, whose International Criminal Tribunal for
Rwanda also seems to have also been complicit in the HIV/AIDS plot. The US
Government cannot be accepted in good faith until they have changed the name of the
Court of International Trade of the United States (CoITUS) to Customs Court (CC).
4. The general lesson of HIV/AIDS is that the actual spreading of epidemics of any kind
is often the result of legislatively sanctioned conspiracies between bio-medical research
and the judiciary who is responsible for the actual de-liver-y of pathogens and might
recruit the neighbors, friends, family and medical establishmnet of the intended victim.
In the report Ethical Issues in the Growing AIDS Crisis adopted December 1987 (JAMA.
1988; 259: the Council on Ethical and Judicial Affairs of the American Medical
Association recognizes AIDS patients are entitled to competent medical service with
compassion and respect for human dignity and to the safeguard of their confidences
within the constraints of the law. Those persons who are afflicted with the disease or who
are seropositive have the right to be free from discrimination. A physician may not
ethically refuse to treat a patient whose condition is within the physician's current realm
of competence solely because the patient is seropositive. Physicians have a responsibility
to prevent the spread of contagious diseases, as well as an ethical obligation to recognize
the rights to privacy and to confidentiality of the AIDS victim. Thus, the societal need for
accurate information and public health surveillance must also be respected.
G. The immune system fights a long, ferocious, but ultimately losing battle against the
AIDS virus. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of
blood if the number is less than 200 CD4 cells or if the CD4 percentage is less than 14%,
the person has AIDS. A person‘s viral load is also considered important in determining
the danger of infection posed by AIDS. In late stages of the infection, victims lose and
replace about 2 billion CD4 lymphocyte cells a day, while new virus particles appear at a
rate between 100 million and 680 million a day. Other viral disease, such as leukemia,
flu, or hepatitis may also trigger such high viral loads, but for a relatively brief time
(Biddle ‘95: 76-81). 9 out 10 people who test positive will develop further problems. The
San Francisco study showed that without use of the latest therapies: 50% with HIV
develop AIDS in ten years, 70% with HIV develop AIDS in fourteen years, and of those
with AIDS, 94% are dead in five years. No antibodies have yet been found in a human
being that are effective in the long term against HIV. That is why a vaccine is so difficult
to find. Attempts have even been made to flood the bloodstream with small pieces of cell
wall (CD4) so the viruses are unable to touch living CD4 white cells. According to a
study in 14th International AIDS Conference, average annual cost of treating HIV-
positive patients in the United States can vary from about $34,000 to $14,000, depending
on the stage of the virus (HIV Symptoms ‘11).
1.The newest and most effective combination AIDS drug is efavirenz/emtricitabine/
tenofovir (Atripla) that promises to totally eliminate viral loads but comes with
considerable hepatoxicity and hepadependence that can be mitigated with Pegalated
interferon alpha-2B injections (Pegasys). The mint family (Lamiaceae) produces a wide
variety of constituents with medicinal properties. Several family members have been
reported to have antiviral activity, including lemon balm (Melissa officinalis L.), sage
1399
(Salvia spp.), peppermint (Mentha x piperita L.), hyssop (Hyssopus officinalis L.), basil
(Ocimum spp.) and self-heal (Prunella vulgaris L.). Aqueous P. vulgaris extracts
inhibited HIV-1 infectivity, primarily through inhibition of early, post-virion binding
events. The ability of aqueous extracts to inhibit early events within the HIV life cycle
suggests that these extracts (or purified constituents) responsible for the antiviral activity
are promising microbicides and/or antivirals against HIV-1.
Fig. 9-11 Seven classes of Retroviral Medicine
Class Drugs Notes
Nucleoside zidovudine (Retrovir), Inhibit the replication of an HIV
analogue lamivudine (Epivir), enzyme called reverse
reverse didanosine (Videx), transcriptase; side effect of
transcriptase stavudine (Zerit), zidovudine is bone marrow
inhibitors abacavir (Ziagen), (Epcicom) suppression, which causes a
(NRTIs) (Trizivir) emtricitabine (Emtriva) decrease in the number of red and
(Truvada combination) white blood cells, 5 percent of
people treated with abacavir
experience rash, fever, fatigue,
nausea, vomiting, diarrhea and
abdominal pain, didanosine caused
fatal liver disease. Symptoms
usually appear within the first six
weeks of treatment and generally
disappear when the drug is
discontinued.
Protease saquinavir (Invirase), PIs interrupt HIV replication at a
inhibitors ritonavir (Norvir)(Kaletra, Aluvia) later stage in its life cycle by
(PIs) indinavir (Crixivan), interfering with an enzyme known
nelfinavir (Viracept), as HIV protease. HIV particles
amprenavir (Agenerase), become structurally disorganized
lopinavir/ritonavir (Kaletra), and noninfectious. Darunavir is for
atazanavir (Reyataz), people who haven't responded to
tipranavir (Aptivus), treatment with other drugs.
Darunavir (Prezista) combination Darunavir is used with ritonavir
and other anti-HIV medications.
side effects are nausea, diarrhea
and other digestive tract problems
Non- nevirapine (Viramune), Bind directly to the enzyme reverse
nucleoside delavirdine (Rescriptor), transcriptase; side effect rash and
reverse efavirenz (Sustiva), aggravation of mood disorders.
transcriptase etravirine (Intelence)
inhibitors
(NNRTIs)
Nucleotide tenofovir (Viread)(Truvada) Inhibits both HIV and hepatitis B
reverse more quickly than NRTIs, side
1400
transcriptase effects, nausea, vomiting, diarrhea
inhibitors and gas, HBV resurgence if
(NtRTIs) discontinued.
―nuke‖
family
Fusion enfuvirtide (Fuzeon) Combination; Injection to suppress
inhibitors resistant strains of HIV
Integrase raltegravir (Isentress) Combination; blocks replication of
inhibitors the HIV integrase enzyme; side
effects include diarrhea, nausea,
headache and fever.
Chemokine maraviroc (Selzentry) Highly effective treatment for a
co-receptor particular type of HIV infection
inhibitors called CCR5-tropic HIV-1; Side
effects may include liver and
cardiovascular problems, as well as
cough, fever, upper respiratory
tract infections, rash and
abdominal pain.
Combination efavirenz/emtricitabine/tenofovir Hepatoxicity and hepatic
(Atripla), dependence noted for Truvada
emtricitabine-tenofovir (Truvada), (2004) and Atripla (2006). Highest
abacavir/lamivudine (Epzicom) marks go to Atripla, the newest
zidovudine/lamivudine/abacavir drug, that promises to totally
(Trizivir), eliminate viral loads. Hepatoxicity
lopinavir/ritonavir (Kaletra, Aluvia) can be mitigated with Pegylated
zidovudine/lamivudine (Combivir) interferon alpha-2B (Pegasys)
injections.
Source: Sanders, Tony J. Table 8 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
2. HIV, which actually refers to two closely related viruses that cause AIDS in separate
geographical regions, is part of a class of retroviruses known as lentiviruses traditionally
associated with chronic arthritis and anemia. Lentiviruses are retroviruses that cause
slowly progressive often fatal disease. HIV interferes with the body's ability to fight off
viruses, bacteria and fungi that cause diseases such as pneumonia and meningitis, by
damaging the immune system. The virus and the infection itself are known as HIV. HIV
tests detect antibodies. HIV attaches itself to the T lymphocytes, that turn the immune
system on and off, with a protein called DF4 on their surface, which is the actual hookup
point for HIV. Once inside a T cell, the virus releases its genetic template (RNA) along
with a chemical that allows it to be transcribed into the cell‘s own DNA. All offspring of
the altered T cell thus contain the virus‘s genetic code. The T cell also may become a
factory for new infectious HIV, which lyse it as they burst out.
3. Two to fifteen years may pass between initial infection and onset of the AIDS
syndrome. Acquired immune-deficiency syndrome (AIDS) is the name given to the later
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stages of an HIV infection. Six to twelve weeks after HIV penetrates the body‘s natural
defenses and programs the white blood cells the first symptom to appear is flu-like
glandular fever with swollen glands in the neck and armpits. Blood test will usually
become positive at this time. HIV AIDS symptoms begin when the immune system starts
to break down. Several glands in the neck and armpits may swell and remain swollen for
more than three months. This is known as persistent generalized lymphadenopathy
(PGL). As the HIV disease progresses, the person starts showing up other AIDS
symptoms. A simple boil or warts may spread all over the body. The mouth may become
infected by thrush (thick white coating), or may develop some other problem. Dentists
are often the first to be in a position to make the diagnosis. People may develop severe
shingles (painful blisters in a band of red skin), or herpes. They may feel overwhelmingly
tired all the time, have high temperatures, drenching night sweats, lose more than 10% of
their body weight, and have diarrhea lasting more than a month. The final stage is AIDS.
Most of the immune system is intact and the body can deal with most infections, but one
or two more unusual infections become almost impossible for the body to get rid of
without medical help, usually intensive antibiotics.
Fig. 9-12 Common AIDS Symptoms and Medicine
Pathogen Symptoms Drug Monograph
persistent generalized Rapid enlargement Begin or intensify antiretroviral therapy,
lymphadenopathy of a previously causes vary, use antibiotics, Cidofivir
(PGL) stable lymph node (Vistide) is the anti-herpes for AIDS
substitute for Acyclovir (Zovirax), that
or a group of nodes
may be improved with Foscarnet Sodium
(Foscavir) injection
Coronavirus, Swollen lymph Cold remedies: Diphenhydramine
Rhinovirus, Influenza nodes, cold and flu- (Benylin, Benadryl), Chlorpheniramine
A & B, like symptoms (Telachlor, Chlo-Amine, Chlor-Trimeton,
Parainfluenza, lasting 4 days to a Aller-Chlor), Brompheniramine
Respiratory syncytial week, bronchiolitis, (Bromphen, Nasahist B, Dimetane
virus pneumonia Extentabs) Bed rest for fevers. Flu vaccine
ineffective. OTC Theraflu, Allegra
(Sanofi-Aventis) and Children's Allegra
(fexofenadine) and Allegra-D
(fexofenadine and pseudoephedrine);
Prescription Oseltamivir (Tamiflu) and
Zanamivir (Relenza). Antibiotics for
pneumonia, ampicillin (Principen),
azithromycin (Zithromax), levofloxacin
(Levaquin). Avoid asthma inhalers that
contain corticosteroids, that suppress the
immune system. Fatal adverse events with
salmeterol inhalers. Smoke jimson weed
for asthma and mullein for bronchitis.
Adenovirus, Upper and lower Rotovirus vaccine (Rotarix
1402
Norovirus, Echovirus respiratory tract GlaxoSmithKline GSK) (Rotateq Merck &
and Rotavirus infections (URI, Co.), LigoCyte phase II intranasal
acquired from LRI), norovirus, White rice water diet. Imodium
children conjunctivitis, (Loperamide), Immune Globulin IV for
diarrhea severe cases
Salmonellosis Severe diarrhea, Hydration, white rice water diet, imodium
Salmonella spp fever, chills, (Loperamide), trimethoprim-
bacteria acquired by abdominal pain sulfamethoxazole (Septra), metronidazole
ingesting and, occasionally, (Flagyl ER) 10 days max
contaminated food vomiting,
and water contagious when
shed in bile
Candidiasis Inflammation of Antimycotics, antifungal drugs: topical
Candida albicans the mouth or clotrimazole (Fungoid Solution, Gyne-
acquired from genitals and thick Lotrimin, Lotrimin, Lotrisone, Mycelex),
antibiotic resistance white coating on topical nystatin (Mycostatin, Mykacet,
the mucous, called Nystat-Rx, Nystop, Pedi-Dri), fluconazole
thrush, usually (Diflucan), and topical ketoconazole
found in children. (Extina, Nizoral, Nizoral A-D, Xolegel).
Take metronidazole (Flagyl ER) to avoid
antibiotic resistant Candidiasis
Cryptosporidiosis Intestinal and White rice water diet,
Cryptosporidium spp. bowel infection Primary: nitazoxanide (Alinia)
Protozoal parasite causes severe Alternates: metronidazole (Flagyl ER),
acquired from soil, diarrhea, cramps, Trimethoprim-sulfamethoxazole (Septra)
bird or bat droppings malnutrition and
weight loss in
AIDS patients
Cryptococcal Fever, Antimycotics: fluconazole (Diflucan),
meningitis hallucinations, flucytosin (Ancobon), amphotericin B IV
Cryptococcus headache, nausea (Amphotec, Abelcet, AmBisome),
neoformans and vomiting, Paromomycin Sulfate (Humatin)
sensitivity to light,
stiff neck
Tuberculosis (TB) Only 10% develop Isoniazid (Rifamate, Rifater), rifampicin
Mycobacterium pulmonary TB (Rifadin, Rimactane, Rifamate, Rifater),
tuberculosis acquired involving fever, dry pyrazinamide (Daraprim, Rifater), and
from cough or sneeze cough, weight loss ethambutol (Myambutol) for two months,
droplets and abnormalities, then isoniazid and rifampicin alone for four
10% of these months. Cured at six months (2 to 3%
develop TB relapse). For latent tuberculosis, standard
pleuritis that infects treatment is six to nine months of
the lining between isoniazid. If the organism is fully sensitive,
the lung and isoniazid, rifampicin, and pyrazinamide for
abdominal cavity two months, combination Rifater (sanofi-
and causes chest aventis) followed by isoniazid and
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pain. TB kills two rifampicin for four months, ethambutol
out of three with need not be used. Hepatoxic
untreated
symptoms, death
rate is 5% with
treatment
Toxoplasmosis Enlarged lymph Combination - Antibiotic: sulfadiazine ie.
Toxoplasma gondii nodes, headache, Trimethoprim-sulfamethoxazole (Septra)
Spread by cat feces mild fever, muscle and Antimalarial : pyrimethamine
pain, sore throat, in (Daraprim) and Antidote: leucovorin
AIDS patients, (Wellcovorin)
retinal
inflammation and Alternate: Atovaquone (Mepron)
seizures
Varicella-zoster virus Chicken pox and Measles, Mumps, Rubella and Varicella
shingles vaccine (MMRV, ProQuad, Merck & Co.,
Inc.) or Varicella vaccine (VARIVAX,
Merck & Co.);
Cidofivir (Vistide), Acyclovir (Zovirax),
Valtrex (Valacyclovir)
Cytomegalovirus After long latency Cidofivir (Vistide), Acyclovir (Zovirax),
(CMV) herpes virus causes damage to Foscarnet Sodium (Foscavir) injection,
acquired from bodily the eyes, digestive topical interferon alpha-2B for eyes and
fluids tract, lungs or other epidermal eruptions
organs,
tumorigenic
Kaposi‘s sarcoma Bluish-red or topical interferon alpha-2B, Cidofivir
human herpesvirus-8 purple bumps on (Vistide), Acyclovir (Zovira), Foscarnet
(HHV-8) the skin, caused by Sodium (Foscavir) injection, intense AIDS
tumor of the blood drugs, Antineoplastic: Cisplatin (Platinol)
vessel walls, may
involve organs, in
lung maybe bloody
sputum, shortness
of breath
Lymphomas Begin with painless Topical or pegylated interferon alpha-2B,
swelling of the Cidofivir (Vistide), Acyclovir (Zovirax),
lymph nodes in Foscarnet Sodium (Foscavir) injection,
neck, armpit or Antineoplastic: Cisplatin (Platinol)
groin
Source: Sanders, Tony J. Table 9 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
4. Persistent generalized lymphadenopathy (PGL), swollen lymph nodes is usually the
first AIDS symptom that develops and indicates that a person should begin taking
antiretroviral therapy if they have not done so already. There are many causes for PGL,
1404
swollen lymph nodes, so antibiotics are used to treat bacterial infections, and Cidofivir
(Vistide), the anti-herpes for AIDS, substitute for Acyclovir (Zovirax), are the first line of
defense. The most common reason for swollen lymph nodes in the general population is
the common cold. Otherwise it is necessary to diagnose and treat the cause of the
lymphatic flare up. Coronavirus and Rhinovirus, are associated with the swollen lymph
nodes of the common cold for which there are a number of OTC remedies such as
Diphenhydramine (Benylin, Benadryl), Chlorpheniramine (Telachlor, Chlo-Amine,
Chlor-Trimeton, Aller-Chlor), Brompheniramine (Bromphen, Nasahist B, Dimetane
Extentabs), Ipratropium intranasal (Atrovent). Flu-like symptoms were formerly
effectively treated overnight with OTC Theraflu but the FDA now approves Allegra
(Sanofi-Aventis), Children's Allegra (fexofenadine) and Allegra-D (fexofenadine and
pseudoephedrine). Because corticosteroids are immune-suppressant, and salmeterol
dangerous, asthma inhalers are not advised for AIDS patients with asthma and bronchitis
might prefer to smoke non-addictive jimson weed for asthma and mullein for bronchitis.
Take these treatments only for the condition it is prescribed. AIDS patients may get
swollen lymph nodes from the common disorders below or others causes.
5. The digestive tract is reputed to be responsible for 80% of the immune system and
gastrointestinal problems and diarrhea are probably the most dangerous common
manifestation of HIV/AIDS. Adenovirus, Norovirus, Echovirus and Rotavirus acquired
from children are the most common viral causes of upper and lower respiratory tract
infections (URI, LRI), conjunctivitis, diarrhea. There is a Rotovirus vaccine (Rotarix
GlaxoSmithKline GSK) (Rotateq Merck & Co.) and LigoCyte is entering phase II of an
intranasal norovirus vaccine clinical trial. Home treatment for diarrhea, that tends to
suppress appetite, is white rice water diet, the objective is to eat white rice boiled for the
proper time in 3 parts instead of 2 parts water, and drink the excess water to keep
hydrated. Imodium (Loperamide) is an effective diarrhea remedy available without
prescription. Immune Globulin IV can be administered for severe cases of viral diarrhea.
It here that AIDS patients need a strong warning that antibiotics cause gastroenteritis in
general and a particular condition called pseudomembranous colitis, known as antibiotic
associated colitis, in particular, resulting from the proliferation of antibiotic resistant
Clostridium difficile bacteria. Metronidazole (Flagyl ER) is an antibiotic and
antiamoebic that treats antibiotic associated colitis as well as antibiotic associated
Candidiasis, and does not disturb the gut, it is however carcinogenic and not very
effective against viruses or funguses, although it causes the least antibiotic resistance.
The most highly recommended broad spectrum antibiotic for AIDS patients against
bacterial infection, while protecting the gut are sulfaminides such as trimethoprim-
sulfamethoxazole (Septra).
6. Salmonellosis symptoms include severe diarrhea, fever, chills, abdominal pain and,
occasionally, vomiting. It is caused by Salmonella spp bacteria acquired by ingesting
contaminated food and water. Like all diarrheas salmonella is treated with hydration,
white rice, and imodium (Loperamide), and because it has a bacterial cause trimethoprim-
sulfamethoxazole (Septra) or metronidazole (Flagyl ER) 10 days max should be effective
where other antibiotics only inflame the gut. Cryptosporidiosis occurs when
contaminated food or water is ingested and the Cryptosporidium spp. protozoal parasite,
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acquired from soil, bird or bat droppings, that grows in the intestines and bile ducts,
leading to severe, chronic diarrhea in people with AIDS. A white rice water diet, is
needed. The primary treatment for Cryptosporidiosis is nitazoxanide (Alinia) and
alternatively metronidazole (Flagyl ER) or Trimethoprim-sulfamethoxazole (Septra).
7. Candidiasis is a yeast infection that causes inflammation of the mouth or genitals and a
thick white coating on the mucous, known as thrush. AIDS is often diagnosed by dentists
noting the oral condition. Candida albicans the yeast causing Candidiasis is often
acquired as the result of antibiotic resistance that metronidazole (Flagyl ER) is very
effective at suppressing, and is the drug of choice for the treatment of mouth infections,
to prevent the otherwise nearly inevitable antibiotic resistant Candidiasis. For the
treatment of serious Candidiasis antimycotics, antifungal drugs, such as topical
clotrimazole (Fungoid Solution, Gyne-Lotrimin, Lotrimin, Lotrisone, Mycelex), topical
nystatin (Mycostatin, Mykacet, Nystat-Rx, Nystop, Pedi-Dri), topical ketoconazole
(Extina, Nizoral, Nizoral A-D, Xolegel) and oral fluconazole (Diflucan), are used.
Cryptococcal meningitis is a common central nervous system infection, caused by a
fungus Cryptococcus neoformans that is present in soil, and may also be associated with
bird or bat droppings. It‘s symptoms are fever, hallucinations, headache, nausea and
vomiting, sensitivity to light and stiff neck. Cryptococcal meningitis is treated with
antimycotics: fluconazole (Diflucan), flucytosin (Ancobon), amphotericin B IV
(Amphotec, Abelcet, AmBisome), and Paromomycin Sulfate (Humatin). AIDS doesn't
appear to infect the nerve cells but can cause neurological symptoms such as confusion,
forgetfulness, depression, anxiety, trouble walking and AIDS dementia complex, which
leads to behavioral changes and diminished mental functioning (Mayo ‗10).
8. Tuberculosis (TB) is the most common opportunistic infection associated with HIV, in
developing nations, and a leading cause of death among people living with AIDS. Only
10% of infected population develops symptoms. Pulmonary TB involves fever, dry
cough, weight loss and abnormalities, 10% of these develop TB pleuritis that infects the
lining between the lung and abdominal cavity and causes chest pain. TB kills two out of
three with untreated symptoms, death rate is 5% with treatmentThe DOTS treatment
prescribed by the world health organization is a combination of Isoniazid (Rifamate,
Rifater), rifampicin (Rifadin, Rimactane, Rifamate, Rifater), pyrazinamide (Rifater), and
ethambutol (Myambutol) for two months, then isoniazid and rifampicin alone for four
months. TB is cured at six months with only a 2 to 3% relapse rate. For latent
tuberculosis, standard treatment is six to nine months of isoniazid. If the organism is fully
sensitive, isoniazid, rifampicin, and pyrazinamide for two months, combination Rifater
(sanofi-aventis) followed by isoniazid and rifampicin for four months, ethambutol need
not be used. Antimalarials are Hepatoxic. Toxoplasmosis is a potentially deadly
infection caused by Toxoplasma gondii, a parasite spread primarily by infected cats who
pass the parasites in their stools, and the parasites may then spread to other animals. The
treatment for Toxoplasmosis involves a combination of Antibiotic: sulfadiazine ie.
Trimethoprim-sulfamethoxazole (Septra) or Atovaquone (Mepron) and the Antimalarial:
pyrimethamine (Daraprim) with Antidote: leucovorin (Wellcovorin).
9. Varicella-zoster virus causes chicken pox in children and shingles in elders and AIDS
patients. There is a Measles, Mumps, Rubella and Varicella vaccine (MMRV, ProQuad,
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Merck & Co., Inc.) or Varicella vaccine (VARIVAX, Merck & Co.). Shingles can also
be treated with Cidofivir (Vistide), Acyclovir (Zovirax), Valtrex (Valacyclovir).
Cytomegalovirus (CMV) is a common herpes virus, that is transmitted in body fluids
such as saliva, blood, urine, semen and breast milk; after long period of latency the virus
resurfaces causing damage to the eyes, digestive tract, lungs or other organs and is
tumorigenic. CMV is treated with topical interferon alpha-2B for eyes and epidermal
eruptions, Cidofivir (Vistide), the AIDS substitute for Acyclovir (Zovirax), and Foscarnet
Sodium (Foscavir) injection if resistant.
10. Cancers common to HIV/AIDS are Kaposi‘s sarcoma and lymphoma. Kaposi's
sarcoma is a tumor of the blood vessel walls caused by human herpesvirus-8 (HHV-8).
Although rare in people not infected with HIV, it's common in HIV-positive people.
Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In
people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can
also affect the internal organs, including the digestive tract and lungs. The initial
treatment is to intensify AIDS drugs, apply topical interferon alpha-2B on epidermal
eruptions, Acyclovir (Zovira), then Cidofivir (Vistide) and then Foscarnet Sodium
(Foscavir) injection, before taking toxic antineoplastics. Lymphomas usually begin in the
lymph nodes with a painless swelling of the lymph nodes in the neck, armpit or groin.
Lymphoma occurs when B or T cells acquire changes that allow them to grow
uncontrollably. The abnormal cells accumulate in the lymphatic system.
11. There are two types of lymphoma: Hodgkin and non-Hodgkin lymphoma. The
majority of Hodgkin lymphomas are classical Hodgkin lymphomas, which consist of
characteristic cells called Reed-Sternberg cells. Another much more rare type of Hodgkin
lymphoma is nodular lymphocyte-predominant Hodgkin lymphoma. The most common
are B cell cancers called diffuse large B cell lymphoma and follicular lymphoma. Other B
cell non-Hodgkin lymphomas include Burkitt lymphoma, immunoblastic large cell
lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T cell
non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma,
and precursor T-lymphoblastic lymphoma. To treat cancer intensify AIDS drugs, take
Cidofivir (Vistide) and then Foscarnet Sodium (Foscavir) and pegyated interferon alpha-
2B (Pegasys) injections. The first resort antineoplastic therapy, that can be used alone or
in combination to treat most cancers, is Cisplatin (Platinol), that contains the precious
metal platinum. Copper is also known to have antiseptic properties.
§346 Cancer
A. Cancer (can-sir) is the uncontrolled growth and spread of cells, also called malignant
melanoma, that may affect almost any tissue in the body. Lung, colorectal and stomach
cancers are amongst the five most common forms of cancer amongst men and women in
the world. CDC reports that Cancer is the second leading cause of death among
Americans, is responsible for one of every four deaths in the United States. In 2005, more
than 570,000 Americans—or more than 1,500 people a day—will die of cancer. Close to
1.4 million new cases will be diagnosed in 2005. This estimate does not include
preinvasive cancer or the more than 1 million cases of nonmelanoma skin cancer
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expected to be diagnosed this year. Incidences of cancer rose dramatically in the 20th
century. Cancer accounted for only 4% of all deaths in 1900 but for 23% in 2000.
1.Cancer is one of the most common causes of morbidity and mortality today, with more
than 10 million new cases and more than 7 million deaths each year worldwide, 12.5% of
all death. More than 20 million persons around the world live with a diagnosis of cancer,
and more than half of all cancer cases occur in the developing countries. Cancer is
responsible for about 20% of all deaths in industrialized countries and 10% in developing
countries. Much of this increase in absolute numbers derives from the ageing of
populations worldwide as reported in WHOs Cancer Prevention and Control A/58/16.
Globally, about 12.4 million people will be diagnosed with some form of cancer this
year, and 7.6 million people will die. The global cancer burden doubled in the last 30
years of the 20th century. Of those 7.6 million people who will die of cancer this year, it
has been estimated that up to 4 million could have been saved just through healthy eating,
and especially avoiding sugar and starch. A diet should include fresh vegetables, a
healthy dose of omega-3 fats and high levels of anti-oxidants such as found in blueberries
and raspberries. That would bring the number down to 3.6 million deaths each year.
2. Cancer is a disease where damaged cells of the patient's body mutate so that they do
not undergo programmed cell death, but their growth is no longer controlled and their
metabolism is altered. Carcinogens may increase the risk of getting cancer by altering
cellular metabolism or damaging DNA directly in cells, which interferes with biological
processes, and induces the uncontrolled, malignant division, ultimately leading to the
formation of tumors. Viruses have been implicated in causing several forms of fungoid
growth and it is usually wise to treat for both fungal and viral infection. Usually DNA
damage, if too severe to repair, leads to programmed cell death, but if the programmed
cell death pathway is damaged, then the cell cannot prevent itself from becoming a
cancer cell.The term carcinogen refers to any substance, nucleotide or radiation that is
directly involved in the promotion of cancer in the increase of its propagation.
Radioactive emissions such as gamma rays and alpha particles are generally considered
carcinogenic. Common examples of carcinogens are inhaled asbestos, certain dioxins
and tobacco smoke.
B. The American Cancer Society estimates that about 1,479,350 Americans (766,130
males and 713,220 females) will be diagnosed with a new case of cancer (not including
pre-invasive cancer or nonmelanoma skin cancer) and 562,340 (292,540 males and
269,800 females) will die of cancer in 2009, which is more than 1,500 cancer deaths per
day. The overall survival rate is 62% (62% males and 62% females). The new report
shows a 19% drop in men's overall cancer death rates between 1990 and 2005 and a
decline of about 11% in women's overall cancer death rates between 1991 and 2005.
These declines reflect a medium-term, gradual decline in cancer death rates, which trace
back to a drop in certain cancers and better screening and survival for certain cancers.
1.Between 1930 and 2006 the number of cancer deaths rose dramatically from 103,500
(53,000 males and 50,500 females) a rate of 84 per 100,000 citizens in 1930 to 520,000
(290,000 male and 230,000 female) a rate of 173 per 100,000 citizens, in 2006. The
primary variable, for both sexes, has been an increase in the number of cases of lung
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cancer and decline in the number of cases of stomach cancer; in women there has also
been a decrease in uterine cancer. In 1930, in both men and women, there was a death
rate of around 4 per 100,000 for lung cancer and a death rate of 45 for men and 37 for
women per 100,000 for stomach cancer. In 2005 there was death rate of 75 and 41 per
100,000 and an incidence rate of 80 and 55 per 100,000 respectively for lung cancer in
men and women. The death rate for stomach cancer declined to around 4 per 100,000 for
both men and women in 2005. There has also been a significant increase in the death rate
from pancreatic cancer from 4 per 100,000 in both men and women in 1930 to 10 in
women and 15 in men in 2005. Most other cancer have remained static with the
exception of prostate cancer in men that underwent a sharp spike in death rates per
100,000 rising from 18 in 1930 to 40 in 1990 before declining to 22 in 2005. Diagnosis
of prostate cancer has however risen from 95 per 100,000 in 1975 to 150 in 1990 where it
remains.
Fig. 9-13 New Cases of Cancer, Death and Survival Rate in the U.S., 2009
a.The American Cancer Society's estimate ranked by number of new cases of cancer,
deaths and survival rate among U.S. men in 2009 (not including nonmelanoma skin
cancer and in situ (noninvasive) cancers.
1. Prostate cancer: 192,280 new cases; 27,360 deaths; 86% survival
2. Lung cancer: 116,090 new cases; 88,900 deaths; 23% survival
3. Colorectal cancer: 75,590 new cases; 25,240 deaths; 66% survival
4. Bladder cancer: 52,810 new cases; 10,180 deaths; 81% survival
5. Melanoma: 39,080 new cases; 2,200 deaths; 94% survival
6. Non-Hodgkin's lymphoma: 35,990 new cases; 9,830 deaths; 73% survival
7. Kidney cancer: 35,430 new cases; 8,160 deaths; 77% survival
8. Leukemia: 25,630 new cases; 12,590 deaths; 51% survival
9. Esophegeal: 25,240 new cases; 11,490 deaths; 55% survival
10. Pancreatic cancer: 21,050 new cases; 18,030 deaths; 14% survival
11. Liver cancer: 12,600; 11,890 deaths; 6% survival
12. Brain cancers: 10,620 new cases; 7,170 deaths; 33% survival
b. American Cancer Society estimates of new cases of cancer, deaths and survival rates in
women:
1. Breast cancer: 192,370 new cases; 40,170 deaths; 79% survival
2. Lung cancer: 103,350 new cases; 70,490 deaths, 32% survival
3. Colorectal cancer: 71,380 new cases; 24,680 deaths; 65% survival
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4. Uterine cancer: 42,160 new cases, 7,780 deaths; 82% survival
5. Non-Hodgkin's lymphoma: 29,990 new cases, 9,670 deaths;
6. Melanoma: 29,640 new cases, 2,890 deaths, 90% survival
7. Thyroid cancer: 27,200 new cases, 940 deaths; 97% survival
8. Kidney cancer: 22,330 new cases, 4,820 deaths; 78% survival
9. Ovarian cancer: 21,550 new cases; 14,600 deaths; 32% survival
10. Pancreatic cancer: 21,420 new cases; 17,210 deaths; 20% survival
11. Leukemia: 15,070 new cases; 9,280 deaths; 38% survival
12. Brain cancers: 7,880 new cases; 5,590 deaths, 29% survival
13. Liver cancer: 5,910 new cases; 4,510 deaths; 24% survival
C. New cancer diagnoses and cancer deaths were more common from 2001 to 2005
among African-Americans than among whites, except for breast cancer (more new cases
among whites), lung cancer (more new cases and more deaths among white women than
African-American women), and kidney cancer (more deaths among whites). New cases
of stomach and liver cancer, and deaths from those cancers, are twice as common among
Asian-American/Pacific Islanders than among whites. That reflects increased prevalence
of chronic infection with H. pylori bacteria and the hepatitis B and C viruses, according
to the American Cancer Society. American Indians/Alaskan natives have the highest rates
of new cases of kidney cancer and kidney cancer deaths.
1. Overall, in 2006 white males suffered a cancer death rate of 230.7 and white females
159.2 per 100,000. African American males had the highest risk of dying from cancer
with a rate of 313.0 and African American females 186.7 per 100,000. Asian and Pacific
Islander males suffered a cancer death rate of 190.0 and females 95.6 per 100,000.
American Indian males suffered a cancer death rate of 190.0 and females 142.0 per
100,000. Hispanic males died from cancer at a rate of 159.0 and females 105.2 per
100,000. The differences in death rates between different ethnicities is probably
attributed to diet, cultural attitudes regarding fitness, cultural exposure to risk factors such
as hepatitis B and C in Asian and Pacific Islanders and the prevalence of a particular type
genocide in, and/or against, a specific racial and sexual group armed with carcinogens.
D. More than 900 chemicals have been determined to be capable of inducing cancer in
humans or animals after prolonged or excessive exposure by numerous agencies involved
in the identification of carcinogens such as the International Agency for Research on
Cancer (IARC), National Toxicology Program (NTP), Environmental Protection Agency
(EPA) monitored by the American Cancer Society list of Known and Probable Human
Carcinogens. There are many well-known examples of chemicals that can cause cancer in
humans. The fumes of the metals cadmium, nickel, and chromium are known to cause
lung cancer. Vinyl chloride causes liver sarcomas. Exposure to arsenic increases the risk
of skin and lung cancer. Leukemia can result from chemically induced changes in bone
marrow from exposure to benzene and cyclophosphamide, among other toxicants. Other
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chemicals, including benzo[a]pyrene and ethylene dibromide, are considered by
authoritative scientific organizations to be probably carcinogenic in humans because they
are potent carcinogens in animals. Chemically-induced cancer generally develops many
years after exposure to a toxic agent. A latency period of as much as thirty years has been
observed between exposure to asbestos, for example, and incidence of lung cancer.
1. Whereas cancer is obviously a disease of 20th century science and social controls
against the disease border on the repressive, it is imperative that biosecurity over
carcinogens be heightened and that carcinogens are preventatively destroyed and that
manufacturers and distributors of weaponized laboratory carcinogens are terminated and
punished. The national program of cancer registries (NPCR) under 42USC(61)IIM§280e
that maintains demographic information about every case of cancer must therefore be
held responsible by the Secretary for monitoring and destroying the carcinogenic
products of cancer research and prevented against conflict of interest with bio-medical
research or the Bar Association. Powerful carcinogens that could be weaponized to
swiftly cause cancerous cells and tumors must be identified in list of dangerous biological
products and highly regulated under 42USC(6A)(2)(F)(1)§262a and subjected to total
recall when not being used in ethical experiments or suspected of abuse posing imminent
harm to human life under 42USC(6A)(2)(F)(1)§262(d). Title 45, U.S. Code of Federal
Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001,
effective December 13, 2001, Declaration of Helsinki, companion Guiding Principles in
the Care and Use of Animals need to be enforced by the Nuremburg Code as in the
Doctor Trials under the Prohibition with respect to biological weapons under
18USC(10)I§175 and the carcinogens destroyed under 18USCI(10)176 the BWC,
Convention on the Prohibition of the Development, Production and Stockpiling of
Bacteriological (Biological) and Toxin Weapons and on their Destruction that was
opened in 1972 and entered into force in 1975 and the Convention on the Prohibition of
the Development, Production, Stockpiling, and Use of Chemical Weapons and on their
Destruction CWC was opened in Paris in 1993 and entered into force in 1997, for
everyone, not merely the highly educated.
2. Carcinogens do not cause cancer at all times, under all circumstances. Some may only
be carcinogenic if a person is exposed in a certain way (for example, ingesting it as
opposed to touching it). Some may only cause cancer in people who have a certain
genetic makeup. Some of these agents may lead to cancer after only a very small
exposure, while others might require intense exposure over many years. Laboratory
research into the carcinogenocy of substances has led to the isolation of more potent
carcinogens and facilitating the weaponization of highly potent carcinogens that cause
targeted cancers, tumors and death very quickly. Although long term exposures to
smelly, moldy and toxic substances substances should be avoided, and addiction to
tobacco and careers in coal mining and painting stand out as being a very noxious, it is
the swift mutations, tumors and death of odorless, colorless weaponized laboratory
carcinogens, permeated materials, and those who bear them, that one must be ever
vigilant for. In most circumstances, presuming normal respect for hygiene,
environemtnal standards and governmental removal of carcinogenic substances such as
1411
asbestos, it is not until one, or a family member, comes down with cancer, that one must
be overly concerned about environmental toxins.
3. There are many natural carcinogens. Aflatoxin B1, which is produced by the fungus
Aspergillus flavus growing on stored grains, nuts and peanut butter, is an example of a
potent, naturally-occurring microbial carcinogen. Certain viruses such as Hepatitis B and
human papilloma viruses and Rous sarcoma virus. Cooking food at high temperatures,
for example grilling or barbecuing meats, can lead to the formation of minute quantities
of many potent carcinogens that are comparable to those found in cigarette smoke (i.e.,
benzo(a) pyrene).
4. Benzene, kepone, EDB, asbestos, and the waste rock of oil shale mining have all been
classified as carcinogenic. As far back as the 1930s, industrial smoke and tobacco smoke
were identified as sources of dozens of carcinogens, including benzopyrene, tobacco-
specific nitrosamines such as nitrosonornicotine, and reactive aldehydes such as
formaldehyde—which is also a hazard in embalming and making plastics. Vinyl chloride,
from which PVC is manufactured, is a carcinogen and thus a hazard in PVC production.
5. Co-carcinogens are chemicals that do not necessarily cause cancer on their own, but
promote the activity of other carcinogens in causing cancer. After the carcinogen enters
the body, the body makes an attempt to eliminate it through a process called
biotransformation. The purpose of these reactions is to make the carcinogen more water-
soluble so that it can be removed from the body. But these reactions can also convert a
less toxic carcinogen into a more toxic one. DNA is nucleophilic, therefore soluble
carbon electrophiles are carcinogenic, because DNA attacks them. For example, some
alkenes are toxicated by human enzymes to produce an electrophilic epoxide. DNA
attacks the epoxide, and is bound permanently to it. This is the mechanism behind the
carcinogenity of benzopyrene in tobacco smoke, other aromatics, aflatoxin and mustard
gas.
6. Tobacco smoke contains over 4000 chemical compounds, many of which are
carcinogenic or otherwise toxic. The American Cancer Society estimates that tobacco
will cause about 169,000 U.S. cancer deaths in 2009. It is highly recommended to quit
smoking to prevent or defeat a diagnosis of cancer. It is however highly questionable as
to whether it is the cigarette smoke and tobacco products, the maliciously added chemical
additives or the vicious campaign against smoking waged by the Surgeon General and
affiliated animal laboratory research scientists that is causing the increase in cancer?
a. It is estimated that around 43% of cancer deaths are due to tobacco use, unhealthy
diets, alcohol consumption, inactive lifestyles and infection. Of these, tobacco use is the
world‘s most avoidable cause of cancer. In addition to lung cancer, tobacco consumption
causes cancer of the oral cavity, pharynx, larynx, oesophagus, stomach, pancreas, liver,
kidney, ureter, urinary bladder, uterine cervix and bone marrow (myeloid leukaemia).
Exposure to environmental tobacco smoke (passive smoking) increases lung cancer risk.
Tobacco use and alcohol consumption act synergistically to cause cancer of the oral
cavity, pharynx, larynx and oesophagus. Using alcohol temperently will reduce long term
the incidence of cancer in sites such as stomach, liver, breast, uterine cervix, colon and
1412
rectum. Infectious agents are responsible for almost 25% of cancer deaths in the
developing world and 6% in industrialized countries.
b. The death rate from lung cancer increased dramatically after scientists identified
tobacco smoke as a carcinogen in the 1930s from 4 per 100,000 in both men and women
to a high of 90 in men and 39 in women in 1990. The rate has subsequently gone down
to 75 in men and 41 in women. The incidence rate is also alarming, increasing from 90 in
men and 25 in women per 100,000 in 1975 to 150 in men and 48 in women in 1990 to
decline to 80 in men and 55 in women in 2005.
c. The reason for this increase is attributed by the scientific community to a dramatic
increase in the per captia consumptin of cigarettes from less than 800 in 1900 to 2000 in
1930 when lung cancer death rate statistics are first available to 3,000 in 1940 when lung
cancer rates began to increase to a high of 4,000 cigarettes in 1960, when 52% of men
and 34% of women smoked cigarettes, and lung cancer began to increase exponentially
and smoking began to taper off. While lung cancer rates continued to rise until the 1990s
when lung cancer rates began to decline, by 2007 the smoking rate had dropped to 28%
of men and 20% of women.
E. A number of animal viruses have the oncogenic potential to change a cell from a
normal one to a cancer or tumor cell. Of the various human DNA viruses three
(papillomaviruses, Epstein-Barr virus (EBC) and hepatitis B virus (HBV) are known to
cause cancer. In 2002 it was reported that viral infections accounted for around 18% of
all cancers worldwide. Different viruses employ different strategies, some highly
complex, to make copies of themselves once they have invaded a host cell. During
replication of the viral nucleic acid, the viral genes may first have to code the
manufacture of special enzymes called polymerases or transcriptases to assist in
replication or may borrow these enzymes from the host cell. Sometimes the viral genome
must invade the nucleus of the host cell and incorporate itself into the cell‘s
chromosomes before it can replicate. Sometimes if the viral genome invades the nucleus
of the host cell, it may not at first replicate but may ―hide‖ there, sometimes becoming
reactivated months or years later. It may also interact with the cell‘s chromosomes, a
process that may convert the cell into a tumor cell. Genetic damage (or mutation) may be
acquired (in somatic cells) by the action of environmental agents, such as chemicals,
radiation, or viruses.
1.The chromosomes in all normal body cells contain 50 or more genes (known as
oncogenes) that are necessary for growth or differentiation of the cells. Certain
retroviruses contain almost identical oncogenes. The oncogene is known as the src gene
(src for sarcoma). Oncogenes, cancer causing genes, are derived from proto-oncogenes
that promote normal growth and differentiation to suppress tumors. Oncogenes encode
proteins called oncoproteins. In the process of replication, these viruses may modify the
chromosomes of the host cell. A small mutation in these can ―switch on‖ the oncogenes
inappropriately, thus prompting the cell to begin unrestrained division, leading to cancer.
Infection by certain types of animal viruses leads to a process called transformation,
during which growth becomes uncontrolled. Because cancerous cells in the animal body
have fewer growth requirements, they grow profusely, leading to the formation of large
1413
masses of cells called tumors. The term neoplasm is often used in the medical literature
to describe malignant tumors. Not all tumors are seriously harmful. Noninvasive tumors
are called benign. Other tumors, called malignant, invade the body and destroy normal
body tissues and organs. In advanced stages of cancer, malignant tumors may develop
the ability to spread to other parts of the body and initiate new tumors, a process called
metastasis. A clinically detectable tumor contains 109. The latent period before which a
tumor becomes clinically detectable is unpredictably long, usually years, and is only
diagnosed after they are fairly advanced in their life cycle. After they become clinically
detectable, the average volume-doubling time for such common killers as cancer of the
lung and colon is about 2 to 3 months. The range of doubling time is broad, varying from
less than 1 month for some childhood cancers to more than 1 years for certain salivary
gland tumors.
2. Retroviruses were the first viruses shown to cause cancer. Retroviruses resemble
bacterial viruses. The enzymatic activities found in the virus particle are reverse
transcriptase, DNA endonuclease (integrase) and a protease. Some tumorigenic
retroviruses are known to cause sarcomas or acute leukemia and possess a high
oncological potential. Infection with one these viruses can cause cellular transformation,
leading to the formation of a tumor. Retroviruses are the agents by which such gene is
transferred from cell to cell. Leukemia (reticulosarcomas) and lymphoma
(lymphosarcomas) have a relationship to Epstein-Barr virus infection, which causes
infectious mononucleosis, Hodgkin‘s disease, nasopharyngeal carcinomas and leukemias.
In addition retrovirus (oncornavirus, leukovirus) particles similar to those found in animal
leukemias have been discovered. Human T-Cell Leukemia virus type 1 HTLV-1 is an
RNA retrovirus endemic to certain parts of Japan and the Caribbean basin but is found
sporadically elsewhere. Leukemia develops in about 1% of infected individual after a
long latent period of 20 to 30 years. HTLV-1 is also associated with a demyelinating
neurologic disorder called tropical spastic parapareses (Cotran ‘94: 286-290). In the
United States the peak of acute lymphocytic leukemia occurs among children between 3
and 4 years of age, then the rate falls until the age of 35, when the incidence of
predominantly chronic lymphocytic leukemia appears to rise. Radiation induces both
chronic myeloid leukemia and acute leukemia, that has also been associated with
exposure to such chemicals as benzene and chloramphenicol. The treatment of leukemia
begins with Acyclovir (Zovirax) and professional treatment begins with Immune
Globulin Intravenous (IGIV) and Pegylated interferon alfa-2b (Pegasys) injection. If that
fails Imatinib (Gleevec) tablets are the first targeted anti-neoplastic therapy approved for
chronic myeloid leukemia, the most common side effect is edema.
Fig. 9-14: Some human cancers that may be caused by viruses
Cancer Virus Family Genome Antiviral Monographs
Adult T-cell Human T-cell Retrovirus RNA Pegylated interferon alpha-2b
Leukemia leukemia virus (Pegasys) injection, Immune
(type I) Globulin Intravenous (IGIV),
monoclonal antibody:
Imatinib (Gleevec)
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Brukitt‘s Epstein-Barr Herpes DNA Topical interferon alpha-2B,
lymphoma virus Acyclovir (Zovirax),
Foscarnet Sodium (Foscavir)
injection, Immune Globulin
(IGIV) Cisplatin (Platinol)
Nasopharyngeal Epstein-Barr Herpes DNA Topical interferon alpha-2B,
carcinoma virus Acyclovir (Zovirax),
Foscarnet Sodium (Foscavir)
injection, Immune Globulin
(IGIV); Combination with
Cisplatin (Platinol)
Hepatocellular Hepatitis B Hepadna DNA Bivalent (Combination)
carcinoma (liver virus Hepatitis A and Hepatitis B
cancer) Vaccine (TWINRIX GSK);
Pegylated interferon alfa-2b
(Pegasys),
Nucleoside/nucleotide
analogues (NAs) adefovir
(Hepsera) tenofovir (Viread);
Antineoplastic Sorafenib
Tosylate (Nexavar)
Colon cancer Polyomavirus Papova DNA topical interferon alfa-2b,
JCV SV40 Acyclovir (Zovirax),
Foscarnet Sodium (Foscavir)
injection monoclonal
antibody: Fluorouricil
(Adrucil) and antidote
leucovorin (Wellcovorin)
Skin and cervical Papilloma virus Papova DNA topical interferon alfa-2b,
cancers Quadrivalent HPV vaccine
(HPV4; Gardasil, Merck &
Co, Inc.), Acyclovir (Zovirax),
Foscarnet Sodium (Foscavir)
injection and Cidofivir
(Vistide) antineoplastics:
Fluorouricil (Adrucil) and
cisplatin (Platinol)
Source: Sanders, Tony J. Table 10 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
F. Cancer screening is a powerful tool to detect cancer in its early stages when treatments
and lifestyle changes are more likely to be successful, but they also come with a high risk
of false diagnosis and associated unecessary harmful medical treatment and a grave risk
of exposure to the professional malevalent distributors of carcinogens. Early detection of
cancer can mean a better prognosis. Some cancers, like ovarian cancer, don't have routine
screening tests, but even when screening tests exist, not everyone uses them. For
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instance, the American Cancer Society notes that mammography usage hasn't increased
since 2000, and that less than half -- 47% -- of Americans 50 and older have gotten a
colorectal cancer screening test.
1. Pancreatic cancer comes with one of the worst prognoses. The American Cancer
Society puts the odds of surviving five years after being diagnosed in the early stages
with the disease at 37 percent rather than 15-20 percent for all people suffering pancreatic
cancer. In comparison, the five-year survival rate for early-stage breast cancer and early-
stage prostate cancer is virtually 100 percent rather than 79 and 89 percent respectively.
Early-stage colon cancer, carries a 93 percent five-year survival rate rather than 66
percent. It would therefore seem that it is a good idea to be regularly screened for cancer.
Many scientists have however argued against routine widespread cancer screening and
improvements in cancer rates in the past two decades could be the general ethical
reluctance to engage in unecessary cancer screening and treatment.
2. Breast self-exams have long been recommended as a simple way for women to keep
track of anything unusual in their breasts. Now, after studies have found that such exams
do not reduce breast cancer death rates, and actually increase the rate of unnecessary
biopsies, many experts are recommending a more relaxed approach known as ―breast
awareness.‖
a.The U.S. Preventive Services Task Force recommends women get a mammogram every
year or two after age 40 (before 2001 it was women over 50). The technology however
carries a first-time false positive rate of up to 6 percent. False positives can lead to
expensive repeat screenings and can sometimes result in unnecessary invasive procedures
including biopsies and surgeries. Women have unnecessarily undergone mastectomies,
radiation and chemotherapy after receiving false positives on a mammogram.
b.Mammograms expose your body to radiation that can be 1,000 times greater than that
from a chest x-ray, which poses risks of cancer. Mammography also compresses your
breasts tightly, and often painfully, which could lead to a lethal spread of cancerous cells,
should they exist. The premenopausal breast is highly sensitive to radiation, and it is
estimated that each 1 rad exposure increasing breast cancer risk by about 1 percent, with
a cumulative 10 percent increased risk for each breast over a decade's screening. The
high sensitivity of the breast, especially in young women, to radiation-induced cancer
was known by 1970. Nevertheless, the establishment then screened some 300,000 women
with Xray dosages so high as to increase breast cancer risk by up to 20 percent in women
aged 40 to 50 who were mammogramed annually. Most doctors however continue to
recommend mammograms for fear of being sued if they do not and the woman develops
breast cancer.
c. The establishment ignores safe and effective alternatives to mammography,
particularly trans illumination with infrared scanning known as thermographic breast
screeing that the radiation of infrared heat from your body and translates this information
into anatomical images. Your normal blood circulation is under the control of your
autonomic nervous system, which governs your body functions. Thermography uses no
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mechanical pressure or ionizing radiation, and can detect signs of breast cancer years
earlier than either mammography or a physical exam. Mammography cannot detect a
tumor until after it has been growing for years and reaches a certain size. Thermography
is able to detect the possibility of breast cancer much earlier, because it can image the
early stages of angiogenesis (the formation of a direct supply of blood to cancer cells,
which is a necessary step before they can grow into tumors of size).
d. A group of researchers who track breast cancer rates have proposed the controversial
notion that some tumors found with mammograms might naturally disappear on their
own if left undetected. Invasive breast cancer rates among nearly 120,000 women age 50
to 64 who had a mammogram over a six-year period. They compared the number of
breast cancers detected with another group of about 110,000 women of the same age who
were screened just once at the end of the six-year period. The researchers said they
expected to find no differences in breast cancer rates -- but instead, they found 22 percent
more invasive breast tumors in the group who had mammograms every two years. This
raises the possibility that some cancers somehow disappear naturally.
3. The Prostate-Specific-Antigen (PSA) blood test — the screening test for prostate
cancer — has been found in two new studies to save few if any lives and exposes large
numbers of men to risky and unnecessary treatment. The findings raise new questions
about the rapid and widespread adoption of the test, which measures a protein released by
prostate cells. It was introduced in 1987 and quickly became a routine part of preventive
health care. With the new data, cancer experts said men should carefully consider the
test‘s risks and benefits before deciding to be screened. Both reports were published
online on Wednesday by The New England Journal of Medicine. One involved 182,000
men in seven Euroepan countries the other, by the National Cancer Institute involved
nearly 77,000 men at 10 medical centers in the United States.
a.Taken together, the studies found that screening was associated with a 20 percent
relative reduction in the prostate cancer death rate. But the number of lives saved was
small — seven fewer prostate cancer deaths for every 10,000 men screened and followed
for nine years. The American study, which had a single design, found no reduction in
deaths from prostate cancer after most of the men had been followed for 10 years. Every
man has been followed for at least seven years. By seven years, the death rate was 13
percent lower for the unscreened group. The European study saw no benefit of screening
in the first seven years of follow-up.
b.The reason screening saved so few lives, cancer experts say, is that prostate cancers
often grow very slowly, if at all, and most never endanger a man if left alone. But when
doctors find an early-stage prostate tumor, they cannot tell with confidence whether it
will be dangerous so they usually treat all early cancers as if they were life-threatening.
As a result, the majority of men, whose early-stage cancers would not harm them, suffer
serious effects of cancer therapy but get no benefit. Others, with very aggressive tumors,
may not be helped by screening because their cancer has spread by the time it is detected.
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c. Prostate cancers often are less dangerous than breast cancers, so screening and
subsequent therapy can result in more harm. In the European study, 48 men were told
they had prostate cancer, and needlessly treated for it, for every man whose death was
prevented. With mammography, about 10 women receive a diagnosis and needless
treatment for breast cancer to prevent one death. One way to think of the data is to
suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer,
and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared
death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance
that he will have been treated unnecessarily for a cancer that was never a threat to his life
or health.
4. Whatever the results of new studies, cancer screening is an important part of
preventive medicine, particularly to detect deadly forms of cancer when the odds of
survival are good. Cancer screening is however dangerous because a false positive can
lead a person with nothing or a mild growth the body would eliminate on its own to
subject themselves to unnecessary, unpleasant and life threatening treatment. On the
other hand cancer screening is important for the person to take steps to combat cancer
and monitor the effectiveness of their lifestyle changes.
G. The basic assumption in cancer treatment is that all cancer cells must be killed or
removed to achieve cure, and render the patient‘s life expectancy the same as a normal
life expectancy. It is comparatively easy to kill 99% of the malignant cells, but resistant
ones are nearly always present, and from these recurrences result. Antineoplastic drugs
work on the basis of the unique abnormal metabolism of malignant cells. Alkylating
agents (cytotoxic compounds, Mechlorethamine (Mustargen) are able to kill malignant
cells during all phases of their cycle by combining chemically with nucleic acids. Other
generic alkylating agents include Thitepa, chlorambucil (Leukeran). Cyclosphosphamide
(Cytoxan) used against Hodgkin‘s disease and other lymphomas, lymphatic leukemia and
certain solid cancers. Antimetabolites available commercially include Methotrexate
(Trexall), mercaptopurine (Purinethol), Thioguanine, Fluorouracil (Adrucil), and
cytarabine (DepoCyt). These agents usually kill cells at the time of DNA synthesis.
Hormones like prednisone, are widely used in compound chemotherapy, diethylstilbestrol
and ethinyl estradiol are estrogens effective in the treatment of breast carcinoma and in
the carcinoma of the prostate, androgens (testosterone propionate, testosterone enanthate,
testolactone) are also effective in the treatment of breast cancer, and the progestagens
(hydroxyprogesterone, megestrol acetate) used to treat metastatic and recurrent
endometrial carcinoma. Radioactive isotopes include iodine are readily taken up by the
thyroid gland, where the destructive action of radiation may be effective in treating
carcinoma of the thyroid.
1. Treatment aims to cure disease, prolong life, and improve the quality of life. The most
effective and efficient treatment is linked to early detection programmes and follows
evidence-based standards of care. Treatments for cancer are particularly harsh, chemo
and radiation therapy both come with devastating side effects. Most pancreatic cancer
patients undergo what is known as a Whipple procedure. In this surgery, parts of the
pancreas are removed along with parts of the stomach and small intestine, the
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gallbladder, part of the common bile duct, and some nearby lymph nodes. Most cancer
patients require palliative care. Palliative care involves not only pain relief, but also
spiritual and psychosocial support to patients and their families from diagnosis,
throughout the course of the disease, to the end of life and bereavement.
2. Radiation has been used for the treatment of cancer since shortly after the x-ray was
invented in 1895. The fallout from Hiroshima and Nagasaki however made it painfully
obvious that radiation causes cancer. Since the mass marketing of the automobile,
television, computer and cell phone the number of cancer cases and mortalities increased
dramatically before subsiding slightly at the beginning of the 21st century. DVD writers
are radioactive, and if broken very radioactive, please remove broken devices,
particularly if experiencing the symptoms of radiation poisoning - convulsions, vascular
damage, cardio vascular collapse, keloids and cancers. Radiotherapy continues to be
commonly used for the treatment of cancer and low relapse rates are reported.
a. Radiation treatment was pioneered by Wilhelm Reich M.D., a protege of Sigmund
Freud, found that orgone, a measurable natural energy found everywhere pulsing with life
and weather, was useful in the treatment of cancer, but was reluctant to call it a cure.
Reich had been disgraced for his anti-fascist writing and found asylum from death
sentences from both Hitler and Stalin, in the United States. In a unique judicial ruling, the
FDA obtained a Federal Court Decree of Injunction, which ruled that the orgone energy
―does not exist‖. Several years later, Reich was charged with Contempt of Court, and
died in federal prison in 1957. Recent clinical trials from hospitals in Germany found the
somatic effects of the orgone energy accumulator were more powerful in the treatment of
cancer than any other form of conventional or natural therapy they had tried. Pain was
relieved, the appetite was stimulated, and the patients became more alert and active. The
blood picture cleaned up, with red cells showing a stronger energetic charge, and fewer t-
bacilli. Tumors ceased growing and in some cases, declined dramatically in size. Reich
warned persons with a history of hypertension, decompensated heart diseases, brain
tumors, arteriosclerosis, glaucoma, epilepsy, heavy obesity, apoplexia, skin
inflammations or conjunctivitis not to use the accumulator, and in some cases, as the
patient‘s tumors began to disintegrate, they would become debilitated by the toxic break-
down products of the tumor, and die of secondary complications, such as kidney or liver
failure. Experimental orgone accumulator products such as boxes and blankets can be
purchased online.
b. Radiation therapy can cause early and late side effects. Early side effects are those that
happen during or shortly after treatment. They usually are gone within a few weeks after
treatment. Late side effects are those that take months or years to develop. They are often
permanent. The most common early side effects are: fatigue (feeling tired) and skin
changes Other early side effects usually are related to the area being treated, such as hair
loss and mouth problems following radiation treatment to the head. Radiation can
damage normal cells, and sometimes this damage can have long-term effects. For
example, radiation to the chest area may affect the lungs or heart. In some people this
may cause scarring, which can affect a person‘s ability to do things. Radiation to the
abdomen (belly) or pelvis can lead to bladder, bowel, or sexual problems in some people.
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Radiation in certain areas can also lead to fluid build-up and swelling in parts of the
body, a condition known as lymphedema. Radiation can also cause another form of
cancer to flare up.
3. Chemotherapy is the use of medicines (or drugs) to treat disease. Although surgery and
radiation therapy destroy or damage cancer cells in a specific area, chemotherapy works
throughout the body. Chemotherapy drugs can destroy cancer cells that have metastasized
or spread to parts of the body far from the primary (original) tumor. More than 100
chemotherapy drugs are used in various combinations. Although a single chemotherapy
drug can be used to treat cancer, generally they are more powerful when used with other
drugs. Usually chemotherapy treatment will consist of more than one drug. This is called
combination chemotherapy. A combination of drugs with different actions can work
together to kill more cancer cells and reduce the chance that you may become resistant to
a particular chemotherapy drug. Unfortunately chemo doesn‘t kill just cancer cells but
also many celss in the body resulting in numerous severe side effects not limited to
nausea and vomiting, hair loss , fatigue, increased chance of bruising and bleeding ,
anemia, infection, intestinal problems , appetite and weight changes , sore mouth, gums,
and throat , nerve and muscle problems , dry and/or discolored skin , kidney and bladder
irritation, sexuality and fertility issues due to effects on reproductive organs
a. Leukemia (reticulosarcomas) and lymphoma (lymphosarcomas) have a relationship to
Epstein-Barr virus infection, which causes infectious mononucleosis, Hodgkin‘s disease,
nasopharyngeal carcinomas and leukemias. In addition retrovirus (oncornavirus,
leukovirus) particles similar to those found in animal leukemias have been discovered.
Human T-Cell Leukemia virus type 1 HTLV-1 is an RNA retrovirus endemic to certain
parts of Japan and the Caribbean basin but is found sporadically elsewhere. Leukemia
develops in about 1% of infected individual after a long latent period of 20 to 30 years.
HTLV-1 is also associated with a demyelinating neurologic disorder called tropical
spastic parapareses. In the United States the peak of acute lymphocytic leukemia occurs
among children between 3 and 4 years of age, then the rate falls until the age of 35, when
the incidence of predominantly chronic lymphocytic leukemia appears to rise. Radiation
induces both chronic myeloid leukemia and acute leukemia, that has also been associated
with exposure to such chemicals as benzene and chloramphenicol. The treatment of
leukemia begins with Acyclovir (Zovirax) and professional treatment begins with
Immune Globulin Intravenous (IGIV) and Pegylated interferon alfa-2b (Pegasys)
injection. If that fails Imatinib (Gleevec) tablets are the first targeted anti-neoplastic
therapy approved for chronic myeloid leukemia, the most common side effect is edema.
Monoclonal antibodies are given in combination with other drugs.
b. Epstein-Barr virus is a member of the herpes family that has been implicated in the
pathogenesis of four types of human tumors: the African form of Burkitt‘s lymphoma, B-
cell lymphomas in immunosuppressed individuals, some cases of Hodgkin‘s disease and
nasopharyngeal carcinomas. EVB infects epithelial cells of the oropharynx and B
lymphocytes causing a latent infection that acquires the ability to propagate indefinitely.
More than 90% of African tumors and 100% of nasopharyngeal carcinomas around the
world, carry the EBV genome that causes infectious mononucleosis. EBV provides
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multiple selective advantages to tumor cells, including promoting cell proliferation and
inhibiting cell death. In the case of Burkitt's lymphomas, most current evidence indicates
that the tumor requires the virus minimally to block apoptosis. Interferon Alpha2-B
should be applied topically, Acyclovir (Zovirax) resistant EBV should be treated with
Foscarnet Sodium (Foscavir) injection with Immune Globulin (IGIV) maintenance before
antineoplastics. The primary drug treatment for Nasopharyngeal carcinomas and
lymphomas is Cisplatin (Platinol) with Prednisone.
c. Hepatitis B virus is highly associated with liver cancer and infection increases the
chance of developing liver cancer 200 fold. Worldwide, chronic infection with hepatitis
causes 80% of all primary liver cancers and more than 500,000 people die each year from
this lethal cancer. With chronic HBV infections on the rise in the United States, there is a
growing incidence of primary liver cancer and it has become one of the three fastest
growing cancers in the country. While the overall incidence of cancer has decreased,
primary liver cancer is an increasing public health threat and has a five-year survival rate
of less than 10%, making it the 2nd deadliest cancer in the U.S. Liver cancer can be cured
only when it's found at an early stage, before it has spread. Bivalent (Combination)
Hepatitis A and Hepatitis B Vaccine (TWINRIX GSK), Pegylated interferon alfa-2b
(Pegasys), Nucleoside/nucleotide analogues (NAs) adefovir (Hepsera) and tenofovir
(Viread) are quite effective at treating the underlying HBV infection. Surgery is
recommended for those liver cancer patients who are healthy enough. Surgery involves
mechanically cleaning and removing cancerous tissue, a partial or full hepatectomy and
transplantation. There are many strange methods for treating liver cancer such alcohol
(methanol) injection to the tumor site, and the surgery seems rushed. Sorafenib Tosylate
(Nexavar) is a new targeted cancer cell therapy approved for the treatment of kidney and
liver cancers.
d. Colorectral cancer is the fourth most common cancer among men and third most
common among women worldwide. In 2002, there were around a million new cases of
colorectal cancer worldwide, accounting for 9.4% of all cancer. The cells of the human
replicate at a relatively high rate with 1010 epithelial cells being replaced every day. If the
colonic epithelial cells accumulate mutations there is a hyper-proliferation of neoplastic
growth, known as Adenomatous polyps (adenomas) that have the potential to develop
into cancer. Other pathways for colorectal cancer include hyperplastic polyps and
ulcerative colitis. The human intestine provides a habitat for over 500 different species
of bacteria, with the highest concentration found in the colon. In addition to bacteria, the
human colon is frequently exposed to viruses. Several studies since 2000 have suggested
that the polyomavirus JCV SV40 is associated with more than 50% of colorectal cancers
but many bacteriophages remain unexplored. Chemical causes can‘t be ruled out either.
Surgery is very dangerous. Cytarabine (DepoCyt) has been reported to target the
Polyomavirus JVC SV40, in progressive multifocal leuoencephalopathy, but may not be
the most effective against colon cancer. Fluorouricil (Adrucil) and antidote leucovorin
(Wellcovorin) is the most likely antineoplastic treatment for colon cancer. Begin
treatment for colon polyps and colon cancer with topical interferon alpha-2B applied to
the colon and Acyclovir (Zovira).
1421
e. Approximately 65 genetically distinct types of human papillomavirus (HPV) have been
identified, many of which have been implicated in squamous papillomas (warts) and 85%
of invasive squamous cell cancers and their presumed precursors (severe dysplasias and
carcinoma in situ). Infection with HPV (human papillomavirus) is very common. About
20 million people in the U.S. are affected. HPV vaccines are directed against two
oncogenic types (HPV 16 and 18) and two nononcogenic types (HPV 6 and 11). HPV
types 6 and 11 cause approximately 90% of 500,000 annual cases of genital warts and
most cases of recurrent respiratory papillomatosis. HPV 16 and 18 cause about 70% of
cervical cancers; as well as vulvar, vaginal, anal, and oropharyngeal and oral cavity
cancers and precancer lesions, caused primarily by HPV 16. HPV-associated cancers in
males include certain anal, penile, and oropharyngeal and oral cavity cancers caused
primarily by HPV 16. Quadrivalent HPV vaccine (HPV4; Gardasil, Merck & Co, Inc.)
was licensed in 2006 for use in females aged 9 through 26 years, and in October 16, 2009
for use in males ages 9-26 but it does not cure people who are already infected. Regular
pap smears help detect precancerous dysplasia. Imiquimod (Aldara), podophyllotoxin
(Condylox), cantharidin (Cantharone) creams are used for warts; topical interferon alpha
2B for cancer. Acyclovir (Zovirax), Foscarnet Sodium (Foscavir) injection and Cidofivir
(Vistide) should be tried before more dramatic treatment. Hysterectomies are fairly safe
whereas the uterus is not a vital organ. The antineoplastics Fluorouricil (Adrucil) and
cisplatin (Platinol) are a good start.
6. Cancer survivors avoid exposure to chemicals, eat vegan organic fruit and vegetables,
plenty of berries and greens high in antioxidants, get plenty of exercise, and lead a
religious life. In general the first line of pharmaceutical defense against tumorgenic
activity is topical interferon alfa-2b and the oral anti-herpes drug Acyclovir (Zovirax) that
can be purchased online without prescription. If online experimentation does not yield the
desired results one should consult a physician to receive an injection of Pegylated
interferon alfa-2b (Pegasys), Foscarnet Sodium (Foscavir) injection and Immune
Globulin Intravenous (IGIV) while watching and waiting for the proper time to
experiment with anti-neoplastic treatment or join a clinical study. Red sap from bloodroot
(Sanguinaria Canadensis) has been used for the treatment of cancerous disease by the
North American Indians living along the shores of Lake Superior. Applied as a salve
daily, generally within 2 to 4 weeks the disease was destroyed, with the mass falling out
in 10 to 14 additional days, leaving a flat healthy sore that usually healed rapidly. All
cases illustrated remissions, if not cures. North American May apple (podophyllum
peltatum) rhizome or underground stem was used by the Penobscot Indians of Maine to
treat cancer and venereal warts (condyloma acuminate), and is the primary ingredient of
the broad spectrum etopiside (Etoposide Etopophos, Toposar, VePesid) but is highly
toxic.
H. The best policy for people wishing to prevent cancer or who have been diagnosed with
cancer is for them to totally reevaluate their lifestyle and terminate relationships with
people who pose a threat of bio-terrorism and move to a new secure location with a
minimum of possibly contaminated possessions and be retested. Bar certified attorneys
and their legal assistants seem to pose the greatest risk of malevalently using weaponized
carcinogens. ―What is your sign?‖ is a pickup line at the bar and Cancer is a month in the
Zodiac so cancer seems to be humorous. Don't smoke or use other tobacco products.
1422
Maintain a healthy weight. Being overweight or obese is linked to increased risk of
certain cancers, including breast cancer, colon cancer, endometrial cancer, esophageal
cancer, kidney cancer and brain cancer. Cancer cells can be stored for years in fat. Many
people who went into remission after a cancer diagnosis, who survived the prescribed
period of time and should have been okay, but did not watch their weight and were obese,
developed another form of cancer entirely, often brain cancer, and died after defeating
their initial diagnosis. The goal is a flat stomach for unimpeded elimination of toxic
waste from the body. Therefore it is imperative to adopt a physically active lifestyle.
Adults should get at least 30 minutes (and ideally 45-60 minutes) of moderate to vigorous
physical activity at least five days per week. Children and teens should get at least an
hour of moderate to vigorous activity at least five days per week. Eat a healthy diet that
emphasizes plant sources. Watch portion sizes, read food labels, eat five or more servings
of vegetables and fruits daily, choose whole grains over processed grains and sugars, and
limit consumption of processed and red meats. Limit or eliminate consumption of
alcoholic beverages. Women should drink no more than one drink per day; men no more
than two drinks per day.
§346 Bacteriology
A.Robert Koch (1842-1920) is generally attributed with being the father of modern
scientific bacteriology. He was twenty-two years old when Lister performed his first
antiseptic operation. Koch began an unparalleled rise from unknown district physician.
First, he explained the secrets of the life of the anthrax bacillus. Next he turned his
attention to the suppuration of wounds and proved that this was caused by various
animate microbes, again a scientific feat. It was not long before Koch was called to the
Imperial Public Health Adminsitration in Berlin, embarked on research into tuberculosis.
On 24 March 1882 with the modesty of true genius, he was able to make known to a
meeting of the Physiologica society in Berlin that he had found the consumption germ to
be a rod-shaped fission-fungus which was between one-and-a-half and three-and-a-half
thousandths of a millimeter long and barely half a thousandth of a millimeter thick. His
fame could no longer be checked. He was awarded honors and distinctions on all sides
and became the most well-known and renowned scientist of his era. He was revered as a
God in Japan where he lived for some time with his Japanese wife. Robert Koch did not
discover the germs of all contagious diseases, what he did achieve, however, by his
tenacious, unflinching work was the creation of the initial procedures which made
possible the construction of an original scientific bacteriology. By a brilliant process of
synthesis of many individual discoveries an entirely new science was created. He taught
people to understand the nature of infectious diseases and epidemics and the manner in
which they were transmitted. He also made clear why uncleanlinesss, dirt and disease are
so closely connected, called into being a new public health service and so by his work,
introduced an entirely new era for all humanity.
1.Bacterial cells are prokaryotes, which lack nuclei and endoplasmic reticulum. Their
cell walls are relatively rigid, composed either of two phospholipid bilayers with a
peptidoglycan layer sandwiched in between (gram-negative species) or of a single bilayer
covered by peptidoglycan (gram positive bacteria). Bacteria synthesize their own DNA,
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RNA and proteins but depend on their host for favorable growth conditions.. There are 10
times more microbes than human cells in our bodies. Humans live in symbiosis with an
estimated 1014.001 bacteria. Normal persons carry 1012 bacteria on the skin, including the
Staphylococcus, we do most of our hand-washing to protect against, epidermidis and
Propionibacterium acnes, the agent responsible for adolescent pimples. Normally, 1014
bacteria reside inside the gastrointestinal tract, 99.9% of which are anaerobic, including
Bacteroides species. Without these symbiotic gut flora humans would not gain any
nutrition from their food and die. Other bacteria are necessary for the proper functioning
of certain joints.
B. There is an international effort to catalogue thousands of new microbe species by
gathering their DNA sequences. They‘re finding that the micro-biome does a lot to keep
us in good health. Micro-biome first came to light in the mid-1600s, when the Dutch
lens-grinder Antonie van Leeuwenhoek scraped the scum off his teeth, placed it under a
microscope and discovered that it contained swimming creatures. A number of teams are
working together to tackle this problem in a systematic way. The biggest of these
initiatives is known as the Human Microbiome Project. The $150 million initiative was
started in 2007 by the National Institutes of Health. The project team is gathering samples
from 18 different sites on the bodies of 300 volunteers and are sequencing the entire
genomes of some 900 species that have been cultivated in the lab. Before the project,
scientists had only sequenced about 20 species in the microbiome. The scientists
published details on the first 178 genomes. They discovered 29,693 genes that are unlike
any known genes. The entire human genome contains only around 20,000 protein-coding
genes. In the mouth alone, there are between 500 and 1,000 species. Next to viruses,
bacteria are the most frequent and diverse class of naturally occurring human pathogens
but this may not hold true as our understanding of the microbiome increases.
C. The development of drugs able to prevent and cure bacterial infections is one of the
twentieth century‘s major contributions to human longevity and quality of life. The term
antibiotics literally means ―against life‖ in this case against microbes. There are many
types of antibiotics, antibacterials, antivirals, antifungals and antiparasitics. Some drugs
are effective against many organisms, these are called broad-specturm antibiotics. Others
are effective against just a few organisms and are called narrow-spectrum antibiotics.
The most commonly used antibiotics are antibacterials. In 1920, British scientist
Alexander Fleming was working in his laboratory at St. Mary‘s Hospital in London when
almost by accident, he discovered a naturally growing substance that could attack certain
bacteria. In one of his experiments Fleming observed colonies of the common
staphylococcus aureaus bacteria that had been worn down or killed by mold growing on
the same plate or petrie dish. He determined that the mold made a substance that could
dissolve the bacteria. He called this substance penicillin, after the Penicillium mold that
made it, by 1941 they recognized even small doses of penicillin cured bacterial infections
and Fleming was awarded the Nobel Prize in Physiology and Medicine. During World
War II antibiotics came into use curing battlefield wound infections and pneumonia. By
the mid-to late 1940s it became widely accessible for the general public. Before
antibiotics 90% of children with bacterial meningitis died, strep throat was at times a fatal
disease.
1424
1.Antibacterial agents are among the most commonly prescribed drugs of any kind
worldwide. At least 150 million antibiotic prescriptions are written in the United States
each year, many of them for chidren. Use of antibacterial agents in hospitals in the
United States accounts for 20 to 50 percent of all drug costs and represents the largest
expenditure for any pharmacologic class. In the outpatient setting, the costs of
antibacterial drugs are second only to those of cardiovascular agents. A survey of office-
based physician found that between 1980 and 1992 there was a marked increase in the
use of expensive broad spectrum antimicrobials. It is not unusual for the purchase cost in
1995 of a newer parenteral antibiotic to be $1,000 to $2,000 for a 10 to 14 day course of
treatment. Therapy with a new oral antibiotic can easily cost $50 to $60. The cost of an
office visit to get a prescription, administrative costs, monitoring costs and pharmacy
charges must be added to these figures for a start-up fee for an as needed refillable
prescription of around $150 dollars (Fauci et al ‘98: 869).
Fig. 9-15 Bacterial Infections
Bacteria Infections Usual Antibiotic Comments
Actinomyces israelii Actinomycosis, Penicillin An anaerobic infection
lumpy jaw disease,
abscesses
Arcanobacterium Pharyngitis Erythromycin Rash similar to scarlet fever
haemolyticum
Bacillus anthracis Anthrax Penicillin, Rate in nature; was used as a
ciprofloxacin, bioterrorism weapon
doxycycline
Bacillus cereus Diarrhea Supportive care Food borne
Bacteroides species Abscesses Metronidazole Anaerobes; part of normal
flora of the bowel
Bartonella henselae Cat-scratch disease None or Kittens are the usual
azithromycin transmitters
Bordetella pertussis Whooping cough Erythromycin, Infection can be prevented
azithromycin by immunization
Borrelia burgdorferi Lyme disease Doxycycline, Transmitted by ticks
amoxicillin,
ceftriaxone
Borrelia recurrentis Relapsing fever Penicillin Transmitted by body lice and
ticks
Brucella species: Brucellosis: flu- Doxycycline Rare in the United States;
abortus, melitensis, like symptoms acquired by animal contract
suis, canis or drinking unpasteurized
milk
Burkholderia Pneumonia Meropenem Causes illness in people with
cepacia cystic fibrosis or chronic
granulomatous disease
Campylobacter Diarrhea Azithromycin Transmitted by food and
species: fetus, animals
jejuni, coli
Chlamydia psittaci Psittacocis Doxycycline Acquired from birds
1425
(pneumonia)
Chlamydia Genital tract Erythromycin, Sexually transmitted
trachomatis infection, newborn doxycycline infection; newborns are
conjunctivitis, infected during birth;
infant pneumonia, trachoma rare in the United
trachoma States
Clostridium Botulism Supportive care; Food-borne and infant
botulinum antitoxin or antibody botulism
Clostridium difficile Diarrhea Stop antibiotics, Occurs in people who have
metronidazole been on antibiotics
Clostridium Food poisoning, Supportive care Food-borne infection
perfringens diarrhea
Clostridium species: Gas gangrene Surgery, penicillin Anaerobic bacteria;
perfringens, uncommon infection of
sordellii, septicum, muscles
novyi
Clostridium tetanus Lockjaw Antitoxin, Rare in United States
metronidazole because of immunization
Corynebacterium Diptheria Antitoxin, Rare in the United States
diphtherieae erythromycin because of immunization
Escherichia coli Sepsis, meningitis, Depends on the site Can be part of normal flora
urinary tract of infection of the bowel
infection, diarrhea,
others
Francisella Tularemia Streptomycin Transmitted by fleas or ticks
tularensis or contact with infected wild
animals
Haemophilus Chancroid Azithromycin Sexually transmitted ulcer
ducreyi disease; unusual in the
United States
Haemophilus Otitis media (ear Amoxicillin Not all ear infections require
influenza infection) clavulanate antibacterial therapy
nontypeable
Haemophilus Meningitis, Ceftriaxone Now rare because of
influenza type b epiglottis, arthritis, immunization
pneumonia
Helicobacter pylori Ulcers Combinations: Persistent infection increase
amoxicillin, the risk for cancer
tetracycline,
metronidazole,
clarithromycin
Kingella kingae Joint and bone Penicillin Not very common
infections
Legionella Legionnaries Erythromycin Rare in children
pneumophila disease
(pneumonia)
Leptospira species Leptospirosis: Penicillin, Acquired through contact
fever, rash, flu-like doxycycline with dog or wild animal
illness, organs urine
Listeria Sepsis, meningitis Ampicillin Occurs in pregnant women,
1426
monocytogenes newborns, and children with
immune problems
Moraxella Otitis media, Ampicillin Not all infections require
catarrhalis sinusitis clavulanate antibacterial therapy
Mycobacterium Leprosy Dapsone Rare in the United States
leprae
Mycobacerium Tubercolosis Combinations: Most infected people have
tuberculosis isoniazid, no symptoms; one third of
pyrazinamide, the world‘ population is
rifampin ethambutol infected
Mycoplasma Bronchitis, Doxycycline, Common cause of
pneumoniae walking erythromycin pneumonia in school-aged
pneumonia children
Neisseria Gonorrhea, Ceftriaxone, Sexually transmitted
gonorrhoeae newborn eye cefixime infection; newborns can
infection, join acquire it during birth
infection
Nocardia species Pneumonia, skin Trimethoprim Serious infection; usually in
sulfamethoxazole children with weakened
immunity
Nontuberculous Lymph glands in Surgery; antibiotic Lymph node infections in
mycobacteria: the neck, depends on the toddlers; invasive infections
Mycobacterium pneumonia, blood organism and in children with weakened
fortuitum, kansasii, infection immunity
marinum, avium-
intracellulare
Pasteurella Bite wound Penicillin Common in cats and dogs
multocida infection
Prevotella species Abscess (dental Clindamycin Anaerobic; part of normal
and lung) flora of the mouth
Salmonella species Diarrhea, bone, None for diarrhea; Acquired by contact with
joint, kidney, depends on site for animals or contaminated
meningitis other infections foods
Shigella species: Diarrhea None, trimethoprim Food borne or contact with
sonnei, flexmero. sulfamethoxazole, infected person
Boydii. dysenteriae others
Staphylococcus Diarrhea, skin, Nafcillin, Becoming more and more
aureus pneumonia, joint, vancomycin; resistant to usual antibiotics
bone, heart depends on
susceptibilities
Steptobacillus Meningitis, sepsis, Penicillin Serious in babies in pregnant
agalactiae (group B pneumonia, skin, women, endocarditis in
streptococcus) urinary tract susceptible adults
infection
Streptococcus Pneumonia, otitis Penicillin, Most serious infection (85%)
pneumoniae media (ear ceftriaxone, prevented by immunization
infection), joint cefotaxime
infection,
meningitis
Streptococcus Pharyngitis, skin, Penicillin Rheumatic fever, rheumatic
1427
pyrogenes (group A pneumonia, joint heart disease, and
streptococcus) glomerulonephritis can
follow an infection after a
week
Treponema Syphilis Penicillin Sexually transmitted disease;
pallidum can affect the fetus
Ureaplasma Urethritis Doxycycline Sexually transmitted disease
urealyticum
Vibrio cholerae Diarrhea Fluids, doxycycline A risk for travelers
Yersinia Diarrhea Trimethprim Food borne from pork,
enterocolitica sulfamethoxazole especially chitterlings
Yersinia pestis Plague Streptomycin Rare in the United States;
transmitted by rodent fleas
Source: Sanders, Tony J. Table 1 Over-the-counter Antimicrobial Agent Course for the
FDA: A Trade for Organic Antibiotics by the Holidays HA-20-11-10
2. Numerous surveys have reported that approximately 50 percent of antibiotic use is in
some way ―inappropriate‖. Aside from the monetary cost of unnecessary antibiotics, that
would be much less if organic broad spectrum antibiotics were sold Over-the-counter,
there is the 1-4% risk contracting recurrent Pseudo-membranous colitis and the excess
costs of treating more resistant organisms. In the 1970s the CDC‘s extensive Study on
the Efficacy of Nosocomial Infection Control found that nosocomial infection rates fell
by 32 percent in hospitals that established programs with organized surveillance and
control activities, a trained, effectual infection-control physician, and one infection-
control practitioner per 250 beds. In contrast, rates in hospitals without effective
programs increased by 18 percent. The most common side effect of antibacterial agents
are an increase in the prevalence of naturally occurring antibiotic resistant C. difficile,
which can cause recurrent Pseudo-membranous colitis but is reluctantly treatable with
metronidazole. Nearly 4% of the population were allergic to the original penicillin, but
that rate has gone down to 1%.
3. Physicians need to be generous with the refillable prescriptions of broad spectrum
antibiotics and antibacterial agents when treating infectious diseases so their patients can
give the effective antibacterial chemotherapy to the people they infect, sparing them the
cost of the doctor‘s visit and incidental unnecessary exposure to Western medicine.
Antibacterial agents, like all antimicrobial drugs are directed against unique targets not
present in mammalian cells. The goal is to limit toxicity to the host and maximize
chemotherapeutic activity affecting invading microbes only. There are a number of
mechanisms of antimicrobial action – inhibition of cell-wall synthesis, inhibition of
protein synthesis, inhibition of bacterial metabolism, inhibition of nucleic acid synthesis
or activity and the alteration of cell-membrane permeability. The term antibacterial agent
refers to all natural, synthetic and semi-synthetic compounds that kill bacteria or inhibit
their growth. The term antibiotic is reserved for those compounds produced by living
organisms. Used appropriately these drugs are lifesaving. However, their indiscriminate
use drives up the costs of health, leads to a plethora of side effects and drug interactions,
and fosters the emergence of bacterial resistance, rendering previously valuable drugs
useless. The rational use of antibacterial agents is dependent on an understanding of their
1428
mechanisms of action, pharmacokinetics. Toxicities and interactions, bacterial strategies
for resistance, and bacterial susceptibility in-vitro. In addition patient-associated
parameters, such as the site of infection and the immune and the excretory status of the
host, are critically important to appropriate therapeutic decisions.
D. Antimicobial agents are able to target bacterial cells but not human cells by a number
of different mechanisms. Some microbes are resistant or have evolved resistance to all or
specific antibiotics. One major difference between bacterial and mammalian cells is the
presence in bacterial cells of a rigid wall external to the cell membrane. The structure
conferring cell-wall rigidity and resistance to osmnotic lysis in both gram-positive and
gram-negative bacteria is peptidoglycan, a large, covalently linked sacculus that
surrounds the bacterium. Chemotherapeutic agents directed at any stage of the synthesis,
export, assembly or cross-linking of peptidoglycan lead to inhibition of bacterial cell
growth and, in most case, to cell death. β-Lactam antibiotics, penicillins, cephalosporins,
carbapenems and monobactams are characterized by a four membered β-lactam ring,
prevent the cross-linking reaction called transpeptidation. The β-lactam ring of the
antibiotic forms an irreversible covalent acyl bond with the transpeptide, known as the
penicillin-binding-proteins, preventing the cross-linking reaction. Virtually all the
antibiotics that inhibit bacterial cell-wall synthesis are bacteriocidal and eventually result
in the cell‘s death (Fauci et al ‘98: 859). Bacitracin is a cyclic peptide antibiotic that
inhibits the conversion of the lipid carrier to its active form that moves the water soluble
cyto-plasmic peptidoglycan subunits through the cell membrane to the cell exterior.
Glycopeptides such as vancomycin and teicoplanin, are high molecular weight antibiotics
that bind to the terminal D-alanine-D-alanine component of the stem peptide while the
subunits are external to the cell membrane but still linked to the lipid carrier, thus
inhibiting peptidoglycan backbone (Fauci ‘98: 856).
Fig. 9-16 Mechanisms of Action of Resistance to Major Classes of Antibacterial
Agents
Antibacterial Major Cellular Mechanisms of Action Major Mechanisms of Resistance
Agent Target
Β-Lactams Cell wall Inhibit cell-wall cross-linking 1.Drug inactivation β-lactamase
(penicillins and 2. Insensitivity of target (altered
cephalosporins) penicillin-binding proteins)
3.Decreased permeability
(altered gram-negative out-
membrane porins)
Vancomycin Cell wall Interferes with the addition of Alteration of target (substitution
new cell-wall subunits of terminal amino acid of
(muramyl pentapeptides) peptidoglycan subunit)
Bacitracin Cell wall Prevents addition of cell-wall Not defined
subunits by inhibiting recycling
of membrane lipid carrier
Macrolides Protein Bind to 50S ribosomal unit 1.Alteration of target (ribosomal
(erythromycin) synthesis methylation
2.Drug interaction
3.Decreased intracellular drug
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accumulation (active efflux)
Lincosamides Protein Bind to 50S ribosomal unit Alteration of target (ribosomal
(clindamycin) synthesis methylation)
Chloramphenicol Protein Binds to 50S ribosomal unit Drug inactivation
synthesis (chloramphenicol
acetyltransferase)
Tetracyclines Protein Bind to 30S ribosomal subunit 1.Decreased intracellular drug
synthesis accumulation (active efflux)
2.Insensitivity of target
Aminoglycosides Protein Bind to 30S ribosomal subunit Drug inactivation
(gentamicin) synthesis (aminoglycoside-modifying
enzyme)
Mupirocin Protein Inhibits isoleucine tRNA Insensitivity of target (mutation
synthesis synthetase of target gene or acquisition of
gene for new, insensitive
enzyme)
Sulfonamides and Cell Competitively inhibit enzymes Production of insensitive targets
trimethoprim metabolism involved in two steps of folic (dihydropteroic acid
acid biosynthesis [sulfonamides] and dihydrofolic
acid [trimethoprim] that bypass
metabolic block
Rifampin DNA synthesis Inhibits DNA dependent RNA Insensitivity of target (mutation
polymerase of polymerase gene)
Metronidazole DNA synthesis Intracellularly generates short- Not defined
lived reactive intermediates by
electron transfer system
Quinolones DNA synthesis Inhibit DNA gyrase (A subunit) 1.Insensitivity of target
(ciprofloxacin) (mutation of gyrase genes)
2. Decreased intracellular drug
accumulation (active efflux)
Novobiocin DNA synthesis Inhibits DNA gyrase (B subunit) Not defined
Polymyxins Cell membrane Disrupt membrane permeability Not defined
by charge alteration
Gramicidin Cell membrane Forms pores Not defined
Source: Sanders, Tony J. Table 2 Over-the-counter Antimicrobial Agent Course for the
FDA: A Trade for Organic Antibiotics by the Holidays HA-20-11-10
1.Most of the antibacterial agents that inhibit protein synthesis interact with the bacterial
ribosome. The difference between the composition of bacterial and mammalian
ribosomes gives these compounds their selectivity. Aminoglycosides, such as
gentamicin, kanamycin, tobramycin, streptomycin, netilmycin and amikacin, are a group
of structurally related compounds containing three linked hexose sugars. They exert a
bactericidal effect by binding irreversibly to the 30S subunit of the bacterial ribosome
and blocking initiation of protein synthesis. Spectinosmycin an aminocyclitol antibiotic,
also acts on the 30S ribosomal subunit but has a different mechanism of action from the
aminoglycosides and is bacteriostatic rather than bactericidal. Macrolides, such as
erythromycin, clarithromycin, and axithromycin, are antibiotics that consist of a large
lactone ring to which sugars are attacked. They bind specifically to the 50S portion of
the bacterial ribosome. After attachment of mRNA to the initiation site of the 50S
1430
subunit becomes bound to the 30S component to form the 70S ribosomal complex, and
protein chain elongation proceeds, thereby inhibiting protein chain elongation.
2. Lincosamides, such as clindamycin and lincomycin, although structurally unrelated to
macrolides, bind to a site on the 50S ribosome nearly identical to the binding site for
macrolides, the number and types of bacteria against which these two groups of agents
are active differ. Chloramphenicaol, a small antibiotic with a single aromatic ring and
short side chain, binds reversibly to the 50S portion of bacterial ribosome at a site close
to but not identical with that of macrolides or lincosamides, and inhibits peptide bond
formation. Tetracycline, doxycycline and minocycline, consist of four aromatic rings
with various substituent groups, which interact reversibly with the bacterial 30S
ribosomal subunit, blocking the binding of aminoacyl tRNA to the mRNA-ribosome
complex, but this mechanism is markedly different from that of the aminoglycosides.
Mupirocin, pseudomonic acid, is produced by the bacterium Pseudomonas fluorescens
and its mechanism of action is unique in that it inhibits the enzyme isoleucine tRNA
synthetase by competing with bacterial isoleucine for its binding site on the enzyme that
is unique to bacteria.
3. The inhibition of bacterial metabolism is caused by antimetabolites that are synthetic
compounds that interfere with the synthesis of folic acid. Products of the folic acid
synthesis pathway function as coenzymes for the one-carbon transfer reaction that are
essential for the synthesis of thymidine, all purines and several amino acids, inhibition of
folate synthesis leads to cessation of cell growth and, in some case, bacterial death. The
principal antimetabolites are sulfonamides, such as sulfisoxazole, sulfadiazine, and
sulfamethoxazole, and trimethoprim. Sulfonamides are structural analogues of p-
aminobenzoic acid (PABA), one of the three structural components of folic acid, the
other two being pteridine and glutamate, the sulfonamides compete with PABA as
substrates for the enzyme. Trimethoprim is a diaminopyrimidine, a structural analogue of
the pteridine moiety of folic acid. It is a competitive inhibitor of the dihydrofolate
reductase, the enzyme responsible for reduction of dihydrofolic acid to tetrahydrofolic
acid.
E. Anti-biotic associated colitis, Pseudomembranous colitis, is an acute colitis
characterized by the formation of an adherent inflammatory pseudomembrane overlying
sites of mucosal injury. It is usually caused by toxins of Clostridium difficile, a normal
gut commensal. This disease occurs most often in patients without a background of
chronic enteric disease, following a course of broad spectrum anti-biotic therapy. Nearly
all bacterial agents have been implicated. Presumably toxin-forming strains flourish
following alteration of the normal intestinal flora, the factors favoring the initiation of
toxin production are not understood. The condition may rarely appear in the absence of
antibiotic therapy, typically after surgery of superimposed on a chronic debilitating
illness. Infrequently the small intestine is involved. Antibiotic associated colitis occurs
primarily in adults as an acute of chronic diarrheal illness, although it has been recorded
as a spontaneous infection in young adults without predisposing influences. Diagnosis is
confirmed by the detection of the C. difficile cytotoxin in stool. Response to treatment is
usually prompt, but relapse occurs in up to 25% of patients
1431
1.The morphology of the pseudomembranous colitis derives its name from the plaque-
like adhesion of fibrinopurulent-necrotic debris and mucus to damaged colonic mucosa,
these are not true ―membranes‖ because the coagulum is not an epithelial layer.
Pseudomembrance formation is not restricted to C. difficile induced colitis, it also may
occur following any severe mucosal injury, as in ischemic colitis, volvulus, and with
necrotizing infections (staphylococci, shigella, candida, necrotizing enterocolitis). What
is striking about C. difficile toxin induced colitis is the microscopic lesion. The surface
epithelium is denuded, and the superficial lamina propria contains a dense infiltrate of
neturophilis and occasional capillary fibrin thrombi. Superficially damaged crypts are
distended by a mucopurulent exudate, which erupts out of the crypt to form a
mushrooming cloud that adheres to the damaged surface, the coalescence of this cloud
forms the pseudomembrane.
2. One common sense procedure that many people with auto-immune disorders of the
gut, particularly antibiotic associated colitis that is not treatable by antibiotics, might
benefit from is fecal transplant, otherwise known as bacteriotherapy. More than 15 fecal
transplants have been performed, 13 of which cured their patients. It is a harmless
procedure that one might be able to perform at home with a healthy loved one, but neither
modern or traditional medicine perform it. In 2008, Khoruts, a gastroenterologist at the
University of Minnesota, took on a patient suffering from a vicious gut infection of
Clostridium difficile. She was crippled by constant diarrhea, which had left her in a
wheelchair wearing diapers. Khoruts treated her with an assortment of antibiotics, but
nothing could stop the bacteria. His patient was wasting away, losing 60 pounds over the
course of eight months. Khoruts decided his patient needed a transplant. But he didn‘t
give her a piece of someone else‘s intestines, or a stomach, or any other organ. Instead,
he gave her some of her husband‘s bacteria. Khoruts mixed a small sample of her
husband‘s stool with saline solution and delivered it into her colon. Writing in the
‗Journal of Clinical Gastroenterology‘, Khoruts and his colleagues reported that her
diarrhea vanished in a day. Her Clostridium difficile infection disappeared as well and has
not returned since. The procedure, known as bacteriotherapy or fecal transplantation, had
been carried out a few times over the past few decades.
3. Assisted by information and technology of the Human Genome Project Khoruts and
his colleagues were able to do something previous doctors could not: They took a genetic
survey of the bacteria in her intestines before and after the transplant. Before the
transplant, they found, her gut flora was in a desperate state. ―The normal bacteria just
didn‘t exist in her,‖ said Khoruts. ―She was colonised by all sorts of misfits.‖ Two weeks
after the transplant, the scientists analysed the microbes again. Her husband‘s microbes
had taken over. ―That community was able to function and cure her disease in a matter of
days,‖ said Janet Jansson, a microbial ecologist at Lawrence Berkeley National
Laboratory and a co-author of the paper. ―I didn‘t expect it to work. The project blew me
away‖ (Zimmer ‘08). The human microbiome has not yet been fully surveyed, let alone
incorporated into standard medical practice, but the Human Microbiome Project holds far
greater potential for curing diseases than the Human Genome Project, whereas 75% of
the immune system occurs in the gut and micriobiomes help to digest all nutrients so they
1432
may be absorbed into the body. The Human Microbiome Project is even more laborious
than the Human Genome Project. After studying 178 distinct genome sequences 29,693
genes that are unlike any of the 20,000 human protein-coding genes identified in the
Human Microbiome Project that faces complications extracting unmutated bacteria from
all locations deep within its living hosts (Zimmer ‘08). The Microbiome Project already
offers a promising and harmless bacteriotherapy of fecal transplant that might cure even
antibiotic resistant auto-immune diseases at little or no cost (Cotran et al ‘94: 306). The
digestive system is reputed to be 75% of the immune system.
4. For bacterial infections originating in the gut Metronidazole, a carcinogen, is the only
antibiotic that reliably treats infectinos of the gut. Garlic is a natural antibiotic, while live
culture acidophilus yoghurt is a natural pro-biotic. Proteins, such as milk, meat, beans
and chilies are however likely to foster enterococcal infections in endocarditis and
should be avoided. Bacterial infections of the lung, such as Steptococcus pyrogenes and
Bordetella pertussis are highly contagious, spread by cough droplets, and can live in
fabrics for lengthy periods of time, and spread from a shirt to couch, but can be washed in
hot water or with antimicrobial detergent, unlike plaque causing chemical dyes. The
sometimes undetectable infection of the lung often triggers rheumatic pains in other parts
of the body. Protein, inactivity, and sedentary employment aggravate rheumatic
conditions greatly. Vigorous sustained exercise is needed. All day hiking and camping
in a tent, with clean clothes and sleeping bag, tends to eliminate Streptococcus but not
Pertussis. If Pertussis is not treated with antibiotics while a runny nose, barely
distinguishable from a common viral cold, descends into the lungs as a whooping cough
for six weeks, and is possibly deadly to newborns and small children unvaccinated with
routine DTaP (Diptheria and Pertussis) vaccine routinely administered at the ages of 2, 4
and 6 months again at 15 to 18 months, 4 to 6 years and at specified intervals for DTP,
DTaP and tdap generations of vaccines, thereafter.
§348 Cadiovascular Disease
A. Coronary heart disease is America's No. 1 killer. Stroke is No. 3 and a leading cause
of serious disability. Of the estimated 65 million Americans with high cholesterol, 7
million Americans suffer angina and of the 2.4 million people who died in 2004, 666,000
died from heart disease and 150,000 from stroke accounting for more than 40% of all
deaths, one every 33 seconds. An estimated 700,000 people suffer strokes annually, of
the survivors, 50-70 percent regain functional independence, but 15-30 percent are
permanently disabled. People suffering angina have a 20% chance of suffering a heart
attack over ten years. Globally heart attacks and strokes kill about 12 million people
every year (7.2 million due to ischaemic heart disease and 5.5 million to cerebrovascular
disease). In addition, 3.9 million people die annually from hypertensive and other heart
conditions.
1.Although overall death rates have gone down considerably and life expectancy
increased dramatically since 1900 heart disease and cancer are more prevalent than ever.
Between 1900 and 2000, life expectancy at birth in the United States increased from 47 to
77 years. In 1900, one third of all deaths in the United States were attributed to three
1433
major categories of infectious disease: pneumonia and influenza, tuberculosis, and
diarrheal diseases and enteritis. Many additional deaths were caused by typhoid,
meningococcal meningitis, scarlet fever, whooping cough, diphtheria, dysentery, and
measles. Altogether, common infectious diseases accounted for 40% of all deaths in 1900
but they accounted for only 4% of all deaths in 2000. Cardiovascular disease (CVD; heart
disease and stroke) accounted for 14% of all deaths in 1900 and for 37% in 2000. Cancer
accounted for only 4% of all deaths in 1900 but for 23% in 2000.
2. According to the U.S. government, one in every 300 Americans will be killed by a
blocked artery in 2007. Every 34 seconds an American dies as the result of a blocked
cardiac artery. As an American, there's a 90 percent chance that poor circulation will
trigger a serious health problem at some point in your life. More than 6.8 million
Americans undergo heart bypass, balloon angioplasty and other circulation-related
procedures each year. 1 million undergo angioplasty and 500,000 heart surgery. 700,000
Americans will suffer a sudden blockage of blood flow to the brain in 2007- 83 every
hour of the day. Each year, about 1.1 million people in the United States have heart
attacks, and almost half of them die. 65 million Americans monitor their cholesterol.
Mortality differs significantly by race or ethnic group as measured by age adjusted death
rates. In 1998 these death rates per 100,000 people from heart disease in the United
States were 211.8 for black non-Hispanics, compared to 145.3 for white non-Hispanics,
101.5 for Hispanics, 106 for American Indians and 78 for Asians.
3. Cardiology specialists and research typically fail to prescribe broad spectrum
antibiotics to treat bacterial endocarditis to sell expensive heart medicine and surgery to
people who never get better. For vegans the concept of plaque in the coronary ateries is
superceded by the concept of vegetations on the exterior of the heart that become
infected, can be treated with antibiotics and heal in time if given enough respite from
further infection. Most heart drugs only treat the symptoms and fail to treat the
underlying condition which is that necrotic heart tissue becomes infected by many
common bacterial pathogens. Statins encourage people to remain fat and eat meat and
cholesterol and can cause dangerous levels of cardio-reactive protein (CRP) that cause
protein and gluten intolerance and can lead to death, but more likely chronic illness and
demand for expensive treatment. Group A and B Streptococcus cause rheumatic heart
disease in auto-immune heart patients, Group A that causes strep throat in young adults,
waits a week after all nasal symptoms stop, while Group B that is dangerous to children
and pregnant mothers causes a more instant rheumatic infection. Streptococcus is the
most common kind pneumonially transmitted infection but heart disease also interacts
with several enterococcal infections that cause endocarditis. Toxic shock syndrome may
result from the mixture of Staphylococcus aureau, a leading cause of food poisoning that
occurs in the skin, and Streptococcus pyogenes (Group A), so shower frequently, wash
your hands and your vegetables carefully and exercise. Garlic is a natural antibiotic,
avoid protein, beans, chilies, milk and meats that take from 1 to 3 weeks to digest while
vegan fare is excreted in one day and fish in 3. Antibiotics have greatly helped to bring
the mortality rate of rheumatic heart disease down in to the United States from 20.6 per
100,000 in 1940 to 2.2 in 1982. Auto-immune heart patients are susceptible to bacterial
infections that leave residue called ―vegetations‖. They must be kept on a strictly vegan
1434
diet, with lots of exercise and no beans, potatoes or chilies, until the ―vegetation‖
undergoes cellular death, decomposes and is washed away. All auto-immune patients
should possess a refillable prescription for a low cost course of broad spectrum antibiotic
like penicillin, ampicillin or erythromycin or metronidazole for bacterial infections
complicated by antibiotic associated colitis. If there is any good reason that these
antibiotics should not be sold Over-the-counter let them be explained on the package for
the consumer to make an educated purchase, wait at least a week between courses if there
is recurrent bacterial infection and stop if they develop a rash, fever, colitis, or sense a
pseudomembrane in their colon.
B. Diseases and conditions of the heart‘s muscle make it difficult for your heart to pump
blood. Oxygen deprivation to the heart muscle itself, usually caused by atherosclerosis, a
build up of plaque in the coronary arteries, causes acute pain in the heart known as
Angina that affects an estimated 7 million Americans. Damaged or diseased blood
vessels make the heart work harder than normal and are often torturously painful.
Problems with the heart‘s electrical system, called arrhythmias, can make it difficult for
the heart to pump blood efficiently. Cardiac patients must take care of their health. It is
important to avoid LDL cholesterol such as that found in potato chips and trans-fats. One
however cannot starve angina, sufficient levels of HDL cholesterol such as that found in
fish oil and brown rice are needed. Smoking, coffee and stimulants should be avoided to
control blood pressure. If wine doesn‘t work don‘t abuse it. Take deep breaths to
understand the relation between heart and lungs instead of stopping breathing to feel the
pain. Exercise enough to increase your heartbeat, regularly.
1.Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs when an area
of the heart muscle doesn't get enough oxygen-rich blood. It's thought that nearly 7
million people in the United States suffer from angina. About 400,000 patients go to their
doctors with new cases of angina every year. Angina may feel like pressure or squeezing
in your chest. The pain also may occur in the shoulders, arms, neck, jaw, or back. It can
feel like indigestion. Angina itself isn't a disease. Rather, it's a symptom of an underlying
heart problem. Angina is usually a symptom of coronary artery disease (CAD), the most
common type of heart disease. CAD occurs when a fatty material called plaque (plak)
builds up on the inner walls of the coronary arteries. These arteries carry oxygen-rich
blood to your heart. When plaque builds up in the arteries, the condition is called
atherosclerosis (ATH-er-o-skler-O-sis). Nitrates are the most commonly used medicines
to treat angina. They relax and widen blood vessels. This allows more blood to flow to
the heart while reducing its workload. Nitroglycerin is the most commonly used nitrate
for angina. Nitroglycerin that dissolves under your tongue or between your cheeks and
gum is used to relieve an angina episode. Nitroglycerin in the form of pills and skin
patches is used to prevent attacks of angina. These forms of nitroglycerin act too slowly
to relieve pain during an angina attack.
Fig. 9-17: Diagram of Atherosclerosis
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Source: Sanders, Tony J. American Heart Month since February 1963 HA-14-2-08
2. A heart attack occurs when blood flow to a section of heart muscle becomes blocked.
If the flow of blood isn‘t restored quickly, the section of heart muscle becomes damaged
from lack of oxygen and begins to die. Heart attack is a leading killer of both men and
women in the United States. But fortunately, today there are excellent treatments for
heart attack that can save lives and prevent disabilities. Treatment is most effective
when started within 1 hour of the beginning of symptoms. If you think you or someone
you‘re with is having a heart attack, call 9-1-1 right away. Heart attacks occur most
often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty
material called plaque (plak) builds up on the inside walls of the coronary arteries (the
arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can
rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes
large enough, it can mostly or completely block the flow of oxygen-rich blood to the
part of the heart muscle fed by the artery. During a heart attack, if the blockage in the
coronary artery isn‘t treated quickly, the heart muscle will begin to die and be replaced
by scar tissue. This heart damage may not be obvious, or it may cause severe or long-
lasting problems. The dead sensation of a heart attack can also be caused by aspirin
overdose in people who haven‘t been prescribed antibiotics.
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3. An aneurysm (AN-u-rism) is an abnormal bulge or ―ballooning‖ in the wall of an
artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other
parts of the body. An aneurysm that grows and becomes large enough can burst, causing
dangerous, often fatal, bleeding inside the body. Most aneurysms occur in the aorta. The
aorta is the main artery that carries blood from the heart to the rest of the body. The aorta
comes out from the left ventricle (VEN-trih-kul) of the heart and travels through the chest
and abdomen. An aneurysm that occurs in the aorta in the chest is called a thoracic (tho-
RAS-ik) aortic aneurysm. An aneurysm that occurs in the aorta in the abdomen is called
an abdominal aortic aneurysm. Aneurysms also can occur in arteries in the brain, heart,
intestine, neck, spleen, back of the knees and thighs, and in other parts of the body. If an
aneurysm in the brain bursts, it causes a stroke. About 15,000 Americans die each year
from ruptured aortic aneurysms. Ruptured aortic aneurysm is the 10th leading cause of
death in men over age 50 in the United States. Many cases of ruptured aneurysm can be
prevented with early diagnosis and medical treatment. Because aneurysms can develop
and become large before causing any symptoms, it is important to look for them in people
who are at the highest risk. Experts recommend that men who are 65 to 75 years old
should be checked for abdominal aortic aneurysms. When found in time, aneurysms can
usually be treated successfully with medicines or surgery. If an aortic aneurysm is found,
the doctor may prescribe medicine to reduce the heart rate and blood pressure. This can
reduce the risk of rupture. Large aortic aneurysms, if found in time, can often be repaired
with surgery to replace the diseased portion of the aorta.
4. A stroke occurs when a blood vessel that brings oxygen and nutrients to the brain
bursts or is clogged by a blood clot or some other particle. Because of this rupture or
blockage, part of the brain doesn‘t get the blood and oxygen it needs. Deprived of
oxygen, nerve cells in the affected area of the brain can‘t work and die within minutes.
And when nerve cells can‘t work, the part of the body they control can‘t work either. The
devastating effects of stroke are often permanent. There are four main types of stroke.
Two are caused by blood clots or other particles (ischemic strokes), and two by bleeding
(hemorrhage). Cerebral thrombosis and cerebral embolism are caused by clots or particles
that plug an artery. They account for about 70–80 percent of all strokes. Ruptured blood
vessels cause cerebral and subarachnoid hemorrhages. These (bleeding) strokes have a
much higher fatality rate than strokes caused by clots. Stroke is a medical emergency.
Every second counts! Stroke affects different people in different ways. It depends on the
type of stroke, the area of the brain affected and the extent of the brain injury. Brain
injury from a stroke can affect the senses, motor activity, speech and the ability to
understand speech. It can also affect behavioral and thought patterns, memory and
emotions. Paralysis or weakness on one side of the body is common.
C. The body is very sensitive to changes in blood pressure. Special cells in the arteries,
called baroreceptors (BAR-o-re-SEP-ters), can sense if blood pressure begins to rise or
drop. When the baroreceptors sense a rise or drop in blood pressure, they cause certain
responses to occur throughout the body in an attempt to bring the blood pressure back to
normal. For example, if you stand up quickly, the baroreceptors will sense a drop in your
blood pressure. They quickly take action to make sure that blood continues to flow to the
brain, kidneys, and other important organs. The baroreceptors cause the heart to beat
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faster and harder. They also cause the small arteries (arterioles) and veins (the vessels
that carry blood back to the heart) to narrow. High blood pressure is a blood pressure
reading of 140/90 mmHg or higher. Both numbers are important. Nearly 1 in 3 American
adults has high blood pressure. Once high blood pressure develops, it usually lasts a
lifetime. The blood pressure level should be lower than 120/80 mmHg. When the level
stays high, 140/90 mmHg or higher, it is considered high blood pressure. For example,
160/80 mmHg would be stage 2 high blood pressure. With high blood pressure, the heart
works harder, arteries take a beating, and the chances of a stroke, heart attack, and kidney
problems are greater. Hypotension is abnormally low blood pressure. Normal blood
pressure is a reading of less than 120/80 mmHg (mmHg = millimeters of mercury, a unit
for measuring pressure). Hypotension is blood pressure that is lower than 90/60 mmHg.
In a healthy person, hypotension without signs or symptoms is usually not a problem and
requires no treatment. Doctors will want to identify and treat any underlying condition
that is causing the hypotension, if one can be found. Hypotension can be dangerous if a
person falls because of dizziness or fainting. Shock, a severe form of hypotension, is a
life-threatening condition that is often fatal if not treated immediately. Shock can be
successfully treated if the cause can be found and the right treatment provided in time.
1.It is estimated that 65 million American adults live with high blood cholesterol (ko-
LES-ter-ol) and need to make the therapeutic lifestyle changes (TLC) to lower their
cholesterol and, with it, their risk for heart disease. Cholesterol is a waxy, fat-like
substance that is found in all cells of the body. The body needs some cholesterol to work
the right way. The body however makes all the cholesterol it needs. Cholesterol is also
found in some foods, such as eggs. The body uses cholesterol to make hormones, vitamin
D, and substances that help you digest foods. Blood is watery, and cholesterol is fatty.
Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is
carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are
made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins
carry cholesterol throughout your body. It is important to have healthy levels of both:
Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol. High
LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in
your blood, the greater the chance of getting heart disease. High-density lipoprotein
(HDL) cholesterol is sometimes called good cholesterol. HDL carries cholesterol from
other parts of the body back to your liver. The liver removes the cholesterol from your
body. The higher the HDL cholesterol level, the lower the chance of getting heart disease.
Fig. 9-18 Initial classification based on total cholesterol
and HDL cholesterol levels
Total Cholesterol Level Category
Less than 200 Desirable level that puts you
mg/dL at lower risk for coronary heart
disease. A cholesterol level of 200
mg/dL or higher raises your risk.
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200 to 239 mg/dL Borderline high
240 mg/dL and High blood cholesterol. A
above person with this level has more
than twice the risk of coronary
heart disease as someone whose
cholesterol is below 200 mg/dL.
HDL Cholesterol Level Category
Less than 40 Low HDL cholesterol. A major
mg/dL risk factor for heart disease.
(for men)
Less than 50 mg/dL
(for women)
60 mg/dL and High HDL cholesterol. An HDL of
above 60 mg/dL and above is considered
protective against heart disease.
2. The American Heart Association endorses the National Cholesterol Education Program
(NCEP) guidelines for detection of high cholesterol. The Third Report of the Expert
panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III or ATP III) was released in 2001. It recommends that
everyone age 20 and older have a fasting ―lipoprotein profile‖ every five years. This test
is done after a 9-12-hour fast without food, liquids or pills. It gives information about
total cholesterol, low-density lipoprotein (LDL) or ―bad‖ cholesterol, high-density
lipoprotein (HDL) or ―good‖ cholesterol and triglycerides (blood fats). Researchers have
established healthy ranges for each of these. If a fasting lipoprotein profile isn‘t possible,
the values for total cholesterol and HDL cholesterol are acceptable. If total cholesterol is
200 mg/dL or more, and HDL cholesterol is less than 40 mg/dL (for men) and less than
50 mg/dL (for women), a lipoprotein profile must done to determine the LDL cholesterol
and triglyceride levels.
LDL Cholesterol Category
Level
Less than 100 Optimal
mg/dL
100 to 129 mg/dL Near or above optimal
130 to 159 mg/dL Borderline high
160 to 189 mg/dL High
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190 mg/dL and Very high
above
3. Triglyceride are the most common type of fat in the body. Many people who have
heart disease or diabetes have high triglyceride levels. Normal triglyceride levels vary by
age and sex. A high triglyceride level combined with low HDL cholesterol or high LDL
cholesterol seems to speed up atherosclerosis (the buildup of fatty deposits in artery
walls). Atherosclerosis increases the risk for heart attack and stroke.
Triglyceride Level Category
Less than 150 Normal
mg/dL
150–199 mg/dL Borderline high
200–499 mg/dL High
500 mg/dL and Very high
above
Source: Sanders, Tony J. American Heart Month since February 1963 HA-14-2-08
4. A 1994 study called the Scandinavian Simvastatin Survival Study (also called 4S)
found that lowering cholesterol can prevent heart attacks and reduce death in men and
women who already have heart disease and high cholesterol. For over 5 years, more than
4,400 patients with heart disease and total cholesterol levels of 213 mg/dL to 310 mg/dL
were given either a cholesterol-lowering drug or a placebo (a dummy pill that looks
exactly like the medication). The drug they were given is known as a statin, and it
reduced total cholesterol levels by 25 percent and LDL-cholesterol levels by 35 percent.
The study found that in those receiving statin, deaths from heart disease were reduced by
42 percent, the chance of having a nonfatal heart attack was reduced by 37 percent, and
the need for bypass surgery or angioplasty was reduced by 37 percent. A very important
finding is that deaths from causes other than cardiovascular disease were not increased,
and so the 42 percent reduction in heart disease deaths resulted in a 30 percent drop in
overall deaths from all causes.
5.In 1996 the results of the Cholesterol and Recurrent Events (CARE) Study also showed
the benefits of cholesterol lowering in heart disease patients. This study reported that
even in patients with seemingly normal cholesterol levels (average of 209 mg/dL),
cholesterol lowering with a statin drug lowered the risk of having another heart attack or
dying by 24 percent. A study published in 1998, the Long-Term Intervention with
Pravastatin in Ischaemic Disease (LIPID) study, examined the effects of cholesterol
lowering in people with CHD (those who had already experienced a heart attack or had
been hospitalized for angina) and who had relatively average cholesterol levels. The
LIPID study used a statin drug to lower cholesterol levels in the treatment group. All
study participants were counseled about following a cholesterol-lowering diet. The LIPID
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results showed that a drop of 18 percent in total cholesterol and 25 percent in LDL-
cholesterol produced a 24 percent decrease in deaths from CHD among the treatment
group compared with the control group.
6. A substance called CRP has been discovered that is even more indicative of a person‘s
risk for heart attack. People should request a CRP test, when checking cholesterol and
triglyceride levels.
F. The American Journal of Physiology: Heart and Circulatory Physiology seems to be
most prolific abuser of cardiac toxins used to cause heart disease in laboratory animals. In
2008 they held that inhibitors of cyclooxygenase (COX)-1, COX-2, and the nonselective
COX inhibitor naproxen on coronary vasoactivity and thrombogenicity under baseline
and lipopolysaccharide (LPS)-induce inflammatory conditions. Preconditioning (PC) is
held to protect against ischemia-reperfusion (I/R) injury but prolonged exposure can lead
to permanent damage. This experiment showed the true cause of what must be the vast
majority of heart disease and death from heart disease – the unethical leaking of academic
animal laboratory research toxins into the community. The American Journal of
Physiology is probably the most prolific producer and distributor of heart, liver and
gastrointestinal toxins in the United States. The conspiracy deterioriated in 2005 when an
Argentine cardiologist was appointed to be the heart and circulatory editor because the
Prosecutor of the International Criminal Court (ICC) is also Argentine and in 2006 two
detainees were killed in the Hague, one from heart disease and the Director General the
day before the World Health Assembly by atherosclerosis. Disciplinary action needs to
be taken against the American Journal of Physiology, the conspiracy is codified in
Chapter 81 of the Title 22 Foreign Relations and Intercourse (a-FRaI-d) pertaining to the
ICC and the 81 mg heart friendly aspirin, that doesn‘t cause the dead feeling from
aspiring overdose.
1.To reduce the national levels of high cholesterol, angina, atherosclerosis, heart attack
and death from heart disease it is imperative that the toxins used to induce cardiac
conditions in laboratory animals have a name in the literature and are added to the list of
dangerous biological products under 42USC(6A)(2)(F)(1)§262a and are subjected to
recall under 42USC(6A)(2)(F)(1)§262(d). Title 45, U.S. Code of Federal Regulations,
Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December
13, 2001, Declaration of Helsinki, companion Guiding Principles in the Care and Use of
Animals need to be enforced by the Nuremburg Code as in the Doctor Trials under the
Prohibition with respect to biological weapons 18USC(10)I§175. The toxic chemicals
must destroyed under 18USCI(10)176, the BWC, Convention on the Prohibition of the
Development, Production and Stockpiling of Bacteriological (Biological) and Toxin
Weapons and on their Destruction that was opened in 1972 and entered into force in 1975
and the Convention on the Prohibition of the Development, Production, Stockpiling, and
Use of Chemical Weapons and on their Destruction CWC was opened in Paris in 1993
and entered into force in 1997.
E. To prevent or recover from a heart attack or angina the best approach is to lose weight.
Risk of cardio vascular and other chronic diseases can be greatly reduced through not
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smoking, smoke free workplaces, temperant consumption of alcohol, healthy low fat diet
and sufficient physical activity to elevate the heart rate for at least thirty minutes a day.
Quitting smoking is generally not critical for cardiovascular disease, although it is a good
idea, quitting trans-fats and cholesterol is a matter of life and death or at the very least
excruciating agony. It is estimated that up to 80% of cases of coronary heart disease,
90% of type 2 diabetes cases, and one-third of cancers can be avoided by changing to a
healthier diet, increasing physical activity, stopping smoking and evading malevolent
laboratory leaks through social and security measures, such as a locking bedroom door,
personal refrigerator, new war-drobe, new bed and bedding and terminating relationships
with toxic agents. If this does not work to protect privacy against breaking and entering
get a new identity and move to a completely new jurisdiction, keep a low profile and
keep moving until a peaceful home can be defended.
1. The diet for people recovering from atherosclerosis or other hearts conditions should
completely avoid cholesterol and trans-fats. Although a change in diet from anything
goes to a healthy diet is a reward in itself for anyone wishing to enjoy greater energy and
health, for a person suffering cardiovascular problems it is particularly rewarding as relief
from pain and the only way to recovery. Planning a heart healthy diet should be done in
three phases.
Phase I: When suffering angina or a heart attack eat only fruits and raw or boiled
vegetables. These foods contain absolutely no fat or cholesterol and contain a number of
helpful vitamins and minerals. These foods are not problematic although personal
allergies may complicate (or simplify) the diet. It may be necessary to eat a lot to be
satisfied. Separate meals of fruit and meals of vegetables to better appreciate them.
Phase II: When feeling somewhat or totally recovered after a few days or weeks begin to
inclue whole grains into the diet of fruit and vegetables. Whole grains like brown rice,
quinoa, beans etc. are more substantial foods and should be used to satisfy the desire for
meat and bread. They often take an hour or more to cook but taste delicious. Olive oil
and other natual oils can be used in moderation to make more flavorful vegetables.
Phase III After a month or two it is okay to include portions of chicken and fish in the
diet. After six months most clogging of the arteries has cleared out. Do not revert to an
anything goes diet although it should be possible to eat a bag of potato chips or steak
without pain after six months of pain free healthy eating. Continue eating healthy and
exercise to keep in shape. Avoid bread because it is fattening. Avoid fried foods and
cholesterol and never eat them in excess or alone.
2. Exercise is also very important and rewarding for people recovering from
cardiovascular disease. Although every person is different and some people need to
avoid vigorous exercise because the strain could blow their heart, cardio-vascular
exercise is an important component for recovery. People should get 30 minutes of
vigorous cardiovascular exercise a day where their respiration is increased and they break
a sweat. The only way to do this is by jogging or playing vigorous sports with a lot of
sprinting like basketball. Walking is also good but to get the healing effects of exercise it
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may take several hours. Sit-ups are also important to keep the abdomen trim and the
excretory system unobstructed. Jogging 3 -7 days a week of sufficient duration to break a
sweat and clear the arteries is the most sensible approach to cardio-vascular exercise.
Ten or twenty mile walk and jogs are a good way to clean out badly clogged arteries and
daily 3 miles for maintenance. Starting out, or when feeling lazy, 1 mile is a miracle but
people should aim to run at least a 5km cross country course daily and strive to run the 26
mile marathon.
§349 Diabetes
A. Not all public health indicators are improving in the United States. While infectious
and communicable disease have for the most part been eliminated or controlled, in the
United States, there has been little improvement in the status of non-communicable and
chronic conditions and in the case of Diabetes the number of new cases has nearly
doubled in the past ten years. On some Native American reservations 60% of the
population has diabetes. In the United States an estimated 23.6 million children and
adults, 7.8% of the population, have diabetes. While an estimated 17.9 million have been
diagnosed with diabetes, 5.7 million people (or nearly one quarter) are unaware that they
have the disease and another 57 million have pre-diabetes. An estimated 177 million
people are affected by diabetes world-wide, the majority by type 2 diabetes. Two-thirds
live in the developing world. The rate of new cases of diabetes has increased by about 90
percent in the United States over the past decade. From 1995 to 1997, newly diagnosed
cases of diabetes were at 4.8 per 1,000 annually. Between 2005 and 2007, that number
rose to 9.1 per 1,000 people. An estimated 90 percent to 95 percent of the new cases are
type 2 diabetes.
1.Diabetes is a disease in which the body does not produce or properly use insulin.
Insulin is a hormone that is needed to convert sugar, starches and other food into energy
needed for daily life. Diabetes is generally a life long condition although some people
with pre-diabetes and type 2 diabetes have recovered. Genetics and environmental factors
such as obesity, lack of exercise and exposure to certain toxic chemicals, such as the
reaction between the bestselling anti-psychotic Zyprexa and alcohol can cause diabetes,
although the cause is officially unkown. Taking into consideration the high rates of
obesity diabetes is the stereotypical American disease of our times.
a. Type 1 diabetes is usually diagnosed in children and young adults, and was previously
known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin
is a hormone that is needed to convert sugar (glucose), starches and other food into
energy needed for daily life.
b. Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the
body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary
for the body to be able to use glucose for energy. When you eat food, the body breaks
down all of the sugars and starches into glucose, which is the basic fuel for the cells in
the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in
the blood instead of going into cells, it can cause two problems: (1) Right away, your
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cells may be starved for energy. (2) Over time, high blood glucose levels may hurt your
eyes, kidneys, nerves or heart.
c. Gestational diabetes is a disease found in pregnant women who have never had
diabetes before but who have high blood sugar (glucose) levels during pregnancy are said
to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women
- about 135,000 cases of gestational diabetes in the United States each year.
d. Pre-diabetes occurs before people develop type 2 diabetes, they almost always have
"pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough
to be diagnosed as diabetes. There are 57 million people in the United States who have
pre-diabetes. Recent research has shown that some long-term damage to the body,
especially the heart and circulatory system, may already be occurring during pre-diabetes.
2. People with diabetes can live long and healthy lives. Most people with diabetes
however have health problems -- or risk factors -- such as high blood pressure and
cholesterol that increase one's risk for heart disease and stroke. In fact, more than 65% of
people with diabetes die from heart disease or stroke, whereas only 35% of the general
population do. With diabetes, heart attacks can occur earlier in life and the risk of death is
greater. By managing diabetes, high blood pressure and cholesterol, people with diabetes
can reduce their risk.
B. In order to determine whether or not a patient has pre-diabetes or diabetes, health care
providers conduct several tests. A urine analysis may be used to look for glucose and
ketones from the breakdown of fat. However, a urine test alone does not diagnose
diabetes. The following blood glucose tests are used to diagnose diabetes:
1.Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two
occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose
or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its
complications.
2.Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200
mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
3.Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200
mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination,
and fatigue. (This test must be confirmed with a fasting blood glucose test.)
4. Diabetics will need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6
months. The HbA1c is a measure of average blood glucose during the previous 2 - 3
months. It is a very helpful way to determine how well treatment is working.
C. Medications to treat diabetes include insulin and glucose-lowering pills called oral
hypoglycemic drugs. Exercise and diet are extremely important for lowering blood
glucose levels and stimulating insulin production in pre-diabetes and type 2 diabetes.
With a completely healthy diet, high levels of exercise and elimination of toxic agents
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many pre-diabetics and people diagnosed with type 2 diabetes can recover, although they
must always maintain their diet and exercise even more than most people.
1. People with type 1 diabetes cannot make their own insulin. They need daily insulin
injections. Insulin does not come in pill form. Injections are generally needed one to four
times per day. Some people use an insulin pump. It is worn at all times and delivers a
steady flow of insulin throughout the day. Other people may use a new type of inhaled
insulin.
2. Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet,
and medicines taken by mouth. There are several types of medicines used to lower blood
glucose in type 2 diabetes.
3. Medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes is treated with changes in diet.
4. Regular exercise is especially important for people with diabetes. It helps with blood
sugar control, weight loss, and high blood pressure. People with diabetes who exercise
are less likely to experience a heart attack or stroke than those who do not exercise
regularly.
5. The recommended diet for people with diabetes is basically the same as for those with
cardiovasculat disease, cancer and any health or weight problem – a diet that consists
entirely of fruit, vegetables and whole grains and entirely abstains from processed sugars
and candy and carbohydrates like bread and cake and alcohol. Meat is not a big problem
for people with diabetes but fats, including those found in meat, and cholesterol, found in
eggs and processed foods, should be consumed in moderation.
D. It is possible that the increase in the number of new cases of diabetes in the United
States can be entirely attributed to the fact that the anti-depressant Zypexa causes
diabetes when mixed with alcohol and death in people who have diabetes and consume
both diabetes and Zyprexa. In Zyprexa Products Liability Litigation HA-12-2-07 it was
found that the anti-psychotic drug Zyprexa (olanzapine) whose warning label cautions
against the consumption of alcohol but covers up the potentially lethal side effect of
diabetes. The manufacturer Eli Lilly has a long history of hiding the dangerousness of its
products.
1.In 1980, Lilly began marketing Oraflex, a drug for arthritis, in the United Kingdom and
eight other countries. In 1982, it obtained FDA approval to market it in the United States.
But the company hid from the FDA that Oraflex had caused many deaths and illnesses in
the earlier markets. In the U.S., the company failed to warn consumers that the drug
might damage the liver and kidneys. At least 100 people died from Oraflex in the U.S.
The drug was withdrawn from the U.S. market in 1982, the same year it was introduced.
In 1985, Lilly was prosecuted for its handling of the drug's marketing.
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2. In 2006 Eli Lilly agreed to a $750 million settlement of lawsuits filed by 8,000 people
who claimed that they contracted diabetes or suffered significant weight gain after being
prescribed Lilly's best-selling drug Zyprexa. Zyprexa is a type of psychiatric drug called
a neuroleptic or anti-psychotic. Attorneys for both sides of these lawsuits agreed to keep
the approximately 11 million documents involved secret. Lilly has annual revenues
greater than the gross national product of many small countries. Sales of Zyprexa were
$4.4 billion in 2005, and $4.2 billion in 2006. It is widely prescribed to deal with
schizophrenia and bipolar disorder. The company has received over $30 billion from
sales of this drug since it first came on the market in 1996. 20 million people have been
given Zyprexa, often involuntarily, since its introduction. According to the Lilly News
release, from Indiana, of 4 January 2007 it is estimated that of 18,000 claims, 1,200 are
not included in this settlement.
3. In 2008 the US District Court of New York confirmed suspicions of a judicial
conspiracy involving Zyprexa, a drug that mentally ill people are often forced to
consume, despite its harmful side-effects, by the same Probate Judges and estate lawyers
who profit from the wills of deceased people, by issuing an injunction against 11 million
pages of evidence of damages caused by Zyprexa instead of against the patent under
21USC(9)III§332. The bio-medical research into the production of Zyprexa may prove
to have been falsified to coerced patients in mental hospitals. The high sales of the drug
Zyprexa since it hit the market in 1996, about when the diabetes epidemic skyrocketed,
could be entirely the result of sales to unethical practitioners of black magic who
distributes them to bar tenders to crush dissidents with diabetes. The theory that it is
Zyprexa alone causing the spike in the diabetes rate and not obesity or some other
laboratory leak is too compelling not to demand the harmful product be recalled to
control the diabetes outbreak under 42USC(6A)IIF§262(d).
§350 Respiratory Infections
A.All lung diseases put together are the third leading killer in the United States and is the
cause of one in six deaths. Lung disease may refer to many chronic conditions such as
asthma, allergies and to deadly, but largely treatable diseases like chronic obstructive
pulmonary disease, pneumonia and tubercolosis. Every year an estimated 400,000 people
die from diseases of the lung; an age adjusted death rate of 135 per 100,000. More than
35 million people have chronic lung diseases. An estimated 12.1 million have COPD,
also known as emphysema or chronic bronchitis; Smoking is the leading cause of COPD.
It is estimated that 438,000 people die from diseases related to smoking cigarettes such as
heart and lung disease and cancer every year.
1. Pneumonia is an inflammation of the lung, usually caused by an infection and is the
typical cause of death amongst people with influenza. Three common causes are bacteria,
viruses and fungi. Pneumococcal pneumonia is caused by bacteria called Streptococcus
pneumoniae. S. pneumoniae is also called pneumococcus. Pneumonia kills an estimated
55,477 annually out of 1.2 million hospital admissions accounting for 5.6% of inpatient
hospital deaths. 60% of elderly people receive a pneumonia vaccine.
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2. Colds are by far the most widespread of all infections in this country affecting more
than 150 million people in the United States each year. Many people, especially children,
have two or more colds annually. In the average year, colds are responsible for a loss of
440 million workdays and 62 million school days. Including time lost from work,
doctors‘ fees and medications purchased, the annual cost of colds has been estimated well
in excess of eight billion dollars annually. Colds are infections of the lining of the nose.
The common cold is caused by a virus, not just a single virus but any one of more than
125. These include rhinovirus, adenovirus, coronavirus, and respiratory syncytial virus.
Because so many viral types cause colds, it has been difficult to develp a vaccine that
would make you immune to the common cold, since vaccines are targeted at a specific
culprit. It also explains why a person who has recovered from one cold is still susceptible
to infection by a different virus and thus can catch other colds. Viruses and bacteria are
two different things. Sinus infections are caused by bacteria (bacteria respond to
antibiotics) while a cold is secondary to a virus (which does not respond to antibiotics).
3. In the U.S., an estimated 25–50 million cases of the flu are reported annually - leading
to 150,000 hospitalizations and 30,000–40,000 deaths yearly. If these figures were to be
estimated incorporating the rest of the world, there would be an average of approximately
1 billion cases of flu, around 3–5 million cases of severe illness, and 300,000–500,000
deaths yearly. Over 90% of those deaths are in persons over the age of 64 years old. On
average there are over 200,000 hospitalizations per year, again a wide range according to
the severity of the season. About 50% of those hospitalizations are among those ages 64
and older. The highest rates of infection are in children. In fact attack rates are often
over 30% in some communities, resulting in school shut downs and parents missing work
due to having to stay home with their kids.
Fig. 9-19 Diagnosis and Treatment of Respiratory Infections
Infectious Agent Symptoms Treatment
Common Cold
Coronaviruses Upper respiratory tract None, clean. For SARS ventilate,
infection (URI) lasting for a medicate with antibiotic levofloxacin
week, nasal congestion (Levaquin), and corticosteroids
Methylprednisolone IV and then oral
Prednisone
Rhinoviruses URI, Swollen lymph nodes, None, clean. Over-the-Counter:
upper respiratory tract Diphenhydramine (Benylin,
infection, nasal infection, peak Benadryl), Chlorpheniramine
misery after two days, lasts a (Telachlor, Chlo-Amine, Chlor-
week Trimeton, Aller-Chlor),
Brompheniramine (Bromphen,
Nasahist B, Dimetane Extentabs),
Ipratropium intranasal (Atrovent)
Echovirus URI, sore throat, skin rash, None, clean. Immune Globulin
harpangia, croup, may inflame Intravenous (IGIV) for serious
endocarditis, pneumonia, infections
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meningitis, prevalent in
summer and fall in US
Adenoviruses URI and lower respiratory None, clean. Vaccine re-authorized to
tract infection (LRI), may also Teva Pharm on contract with the U.S.
cause conjunctivitis, bladder Army. Get light exercise. Eat white
infection, inflamed pharynx, rice for diarrhea. Clean. Avoid young
diarrhea and rheumatism of children.
the lower extremities for a
week, prevalent in late winter,
spring and summer
Flu Like Symptoms
Influenza A & B Body or muscle aches, chills, Bed rest for one to two days. Vaccine
cough, fever over 101° F, ineffective. OTC Theraflu, Allegra
38°C, headaches, and sore (Sanofi-Aventis) and Children's
throat, incubates for two days, Allegra (fexofenadine) and Allegra-D
lasts two days, prevalent in (fexofenadine and pseudoephedrine);
winter. Prescription Oseltamivir (Tamiflu)
and Zanamivir (Relenza).
Antibiotics for pneumonia
Parainflueza Types 1-4 LRI in children, URI in adults, No vaccine, clean. Treat secondary
prevalent in fall and winter infections with Antibiotics
Respiratory Syncytial LRI and breathing passages. Ribavirin (Virazole), asthmas
Infection Most otherwise healthy people inhalers ie. corticosteroids:
recover from RSV infection in flunisolide (Aerobid),
1 to 2 weeks beclomethasone (QVAR), (Flovent);
triamcinolone, (Azmacort),
Antibiotics for pneumonia or ear
infection
Bacterial Agent
Whooping cough Sporadic epidemic respiratory Antibiotics only cure if taken the first
Bordetella pertussis infection begins with runny week before the infection descends
nose that lasts a week, before into the lungs. Antibiotics taken later
the infection descends to the reduce contagiousness. Clean.
lungs for six weeks of mild
rheumatism and coughing
Strep Group A Highly contagious URI, sore Cured quickly with antibiotics and
Rheumatic Heart Disease: throat, lasting a week, plenty of cardiovascular exercise.
Streptococcus pyogenes, rheumatic heart disease sets inEat vegan. No sugar. Clean. Stock
acquired from young after a week with a 25% up or get a refillable prescription for
adults chance of dying over 10 years, antibiotics. Give your infected
if untreated friends, family and co-workers
antibiotics.
Strep Group B LRI infection, persistent Cured with a full course of
Gout: Steptobacillus endocarditis, hyper uremia and antibiotics, long periods of light
agalactiae acquired from severe prolonged rheumatism exercise, sunlight or Vitamin D for
nursing mothers of the lower extremities cripples. Eat vegan, no caffeine.
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Clean. Avoid nursing mothers and
contaminated fabrics.
Pneumonia: The term pneumonia is used to penicillin, ceftriaxone, cefotaxime
Streptococcus describe any severe and cardiovascular exercise. The
pneumoniae, Chlamydia respiratory infection, these corticosteroid Prednisone is also
pneumoniae and strains are most highly used, but is immune-suppressant.
Staphylococcus aureus contagious, also cause Ventilation in hospitals saves lives.
acquired from hospitals, meningitis, ear and skin Antitoxin for Step/Staph toxic shock
Strep + Staph = toxic infection, endocarditis and syndrome. Eat vegan. Drink safely.
shock syndrome mix and mutate with other Clean. Avoid people for their sake.
resistant systemic bacterial
and viral infections.
Source: Sanders, Tony J. Table 10 Antiviral Medicine for the Treatment of Chronic
Disease. Hospitals & Asylums HA-24-4-11
B. Currently Vitamin C from citrus is the most reliable medicine for the treatment of viral
respiratory infections, vaccines can be effective but there are too many types of viruses to
be effective. Coronaviruses are one of the viruses behind the common cold. Named for
their crown of club-shaped thorns, which can be seen with an electron microscopes, they
cause colds especially during the winter and spring. Coronaviruses need only about three
days to multiply in the respiratory tract before their victim starts feeling miserable. On
average the cold lasts for a week, a few days shorter than a typical rhinovirus cold, but
with more nasal congestion. Coronaviruses are remarkably good at re-infecting their
hosts, which is one reason why vaccines remain elusive. Normally there is no treatment
for coronaviruses other than a caution to wash hand and keep clean. For Severe Acute
Respiratory Syndrome (SARS), a coronavirus, the treatment with no fatalities was to
ventilate the patient and medicate with the antibiotic levofloxacin (Levaquin), and
corticosteroids Methylprednisolone IV and then Prednisone.
1.The rhinovirus genus is the most common cause of the common cold. Rhinoviruses
come in hundreds of types, so a universal cure is hopeless. Rhinoviruses thrive at the
average temperature of our nasal mucous membranes, about 93ºF. They are cousins of
the poliovirus, in the Picornavirus family, possessing about half the same genes, and
strike in late summer and fall, in the Northern hemisphere. A rhino cold lasts on average
about a week, with peak misery on the second and third days. There is shaky evidence
that heavy doses of vitamin C may reduce the length of colds, but not the frequency of
catching them. Washing your hands is a lot is better. Concentrated rhinoviruses in snot
survive for hours on skin, plastic, wood, Formica, steel and many fabrics. Stuff a cold
and starve a fever. A number of Over-the-Counter remedies are known to be effective
with rhinoviruses ie. diphenhydramine (Benylin, Benadryl), chlorpheniramine (Telachlor,
Chlo-Amine, Chlor-Trimeton, Aller-Chlor), brompheniramine (Bromphen, Nasahist B,
Dimetane Extentabs) and Ipratropium intranasal (Atrovent).
2. Adenoviruses are a family of viruses, the ones that like people cause about 5 percent of
all respiratory illnesses, from mild flulike symptoms to pneumonia, involving upper and
lower respiratory tract infections (URI, LRI), swollen adenoids, conjunctivitis and
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diarrhea. The typical incubation period for gastroenteritis is 3-10 days; for respiratory
tract infections it is between 2 and 14 days. Outbreaks of adenovirus-associated
respiratory disease have been more common in the late winter, spring, and early summer;
however, adenovirus infections can occur throughout the year. Most children, in urban
areas, have been infected with the more common adenoviruses by the time they reach
school age. Up to twenty cases a week per one hundred WWI recruits could be expected.
Adenoviruses are often isolated from apparently healthy individuals. The adenoviruses
are a major family of icosahedral DNA containing viruses which have unique molecular
biological properties. ARD is most often associated with adenovirus types 4 and 7, and
more recently adenovirus 14, in the United States. Enteric adenoviruses 40 and 41 cause
gastroenteritis, usually in children. An effective vaccine against Adenovirus serotype 4
(Ad4) and serotype 7 (Ad7) was approved in 1971. The economy-driven cessation of
vaccine production by its sole producer in 1996 resulted in re-emergence of outbreaks,
with Ad4 predominating in 98% of cases, 5 fatalities. On March 16, 2011, the FDA
approved an adenovirus vaccine for manufacture by Teva Pharmaceuticals.
3. Echovirus is one of several families of viruses that affect the gastrointestinal tract
collectively called enteroviruses. Echoviruses also cause respiratory infections. In the
US, echovirus infections are most common in the summer and fall. It is transmitted by
contact with stools contaminated by the virus, and possibly by breathing in air particles
from an infected person. Serious infections with echoviruses are less common, but can
be significant particularly in immune compromised patients. As many as 1 in 5 cases of
viral meningitis are caused by an Echovirus. Complete recovery without treatment is
expected in patients who have the less severe type of illness. Infections of organs such as
the heart (pericarditis and myocarditis) may cause severe distress and can be fatal. No
specific antivirals are available for the Echovirus other than hand-washing, when in
contact with sick people, no vaccines are available. Immune Globulin (IGIV) may help
people with severe Echo virus infections.
C. Parainfluenza and respiratory synctial viruses (RSVs) cause bronchitis, bronchiolitis,
sinus tenderness, swollen glands, red throat, croup and pneumonia, primarily in young
children by members of the paramyxoviridae family of viruses, others of which cause
mumps and measles. Para-influenza viruses, there are four types of medical interest,
cause lower respiratory diseases in kids and upper respiratory problems in adults. The
virus, that strikes in fall and winter, is responsible for approximately 40-50% of croup
cases and 10-15% of bronchiolitis and bronchitis cases and some pneumonias. They are
highly infectious through personal contact and need invade our bodies no deeper than our
noses or throats to replicate in the mucus there. Most people grow immune to them,
which is why parents at the playground aren‘t hacking as much as the kids. There is no
vaccine. People usually recover without treatment. Theraflu was known to cure
overnight. The FDA has approved Allegra (Sanofi-Aventis) and Children's Allegra
(fexofenadine) and Allegra-D (fexofenadine and pseudoephedrine) for sale Over-the-
counter. Corticosteroid inhalers and Prednisone may be effective for the treatment of
chronic disease but they depress the immune system. Treat secondary infections with
Antibiotics.
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1.Respiratory syncytial virus (RSV) infections are usually mild and seem like a common
cold. In most cases, RSV infections go away in about 10 to 14 days. Home treatment to
ease symptoms and prevent complications is usually all that is needed. NSAIDS such as
acetaminophen or ibuprofen may be taken to relieve suffering. Corticosteroids may be
administered if the pneumonia worsens or does not go away on time. Antibiotics are not
usually necessary but should be administered if an ear infection (otitis media) or
pneumonia develop, both are caused by the same Streptococcus pneumonia bacterium,
treated with antibiotics, eg. Penicillin, Streptomycin and Tetracycline, protected against
antibiotic associated colitis with courses of metronidazole (Flagyl ER), a carcinogen.
Children who develop lower respiratory infections, especially bronchiolitis, may need
medicines, such as bronchodilators, for the rest of their lives. When selecting an inhaler
for the first time, or choosing a new one after triamicinolone (Azmacort) was removed by
the producer for fluorocarbon concerns, avoid salmeterol, salmeterol has been known to
be fatal. Flovent (Fluticasone Propionate) seems a safe corticosteroid inhaler, available
without prescription (Generics-Discount).
D. Human influenza is a highly transmissible respiratory illness that‘s caused by the
influenza viruses. We see yearly winter epidemics, called seasonal influenza that affect
up to 30% of the population, killing on average 30,000 a year in the US or 350,000
globally. The incubation time for influenza (time from exposure to onset of symptoms) is
short, about two days. The onset usually is sudden. It is marked by chills, fever,
headache, lassitude and general malaise, loss of appetite, muscular aches and pains and
sometimes nausea, occasionally with vomiting. Respiratory symptoms, such as sneezing
and nasal discharge, may be present coughing, with or without sputum, may occur, and
hoarseness sometimes develops. The fever of 101-105 ° F (40.6 º C) usually lasts for two
to four days. Treatment consists of rest in bed, continuing for twenty-four to forty-eight
hours after the temperature has become normal. Flu is dangerous to the extent that it can
lead to pneumonia, especially for the elderly, the malnourished, or individuals stressed by
chronic lung or heart problems. The viruses that cause flu are prone to antigenic drift,
making vaccine manufacture difficult. Type A Influenza viruses are subdivided into
groups based on two surface proteins, HA and NA, Influenza B or Influenza C based on
protein composition. Type A viruses are found in many kinds of animals, including
ducks, chickens, pigs, and whales, and also humans. The type B virus widely circulates in
humans. Type C has been found in humans, pigs, and dogs and causes mild respiratory
infections, but does not spark epidemics. Flu viruses last for hours in dried mucus.
1.Influenza attacks the respiratory tract in humans (nose, throat, and lungs). The flu is
different from a cold. Influenza usually comes on suddenly and may include these
symptoms: (1) Fever, (2) Headache, (3) Tiredness (can be extreme), (4) Dry cough, (5)
Sore throat, (6) Nasal congestion, (7) Body aches. These symptoms are usually referred
to as "flu-like symptoms." An outbreak of influenza outside of the flu season (winter in
the northern hemisphere) is known as a pandemic. Many people use the term "stomach
flu" to describe illnesses with nausea, vomiting, or diarrhea. These symptoms can be
caused by many different viruses, bacteria, or even parasites. While vomiting, diarrhea,
and being nauseous or "sick to your stomach" can sometimes be related to the flu –
particularly in children – these problems are rarely the main symptoms of influenza. The
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flu is a respiratory disease and not a stomach or intestinal disease. The main way that
influenza viruses and other respiratory ailments are spread is from person to person in
respiratory droplets of coughs and sneezes. (This is called "droplet spread.") This can
happen when droplets from a cough or sneeze of an infected person are propelled
(generally up to 3 feet) through the air and deposited on the mouth or nose of people
nearby. Though much less frequent, the viruses also can be spread when a person touches
respiratory droplets on another person or an object and then touches their own mouth or
nose (or someone else‘s mouth or nose) before washing their hands.
2. Flu patients should, (1) Rest, (2) Drink plenty of liquids, (3) Avoid using alcohol and
tobacco, (4) Take medication to relieve the symptoms of flu. Most people who get
influenza will recover in one to two weeks, but some people will develop life-threatening
complications (such as pneumonia) as a result of the flu. The FDA recently removed
some 600 different types of flu remedies from the market. The most effective remedy has
always been Over-the-counter Theraflu, most consumer are better the next day. The
FDA has approved Allegra (Sanofi-Aventis) and Children's Allegra (fexofenadine) and
Allegra-D (fexofenadine and pseudoephedrine) product lines to be marketed over-the-
counter. The two prescription antivirals that are most commonly used these days are the
neuraminidase inhibitors Oseltamivir (Tamiflu) and Zanamivir (Relenza). Systematic
review of 51 studies found no evidence that the flu vaccine is any more effective than a
placebo in children. Studies published in 2008 found that influenza vaccination was not
associated with a reduced risk of pneumonia in older people although it did contribute to
a reduction in mortality (Jackson et al ‘08)(Eurich et al ‘08). Dangerous complications
with influenza involve bacterial infections that cause pneumonia wherefore broad
spectrum antibiotics that are effective against Haemophilus influenziae such as ampicillin
(Principen) or levofloxacin (Levaquin) save lives.
3. Influenza is the deadliest disease in the history of the world. Influenza, also known as
the flu, is a contagious disease that is caused by the influenza virus. History suggests that
the influenza pandemics have occurred three times in the 20th century 1918, 1957, and
1968. The 1918 Spanish flu caused an estimated 600,000 death in the US alone, 218.4
deaths per 100,000 Americans, and between 40 and 60 million worldwide. The 1918
Spanish Flu killed the greatest number of people over such a period of time of any natural
or man made calamity. The 1957 Asian flu, 2 million lives globally, 22 deaths per
100,000 population; and 1968 Hong Kong flu, 1 million lives globally, 13.9 deaths per
100,000 population. The outbreak of severe acute respiratory syndrome (SARS) in 2003
lasted around three months, resulting in a total of 774 deaths from more than 8,000 cases
of infections in close to 30 countries. In Hong Kong the total number of deaths was
around 300, or roughly 0.004% of the population. Yet Hong Kong's GDP for the affected
quarter fell an estimated 2% and retail sales fell by 6.1%. A 2005 report by the U.S.
Congressional Budget Office estimated the damage from a severe flu pandemic to the
American economy at around 5% of GDP.
4. Of the 10 influenza pandemics over the past 300 years, about half have begun in fall or
winter, while the other half began in the spring or summer, according to the Center for
Infectious Disease Research and Policy at the University of Minnesota. The infamous
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1918 flu pandemic, which killed 50 million people worldwide, began in the spring,
became dormant in the summer and roared back to life in the fall. Almost all deaths
related to current influenza epidemics occur among the elderly. However, mortality was
greatest among the young, ages 20-40, during the 1918–1919 pandemic. Mortality
during the swine flu A(H1N1) pandemic of 2009 also seems to indicate mortality are
mostly amongst people in their 30s.
5. The virologic basis for a recurrent epidemics is a continued process of antigenic
change (antigenic drift) among circulating influenza viruses. Between 1972 and 1992
influenza claimed the lives of an average of 21,000 each season with a range between 0
and 47,000 deaths, in the United States. In recent years 95% of deaths have occurred
amongst people older than 65 years of age. Mortality is generally highest in seasons
when H3N2 predominates. In contrast to annual epidemics worldwide pandemics occur
infrequently in association with the unpredictable emergence of a new Influenza A
subtype. Pandemics can lead to widespread increases in Influenza morbidity and
mortality. The 1918-1919 Spanish influenza was an A(H1N1) and led to an estimated
500,000 deaths in the United States and more than 20 million worldwide. The 1957-1958
Asian influenza was an A(H2N2), the 1968-1969 Hong Kong Influenza was an A(H3N2).
Influenza A(H1N1) stopped circulating in 1957 and reappeared in 1977. Influenza
A(H2N2) disappeared from the human population in 1968
6. Pandemic influenza is a global threat from which no country is immune and the actions
required are a shared responsibility of the whole international community. The
experience of SARS has demonstrated that in the 21st century a pandemic virus could
spread throughout the world in a matter of months, if not weeks. In response WHO
devised a five point strategic action plan. (1) Reduce human exposure to the H5N1 virus.
By reducing opportunities for human infection WHO would reduce opportunities for a
pandemic virus to emerge. (2) Strengthen the early warning system to ensure that affected
countries, WHO, and the international community have all data and clinical specimens
needed for an accurate risk assessment. (3) Intensify rapid containment operations to
prevent the H5N1 virus from further increasing its transmissibility among humans or
delay its international spread. (4) Build capacity to cope with a pandemic to ensure that
all countries have formulated and tested pandemic response plans and that WHO is fully
able to perform its leadership role during a pandemic. (5) Coordinate global scientific
research and development to ensure that pandemic vaccines and antiviral drugs are
rapidly and widely available shortly after the start of a pandemic and that scientific
understanding of the virus evolves quickly.
7. The WHO interim protocol: Rapid operations to contain the initial emergence of
pandemic influenza, of 2007 helps national authorities, with the assistance of WHO and
international partners, to stop the development of pandemic influenza when it is initially
detected and before the virus has been able to spread more widely. The strategy evolved
from 1) recognition that the potential for widespread harm and social disruption from an
influenza pandemic is considerable; 2) recognition, based in part on the experience with
SARS, that mobilization of large and complicated public health operations is possible in
the modern era; and 3) from mathematical modeling studies suggesting that containment
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of a pandemic might be possible in the initial stages if the initial outbreak of human cases
is localized and antiviral prophylaxis, movement restrictions, and non-pharmaceutical
interventions are implemented in the affected area within the first 3 weeks. Detection,
investigation, and reporting of the first cases must happen quickly for rapid containment
of a pandemic to be possible. National authorities and WHO would jointly assess all
relevant technical, operational, and political factors to determine if 1) there is compelling
evidence to suggest that a novel influenza virus has gained the ability to transmit easily
enough from person to person to initiate and sustain community level outbreaks and, if so
2) are there any compelling reasons why a containment operation should be deferred.
Ultimately, the decision to launch a containment operation lies with national authorities.
a.The increase in the pandemic alert phase indicates that the likelihood of a pandemic has
increased. In nature, influenza viruses circulate continuously among animals, especially
birds. Even though such viruses might theoretically develop into pandemic viruses,
Phase 1 no viruses circulating among animals have been reported to cause infections in
humans.
Phase 2 an animal influenza virus circulating among domesticated or wild animals is
known to have caused infection in humans, and is therefore considered a potential
pandemic threat.
Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases
or small clusters of disease in people, but has not resulted in human-to-human
transmission sufficient to sustain community-level outbreaks.
Phase 4 is characterized by verified human-to-human transmission of an animal or
human-animal influenza reassortant virus able to cause ―community-level outbreaks.‖
Phase 5 is characterized by human-to-human spread of the virus into at least two
countries in one WHO region.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least
one other country in a different WHO region.
Post-peak period, pandemic disease levels in most countries with adequate surveillance
will have dropped below peak observed levels.
Post-pandemic period, influenza disease activity will have returned to levels normally
seen for seasonal influenza.
8. There are a variety of different ways to test for influenza virus. The viral culture has
been the gold standard and been around for many decades. It's a useful test from a
surveillance point of view. And these viruses taken from the culture testing are used for
vaccine development and also for monitoring antiviral resistance. However, from a
clinician's point of view, this test does not help much with the management of an
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individual patient because it takes as many as seven days to come back. Serology can be
used. But again, you need some time for this. There's inevitably a delay because you need
paired serum samples to show the rise in the antibody titer. Immunofluorescence is
available at some hospitals. This is a good test but requires intact cells and laboratory
skill and experience. And again, takes some time to get a result back. Reverse
transcriptase preliminary chain reaction or RT-PCR is the most sensitive test and it's
becoming more widely available. The state health labs and some reference labs can now
use the RT-PCR not only to diagnose influenza type, but also to distinguish the influenza
A sub-type.
9.Rapid antigen tests are the most common tests that are used these days. Rapid antigen
tests have their advantages and their disadvantages. They are useful for detecting
outbreaks. They are useful for clinical management, largely because the results get back
within 30 minutes and the testing can be done in the clinic itself. Some of these tests
distinguish Influenza A from Influenza B. However, rapid antigen tests do have some
disadvantages. They are less accurate than viral culture and none of these rapid antigen
tests are able to identify the Influenza A sub-type. Rapid antigen tests can tell you
Influenza or Influenza B, but not whether it is Influenza A H3N2, Influenza A H1N1 or
Influenza H2N2.
10. There are four flu antiviral drugs approved for use in the United States. CDC has
issued interim guidance on which antiviral drugs to use during the 2008-09 flu season
wben the antivirals were reported to have been a extraordinarily good match with 70-90%
success rates. The four antiviral drugs are subdivided into two classes (1) neurominidase
inhibitors and (2) admantanes: The two antivirals that are most commonly used these
days are the neuraminidase inhibitors. What neuraminidase normally does is break the
bond between the infected cell and the virus so the virus can be released to go and cause
infection in other cells. What the neuraminidase inhibitor does is make the virus unable to
detach and as the result virus replication gets slowed or halted. In randomized controlled
trials where one group got a placebo and the other got the drug the duration of influenza
symptoms in the group of people who got the drug was reduced by 1 to 1.5 days. These
drugs are also effective at preventing infection. Several percent of the population
however suffer from the side effects of nausea and vomiting. Drug resistance is a
common problem typically affecting between 1 to 16% of patients who have been treated
with antivirals.
a.Oseltamivir (brand name Tamiflu ®) is approved to both treat and prevent influenza A
and B virus infection in people one year of age and older. It is made by Roche it is
delivered by oral suspension or pill.
b.Zanamivir (brand name Relenza ®) is approved to treat influenza A and B virus
infection in people 7 years and older and to prevent influenza A and B virus infection in
people 5 years and older. Treatment should start if possible within the first 48 hours after
the onset of illness. It is made by GlaxoSmithKline it is delivered by inhalation
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11. The other antivirals that are active against Influenza A are two drugs that were
licensed in the past, amantadine, which was licensed in the 1960s and rimantadine which
was licensed in the late 1980s. The trade names of these two drugs are Suymmetrel for
amantadine and Flumadine for rimantadine. But it is important to note that these are
manufactured generically now that they are off patent. They are chemically related,
orally administered, drugs. As a class they have become known as admantanes. They
have a different mechanism of action from the neuraminidase inhibitors. They inhibit the
function of the M2 ion channel. Unlike the neuraminidase inhibitors, they do not have
activity against Influenza B. Resistance does develop rapidly through the influenza A
viruses over the course of treatment, more rapidly than with the neuraminidase inhibitors.
Currently there is a high prevalence of resistance among the human influenza A H3N2
viruses. There are a number of adverse affects associated with these two drugs, but they
are somewhat rare. These side effects include gastrointestinal and neurologic symptoms.
They are not currently recommended because of the concern with resistance, particularly
the H3N2 viruses.
a.Amantadine (Symmetrel®, generic) is approved to treat and prevent only influenza A
viruses in people older than 1 year.
b.Rimantadine (Flumadine®, generic) is approved to prevent only influenza A virus
infection among people older than 1 year. It is approved to treat only influenza A virus
infections in people 13 and older.
12. The development of vaccines for influenza is complicated by a gene mutation theory
known as antigenic drift. Antigenic drift is a continual process that involves point
mutations or re-combinations in the viral genome. What this means is that a person who
has been exposed to the virus in the past or who has been immunized in the past has a
diminished immune response to these drifted strains. That is why there are yearly
epidemics because people have lost immunity to these somewhat different strains.
Vaccines therefore need to be updated yearly. The antigenic shift is a sporadic and
unpredictable event in which one entire gene, the hemagglutinin gene or the
hemagglutinin gene and the neuraminidase gene are entirely replaced resulting in a new
sub-type. The population doesn‘t have any immunity and this can result in a pandemic.
13.This excuse is so lame that a large-scale, systematic review of 51 studies, published in
the Cochrane Database of Systematic Reviews in 2006, found no evidence that the flu
vaccine is any more effective than a placebo in children. The studies involved 260,000
children, age 6 to 23 months. A recent study published in the October 2008 issue of the
Archives of Pediatric & Adolescent Medicine found that vaccinating young children
against the flu had no impact on flu-related hospitalizations or doctor visits during two
recent flu seasons. The researchers concluded that "significant influenza vaccine
effectiveness could not be demonstrated for any season, age, or setting" examined.
14. In study in The New England Journal of Medicine, concluded that vaccination against
pneumonia does not reduce the risk of contracting a disease. Studies published in both
the Lancet and the American Journal of Respiratory and Critical Care Medicine in 2008
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found that influenza vaccination was not associated with a reduced risk of pneumonia in
older people although it did contribute to a reduction in mortality. Vaccination coverage
among the elderly increased from 15 percent in 1980 to 65 percent now, yet there has
been no decrease in deaths from influenza or pneumonia. In 2007 researchers with the
National Institute of Allergy and Infectious Diseases, and the National Institutes of
Health published this conclusion in the Lancet Infectious Diseases: “We conclude that
frailty selection bias and use of non-specific endpoints such as all-cause mortality have
led cohort studies to greatly exaggerate vaccine benefits.”
15. This leads us to think more critically regarding influenza and pneumonia vaccines,
their manufacturers and distributors. Is the profit motive the only reason that the
influenza virus is still in circulation to this day? Although many vaccines have
undeniable value as preventative medicine and have completely erradicated certain
disease from the nation and world, it is evident that the efficacy of the vaccine is
controversial and that the vaccine manufacturers themselves, and their associates, may be
engaging in criminal or illegal activity relating to the malevolent distribution of live
influenza viruses used in manufacturing the vaccines which leads the vaccine-related
injury of millions and death of 20,000-50,000 Americans annually, not including
pandemics pursuant to punitive damages under 42USC(6A)XIX(2)(B)§300aa-
23(d)(2)(A-C).
16. Two issues arise, first whether information has been fraudulently withheld and second
whether the government needs to exercise greater control over the viruses used in the
research of and manufacture of influenza vaccines. Whereas the vaccines have been
approved by the Secretary and the government typically asks for the vaccines to be
produced and the government was involved in the both the approval of influenza vaccines
and their discrediting, to a limited extent, it would probably be wise to rule out the
fraudulent withholding of information. In regards to the second the government clearly
needs to excersize much more control over all influenza viruses used in research
laboratories. The financial incentive to malevolently distribute influenza viruses exists
for the exact same corporations that engage in the research and manufacture of influenza
vaccines and are licensed to possess influenza viruses. Influenza is not cowpox, it is live
influenza viruses that researchers and vaccine manufacturers use to produce new
vaccines, which apparently don‘t work, although the viruses sure do.
17. The Director of the National Vaccine Program shall, therefore coordinate and provide
direction to the National Institutes of Health, the Centers for Disease Control and
Prevention, the Office of Biologics Research and Review of the Food and Drug
Administration, the National Center for Health Statistics, the National Center for Health
Services Research and Health Care Technology Assessment, and the Centers for
Medicare&Medicaid Services in monitoring the need for and the effectiveness and
adverse effects of vaccines and immunization activities under 42USC(6A)XIX(1)§300aa-
2(a)(7) in regards to enhancing control of dangerous influenza viruses under
42USC(6a)§262a. Whereby all possession and transfer of influenza viruses will be
monitored in the national database required by the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002 (Public Law 107-188; June 12,
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2002) and shall be subjected to recall, or destruction, when no longer in use in bona fide
research, under 42USC(6A)(2)(F)(1)§262(d).
a.Whereupon, it would be an offense under 18USC(10)I§175 for a vaccine manufacturer
to possess any live viruses after they had manufactured their vaccine. It would also be an
offense for an academic research institution to stockpile or posses live influenza virsues
or for any vaccine manufacturer being adjudicated the special master on Vaccine Injury
Compensation of the Federal Court of Claims. It would be prohibited to use live
influenza viruses in any products distributed for health care, ie. influenza tests. As the
result of heightening the regulation of the influenza virus the futile process of studying
the antigenic drift of the viruses will no longer be a study of the latest upatented
inventions of laboratory scientists but in response to clinical specimens, regulated by the
Secretary, in hopes of ultimately eliminating all influenza viruses from existence as
intended by 18USCI(10)176 the BWC, Convention on the Prohibition of the
Development, Production and Stockpiling of Bacteriological (Biological) and Toxin
Weapons and on their Destruction that was opened in 1972 and entered into force in 1975
and the Convention on the Prohibition of the Development, Production, Stockpiling, and
Use of Chemical Weapons and on their Destruction CWC was opened in Paris in 1993
and entered into force in 1997.
§350 TB, Malaria and Tropical Diseases
A. Tropical diseases encompass all diseases that occur solely, or principally, in the
tropics. In practice, the term is often taken to refer to infectious diseases that thrive in hot,
humid conditions, such as malaria, leishmaniasis, rabies, schistosomiasis, onchocerciasis,
lymphatic filariasis, Chagas disease, African trypanosomiasis, and dengue. Tubercolosis
(TB) is not exclusively a tropical disease but similar to most tropical diseases, thanks to
advances in medical science, has been nearly completely eliminated in industrialized
nations and affects nearly exclusively people in middle and low income countries. The
two major killers of people infected with HIV/AIDS in Sub-Saharan Africa are
Tubercolisis (TB) and Malaria.
1. United States immigration law requires immigrant visa applicants to obtain certain
vaccinations prior to the issuance of an immigrant visa. Panel physicians who conduct
medical examinations of immigrant visa applicants are required to verify that immigrant
visa applicants have met the vaccination requirements, or that it is medically
inappropriate for the visa applicant to receive one or more of the listed vaccinations: --
Acellular pertussis, Hepatitis A, Hepatitis B, Human papillomavirus (HPV), Influenza,
Influenza type b (Hib), Measles, Meningococcal, Mumps, Pneumococcal, Pertussis,
Polio, Rotovirus, Tetanus and diphtheria toxoids, Varicella, and Zoster
2. When travelling to foreign countries it is important to be up to date with vaccinations
for diseases that exist there but are not prevalent enough in the United States to justify
routine vaccination. CDC divides vaccines for travel into three categories: routine,
recommended, and required. Routine vaccinations are necessary for protection from
diseases that are still common in many parts of the world even though they rarely occur
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in the United States as the result of complete coverage of the population with effective
vaccines. The only vaccine required by International Health Regulations is yellow fever
vaccination for travel to certain countries in sub-Saharan Africa and tropical South
America. Meningococcal vaccination is required by the government of Saudi Arabia for
annual travel during the Hajj. Recommended vaccinations protect travelers from
illnesses present in other parts of the world and to prevent the importation of infectious
diseases across international borders. The Centers for Disease Control prepares
recommendations for Traveler‘s Health in a List of Destinations.
B. Tuberculosis (TB) kills about two million people each year, making it one of the
world's leading infectious causes of death among young people and adults. One-third of
the world's population is infected with TB. Five to 10 percent of people who are infected
with TB become sick with active TB at some time during their life. Each year, more than
8 million people become sick with TB. Pulmonary tuberculosis (TB) is a contagious
bacterial infection that mainly involves the lungs, but may spread to other organs.
Pulmonary tuberculosis is caused by the bacteria Mycobacterium tuberculosis (M.
tuberculosis) and can be transmitted by breathing in air droplets from a cough or sneeze
of an infected person. People most at risk are infants, elderly, people with compromised
immune systems (ie. AIDS) and people who live in crowded unsanitary conditions with
other people who have TB.
1. The outlook is excellent if pulmonary TB is diagnosed early and treatment is begun
quickly. A positive skin test indicates TB exposure and an inactive infection. The goal
of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of
active pulmonary TB will always involve a combination of many drugs (usually four
drugs). It is continued until lab tests show which medicines work best. Symptoms may
improve in 2 - 3 weeks. A chest x-ray will not show this improvement until later.
Treatment usually lasts for 6 months and may require quarantine in a hospital until after
the threat of contagion has eased. Due to a combination of economic decline, the
breakdown of health systems, insufficient application of TB control measures, the spread
of HIV/AIDS and the emergence of multidrug-resistant TB (MDR-TB), TB is on the rise
in many developing and transitional economies. Between 2000 and 2020, it is estimated
that: a. Nearly one billion people will be newly infected with TB, b. 200 million people
will become sick from TB and c. TB will claim at least 35 million lives.
2. TB is a leading cause of death among women of reproductive age and is estimated to
cause more deaths among this group than all causes of maternal mortality. Women are
less likely than men to be tested and treated for TB, and are also less likely to develop an
infection. Over 250,000 children die every year of TB. Children are particularly
vulnerable to TB infection because of frequent household contact. The Global TB
Database reveals low- and lower-middle-income countries (those with an annual GNP per
capita of less than US$2,995) account for more than 90% of TB cases and deaths. The
regions most affected by TB include: a. Southeast Asia: With an estimated three million
new cases of TB each year, this is the world's hardest-hit region. b. Eastern Europe: In
Eastern Europe, TB deaths are increasing after almost 40 years of steady decline. c. Sub-
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Saharan Africa: More than 1.5 million TB cases occur in Sub-Saharan Africa each year.
This number is rising rapidly, largely due to high prevalence of HIV.
3. Poverty, a lack of basic health services, poor nutrition, and inadequate living
conditions all contribute to the spread of TB. In turn, illness and death from TB
reinforces and deepens poverty in many communities. The average TB patient loses
three to four months of work time as a result of TB. Lost earnings can total up to 30% of
annual household income. Some families lose 100% of their income. TB is estimated to
deplete the incomes of the world's poorest communities by a total of US$12 billion. More
than 75% of TB-related disease and death occurs among people between the ages of 15 to
54 - the most economically active segment of the population. TB and HIV/AIDS
HIV/AIDS and TB form a lethal combination, each speeding the other's progress. HIV
promotes rapid progression of primary TB infection to active disease and is the most
powerful known risk factor for reactivation of latent TB infection to active disease. TB is
a leading killer of people living with HIV/AIDS. One-third of people infected with HIV
will develop TB.
4. TB infection can be prevented, treated and contained. The World Health Organization
recommends a strategy for detection and cure called DOTS. DOTS combines five
elements: political commitment, microscopy services, drug supplies, surveillance and
monitoring systems, and use of highly efficacious regimes with direct observation of
treatment. Drugs for DOTS can cost only US $10 per person for the full treatment course
(six to eight months). DOTS is successful and has a success rate of up to 80% in the
poorest countries, prevents new infections by curing infectious patients. It has been
estimated that the gap is U$300 million a year to address the TB epidemic in low and
middle-income countries.
C. Malaria is an infection of the blood by a minute plasmodium parasite. The parasites
multiply rapidly and destroy red cells. Victims normally suffer severe fevers, general
malaise, and sometimes death, depending upon the age and general health of the victim
and the particular species of plasmodium parasites. In A/58/8 WHO‘s Secretariat
estimates of the annual number of deaths directly attributable to malaria in the world lie
between 1.1 and 1.3 million and that 803,000 children under the age of five years in sub-
Saharan Africa died of malaria in 2000 (range 710 000-896 000) and. Based on reported
data and estimations of populations at risk and incidence rates, it also estimates the
incidence of malaria in 2004 in 107 countries and territories affected at between 350 and
500 million cases.
1. The Africa Malaria Report 2003 issued by WHO and UNICEF made the following
observations. a.Malaria remains a principal cause of death for nearly 20% of all children
under the age of five years in Africa; the mortality rate in eastern and southern Africa
almost doubled over the period 1990-1998 compared with 1982-1989 possibly as a result
of increasing resistance of plasmodia to chloroquine. b. In malaria-endemic countries,
25% to 40% of all outpatient visits and 20% to 50% of hospital admissions were for
malaria. c. Malaria was also an important indirect cause of mortality, estimated to cause
75 000-200 000 infant deaths per year, for example through malaria-related maternal
anaemia in pregnancy and low birth weight. d. Only 2% of children under five years of
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age slept under insecticide-treated mosquito nets; the proportion for untreated nets was
13%. e. On average, 42% of children under five years of age with fever were treated with
an antimalarial agent, but in many cases this was chloroquine whose efficacy is declining.
f. More than 60% of pregnant women in 15 of 17 countries sought antenatal care;
however, few countries were using such care services to provide intermittent preventive
treatment against malaria. g. Some 110 million Africans lived in areas at risk for
epidemics of malaria; complex emergencies are one of the determinants of such
epidemics and many of the deaths due to malaria in Africa occur in populations affected
by conflicts.
2. Malaria Control WHA58.2 Recognizes that the Global Fund to Fight AIDS,
Tuberculosis and Malaria has committed 31% of its grants or US$ 921 million over two
years, to projects to control malaria in 80 countries, URGES Member States:
a. To establish national policies and operational plans to ensure that at least 80% of those
at risk of, or suffering from, malaria benefit from major preventive and curative
interventions by 2010 in accordance with WHO technical recommendations so as to
ensure a reduction in the burden of malaria of at least 50% by 2010 and 75% by 2015;
b. To assess and respond to the need for integrated human resources at all levels of the
health system in order to achieve the targets on the Abuja Declaration on Roll Back
Malaria in Africa and the internationally agreed development goals of the United Nations
MillenniumDeclaration, and to take the necessary steps to ensure the recruitment, training
and retention of health personnel;
c. To further enhance financial support and development assistance to malaria activities
in order to achieve the above targets and goals, and to encourage and facilitate the
development of new tools to increase effectiveness of malaria control, especially by
providing support to the UNICEF/UNDP/World Bank/WHO Special Programme for
Research and Training in Tropical Diseases;
d. To ensure financial sustainability and to increase, in countries endemic for malaria,
domestic resource allocation to malaria control and to create favourable conditions for
working with the private sector in order to improve access to good-quality malaria
services;
e. To pursue a rapid scale-up of prevention, by applying expeditious and cost-effective
approaches, including targeted free, or highly subsidized, distribution of materials and
medicines to vulnerable groups, with the aim of at least 60% of pregnant women
receiving intermittent preventive treatment and at least 60% of those at risk using
insecticide-treated nets wherever that is the vector-control method of choice;
f. To support indoor residual insecticide spraying, where this intervention is indicated by
local conditions;
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g. To achieve community participation and multisectoral collaboration in vector-control
and other preventive actions;
h. To develop or strengthen intercountry cooperation to control the spread of malaria
across shared borders and migratory routes;
i. To encourage intersectoral collaboration, both public and private, at all levels,
especially in education;
j. To support expanded access to artemisinin-based combination therapy, including the
commitment of new funds, innovative mechanisms for the financing and national
procurement of artemisinin-based combination therapy, and the scaling up of artemisinin
production to meet the increased need;
k. To support the development of new medicines to prevent and treat malaria, especially
for children and pregnant women; of sensitive and specific diagnostic tests; of effective
vaccine(s); and of new insecticides and delivery modes in order to enhance effectiveness
and delay the onset of resistance, including through existing global partnerships;
l. To support coordinated efforts to improve surveillance, monitoring and evaluation
systems so as better to track and report changes in the coverage of recommended ―Roll
Back Malaria‖ interventions and subsequent reductions in the burden of malaria;
3. International funding for malaria control in 2002 was estimated to have been only
about US$ 130 million. Since 2002, when the Global Fund to Fight AIDS, Tuberculosis
and Malaria started its operations, it has to date allocated a total of US$ 940 million for
malaria control over a two-year period and US$ 1800 million over five years. Current
malaria control is based on large-scale application of antimalarial medicines and
insecticides. The rapid increase in demand for artemisinin-based combination therapies in
2004 and the fact that it takes six to eight months for the plant from which artemisinin is
extracted to grow have led to higher prices and temporary supply shortages. For
countries in Africa to attain this goal will require international investments of on average
US$ 1900 million per year and for 36 countries endemic for malaria outside Africa with a
heavy burden of disease about US$ 1300 million per year.
§351 Polio, Plague and Smallpox
A.The United States and other industrialized nations have been largely successful in
reducing the death rate from, and indicedence of, many infectious and diarrheal diseases
and has been successful in completely eradicating many persistent and deadly ailments
such as polio, plague and smallpox, through vaccination and quarantine.
B. Poliovirus is a member of the enterovirus subgroup, family Picornaviridae.
Enteroviruses are transient inhabitants of the gastrointestinal tract, and are stable at acid
pH. Picornaviruses are small, ether-insensitive viruses with an RNA genome. There are
three poliovirus serotypes (P1, P2, and P3). There is minimal heterotypic immunity
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between the three serotypes. That is, immunity to one serotype does not produce
significant immunity to the other serotypes. The poliovirus is rapidly inactivated by heat,
formaldehyde, chlorine, and ultraviolet light. The virus enters through the mouth and
primary multiplication of the virus occurs at the site of implantation in the pharynx and
gastrointestinal tract. The virus is usually present in the throat and in the stool before the
onset of illness. One week after onset there is little virus in the throat, but virus continues
to be excreted in thestool for several weeks. The virus invades local lymphoid tissue,
enters the blood stream, and then may infect cells of the central nervous system.
Replication of poliovirus in motor neurons of the anterior horn and brain stem results in
cell destruction and causes the typical manifestations of poliomyelitis.
1. Paralytic polio is classified into three types, depending on the level of involvement.
Spinal polio is most common, and accounted for 79% of paralytic cases from 1969–1979.
It is characterized by asymmetric paralysis that most often involves the legs. Bulbar
polio accounted for 2% of cases and led to weakness of muscles innervated by cranial
nerves. Bulbospinal polio accounted for 19% of cases and was a combination of bulbar
and spinal paralysis. The death-to-case ratio for paralytic polio is generally 2%–5% in
children and up to 15%–30% in adults (depending on age). It increases to 25%–75% with
bulbar involvement.
2. Poliovirus is highly infectious, with seroconversion rates in susceptible household
contacts of children nearly 100% and more than 90% in susceptible household contacts of
adults. Persons infected with poliovirus are most infectious from 7 to 10 days before and
after the onset of symptoms, but poliovirus may be present in the stool from 3–6 weeks.
3. Oral Polio Vaccine (OPV) is highly effective in producing immunity to poliovirus. A
single dose of OPV produces immunity to all three vaccine viruses in about 50% of
recipients. Three doses produce immunity to all 3 poliovirus types in more than 95% of
recipients. As with other live virus vaccines, immunity from oral poliovirus vaccine is
probably lifelong. The risk of Vaccine Associated Paralytic Polio (VAPP) is about one
case per 6.2 million doses. It is therefore recommended to erradicate the disease through
thorough immunization and then terminate the program after 3 years without infection.
4. WHA58/11 reports that in 1988, wild-type poliovirus was endemic in more than 125
countries and the Health Assembly, called on all Member States to accelerate eradication
activities. On 15 January 2004, the Director-General, the spearheading partners of the
Global Polio Eradication Initiative and health ministers of the six countries remaining
endemic for poliomyelitis signed the Geneva Declaration for the Eradication of
Poliomyelitis committing themselves to interrupting the final chains of poliovirus
transmission through intensified immunization campaigns. In 2004 there were a total of
1,264 reported cases of polio. The intensified eradication activities made good progress
in Asia. Health ministers from countries in Africa and Asia affected by poliomyelitis
reconvened on 13 January 2005 and 4 February 2005, respectively, to assess progress in
completing the activities set out in the Geneva Declaration and to identify the actions
needed to interrupt poliovirus transmission in 2005.
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a. An increase in the quality and quantity of poliomyelitis campaigns in Afghanistan,
India and Pakistan reduced the geographical distribution of wild-type poliovirus in those
countries, with altogether just 194 cases reported compared with 336 for the same period
in 2003.
b. In Egypt, poliovirus transmission fell to its lowest level ever as the quality of
poliomyelitis campaigns improved further.
c. In contrast, sub-Saharan Africa experienced epidemic poliomyelitis as a result of a
suspension (from August 2003 to 31 July 2004) of immunization against the disease in
the state of Kano, Nigeria, and low routine immunization coverage in some neighbouring
countries.
d. Consequently, reported cases of poliomyelitis in Niger and Nigeria increased to 814 by
8 March 2005 compared with 395 at the same time in 2003,
e. 254 cases occurred in 12 previously poliomyelitis-free countries due to imported wild-
type polioviruses. In five of these countries (Burkina Faso, Central African Republic,
Chad, Côte d‘Ivoire and the Sudan) endemic transmission of the imported polioviruses
was re-established.
5. The Ad Hoc Advisory Committee on Polio Eradication recommens synchronous
cessation of use of the oral vaccine as early as three years after interruption of wild-type
poliovirus transmission worldwide. Safely stopping use of oral poliomyelitis vaccine will
require: (i) confirmation of interruption of transmission of wild-type poliovirus globally,
(ii) appropriate containment of all poliovirus strains (wild-type, vaccine-derived and
Sabin) in laboratories and vaccine-production facilities, (iii) a WHO/UNICEF-managed
stockpile of monovalent oral poliomyelitis vaccines with internationally agreed
mechanisms for their use, (iv) continued poliovirus surveillance and notification capacity
that meet international standards globally, (v) processes for synchronously stopping use
of oral poliomyelitis vaccine globally, and (vi) decisions by all countries using oral
poliomyelitis vaccine on their long-term poliomyelitis immunization policy for the period
following cessation of use of oral vaccine.
6. Although records from antiquity mention crippling diseases compatible with
poliomyelitis, it was Michael Underwood from England who, in 1789, first described a
debility of the lower extremities in children that was recognizable as poliomyelitis. The
first outbreaks in Europe were reported in the early 19th century, and outbreaks were
reported in the United States a few years later. For the next hundred years, epidemics of
polio were reported from developed countries in the northern hemisphere each summer
and fall. These epidemics became increasingly severe, and the average age of persons
affected rose. The increased age of primary infection increased both the disease severity
and number of deaths from polio.
7. Polio reached a peak in the United States in 1952, with more than 21,000 paralytic
cases. Polio incidence fell rapidly following introduction of effective vaccines. The last
case of wild-virus polio acquired in the United States was in 1979. A polio eradication
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program conducted by the Pan American Health Organization led to elimination of polio
through the Western Hemisphere in 1991. In 2003 only 784 confirmed cases of polio
were reported globally and polio was endemic in 6 countries.
8. Owing to the international spread of wild-type poliovirus in central and western Africa,
planned supplementary poliomyelitis immunization activities were markedly expanded
for 2005 and extended through to the end of 2006. As of 18 March 2005, the funding gap
for activities in the second half of the year was US$ 75 million and the gap for activities
in 2006 was US$ 200 million.
. The World Health Organization reports, Plague is a zoonotic disease circulating
mainly among small animals and their fleas. The bacteria Yersinia pestis can also infect
humans. It is transmitted between animals and humans by the bite of infected fleas, direct
contact, inhalation and rarely, ingestion of infective materials. Plague can be a very
severe disease in people, with a case-fatality ratio of 30%-60% if left untreated. Infected
persons usually start with ―flu-like‖ symptoms after an incubation period of 3-7 days.
Patients typically experience the sudden onset of fever, chills, head and body-aches and
weakness, vomiting and nausea. Clinical plague infection manifests itself in three forms
depending on the route of infection: bubonic, septicaemic and pneumonic.
1. Bubonic form is the most common form of plague resulting from the bite of an
infective flea. Plague bacillus enters the skin from the site of the bite and travels through
the lymphatic system to the nearest lymph node. The lymph node then becomes inflamed
because the plague bacteria, Yersinia pestis or Y. pestis, will replicate here in high
numbers. The swollen lymph node is called a "bubo" which is very painful and can
become suppurated as an open sore in advanced stage of infection;
2. Septicaemic form of plague occurs when infection spreads directly through the
bloodstream without evidence of a "bubo". More commonly advanced stages of bubonic
plague will result in the presence of Y. pestis in the blood. Septicaemic plague may result
from flea bites and from direct contact with infective materials through cracks in the skin.
3. Pneumonic form of plague is the most virulent and least common form of plague.
Typically, pneumonic form is due to a secondary spread from advanced infection of an
initial bubonic form. Primary pneumonic plague results from inhalation of aerosolized
infective droplets and can be transmitted from human to human without involvement of
fleas or animals. Untreated pneumonic plague has a very high case-fatality ratio.
4. Plague is endemic in many countries in Africa, in the former Soviet Union, the
Americas and Asia. In 2003, 9 countries reported 2118 cases and 182 deaths. 98.7% of
those cases and 98.9% of those deaths were reported from Africa. Today the distribution
of plague coincides with the geographical distribution of its natural foci.Rapid diagnosis
and treatment is essential to reduce complications and fatalities. Effective treatment
enables most plague patients to be cured if diagnosied in time. These methods include
the administration of antibiotics and supportive therapy. The objective of preventive
measure is to inform people in infected areas where zoonotic plague is active and take
1465
pracautions against flea bites and handling carcasses. People should avoid having direct
contact with infected tissue or being exposed to patients with pneumonic plague.
Diagnosis and confirmation of plague requires laboratory testing. Recovery and
identification of Y pestis culture from a patient sample is optimum for confirmation.
Vaccinations are not recommended for anyone but laboratory personnel. Outbreaks of
the plague should be managed to identify animal and flea species that are implicated in
the enzootic cycle of the region and develop a programme on environmental management
to limit its portential spread by identifying zoonotic foci for the public to avoid.
5. The earliest known epidemic of the plague, also known as ―Black Death‖, was in
Athens in 430 B.C. that succumbed an estimated 25% to 50% of the population. The
epidemic spread widely across Europe in 1334 and killed three quarters of the European
population and Asia in less than 20 years. By 1349 it swept across Hungary, Italy, Spain,
France, Germany and England. Followed by the sporadic outbreaks of bubonic plague
throughout the three centuries plague returned to Holland in 1663, and to London in
1665. There are about 20 cases of plague in the United States each year, mostly in parts
of California, Colorado, Utah, Arizona, Nevada and New Mexico. It is carried by fleas
that live on rodents such as prairie dogs and rats. The last known case of person-to-person
transmission of plague in the United States was in 1924. Plague is still a problem in the
developing world, where about 3,000 cases are reported each year.
D. Smallpox is a serious, contagious, and sometimes fatal infectious disease. There is no
specific treatment for smallpox disease, and the only prevention is vaccination. The name
smallpox is derived from the Latin word for ―spotted‖ and refers to the raised bumps that
appear on the face and body of an infected person.
1. There are two clinical forms of smallpox. Variola major is the severe and most
common form of smallpox, with a more extensive rash and higher fever. There are four
types of variola major smallpox: ordinary (the most frequent type, accounting for 90% or
more of cases); modified (mild and occurring in previously vaccinated persons); flat; and
hemorrhagic (both rare and very severe). Historically, variola major has an overall
fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal.
Variola minor is a less common presentation of smallpox, and a much less severe disease,
with death rates historically of 1% or less.
2. Smallpox outbreaks have occurred from time to time for thousands of years, but the
disease is now eradicated after a successful worldwide vaccination program. The last case
of smallpox in the United States was in 1949. The last naturally occurring case in the
world was in Somalia in 1977. After the disease was eliminated from the world, routine
vaccination against smallpox among the general public was stopped because it was no
longer necessary for prevention.
3. The smallpox vaccine helps the body develop immunity to smallpox. The vaccine is
made from a virus called vaccinia which is a ―pox‖-type virus related to smallpox. The
smallpox vaccine contains the ―live‖ vaccinia virus—not dead virus like many other
vaccines. For that reason, the vaccination site must be cared for carefully to prevent the
1466
virus from spreading. The vaccine does not contain the smallpox virus and cannot give
you smallpox. Smallpox vaccination provides high level immunity for 3 to 5 years and
decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even
longer. Historically, the vaccine has been effective in preventing smallpox infection in
95% of those vaccinated. Currently, the United States has a big enough stockpile of
smallpox vaccine to vaccinate everyone in the United States in the event of a smallpox
emergency.
4. In the Global Smallpox Vaccination Reserve Report by the Secretariat for the World
Health Assembly Provisional Agenda 13.6 A/56/9 of 7 April 2005 recommended that
whereas the immunity from the elimination campaign had waned and danger from
possible bioterrorist attacks compells first the stock of vaccine in Geneva be increased to
5 million and second the donor nations should increase reserves to 1979 levels and third
at least two pharmaceutical factories able to manufacture at least 20 million doses would
be discovered.
5. In its final report of 1979, the Global Commission for the Certification of Smallpox
Eradication discussed the need to maintain reserve stocks of vaccine and concluded that it
would be prudent for WHO and national authorities to be prepared for unforeseen
circumstances. At that time, the source of the risk of a reintroduction of smallpox was
perceived to be laboratories or natural or animal reservoirs, and that likelihood was
considered negligible. The Commission recommended that freeze-dried smallpox vaccine
sufficient to vaccinate 200 million people should be maintained by WHO, together with
stocks of bifurcated needles. In 1986, the WHO Committee on Orthopoxvirus Infections
concluded that an unforeseen emergency was so unlikely that WHO no longer needed to
maintain a large global reserve of smallpox vaccine. The global reserve was gradually
reduced to its present level of around 2.5 million doses, held in Geneva and regularly
tested for potency. Population immunity following mass vaccination during the
eradication era has waned, leaving much of the world‘s population vulnerable.
Art. 5 International Standards
§352 International Health Regulation
A. The purpose of the International Health Regulations is to ensure the maximum
security against the international spread of diseases with minimum interference
with world traffic. Its origins date back to the mid-nineteenth century when
cholera epidemics overran Europe between 1830 and 1847.
1. These epidemics were catalysts for intensive infectious disease diplomacy and
multilateral cooperation in public health, starting with the first International
Sanitary Conference in Paris in 1851.
2. Between 1851 and the end of the century, eight conventions on the spread of
infectious diseases across national boundaries were negotiated.
1467
3. The beginning of the 20th century saw multilateral institutions established to
enforce these conventions.
4. In 1948, the WHO Constitution came into force and in 1951 WHO Member
states adopted the International Sanitary Regulations, which were renamed the
International Health Regulations in 1969. The regulations were modified in 1973
and 1981.
5. IHR were initially intended to help monitor and control six serious infectious
diseases – cholera, plague, yellow fever, smallpox, relapsing fever and typhoid.
6. Today, only cholera, plague and yellow fever are notifiable diseases although the
new HIV AIDS epidemic has become the deadliest plague ever.
§353 International Classification of Diseases
ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and
came into use by WHO member states in 1994. The codification is the latest in a
series that has its origins in the 1850‘s.
1. The first edition known as the International List of the Causes of Death was
adopted by the International Statistical Institute in 1893.
2. WHO took over responsibility for the ICD after its foundation in 1948.
3. The ICD is used to classify diseases and other health problems and is XXII
Chapters long.
§354 International Classification of Functioning, Disability and Health
The International Classification of Functioning, Disability and Health (ICF), is a
new classification of health and health related domains that describe body
functions and structures, activities and participation. The domains are classified
from body, individual and societal perspectives.
§355 Codex Alimentarius
The Codex Alimentarius Commission was created in 1963 by Food and Agriculture
Organziation (FAO) and the World Health Organization (WHO) to develop food
standards, guidelines and related texts such as codes of practice under the Joint
FAO/WHO Food Standards Programme. The main purposes of this Programme are
protecting health of the consumers and ensuring fair trade practices in the food trade, and
promoting coordination of all food standards work undertaken by international
governmental and non-governmental organizations.
§356 Convention on the Metric System of 1875 (CMS)
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A. The US does not officially recognize the metric system although it is used in medical
practice. The Bureau International des Poids et Mesures (BIPM) The Convention of the
Metre (Convention du Mètre) is a diplomatic treaty which gives authority to the General
Conference on Weights and Measures, Conférence Générale des Poids et Mesures,
(CGPM), the International Committee for Weights and Measures, Comité International
des Poids et Mesures, (CIPM) and the International Bureau of Weights and Measures,
Bureau International des Poids et Mesures, (BIPM) to act in matters of world metrology,
particularly concerning the demand for measurement standards of ever increasing
accuracy, range and diversity, and the need to demonstrate equivalence between national
measurement standards.
1. The Convention on the Metric System (CMS) was signed in Paris in 1875 by
representatives of seventeen nations. As well as founding the BIPM and laying down the
way in which the activities of the BIPM should be financed and managed, the Metre
Convention established a permanent organizational structure for member governments to
act in common accord on all matters relating to units of measurement. The Convention,
modified slightly in 1921, remains the basis of international agreement on units of
measurement. There are now fifty-one Member States, including all the major
industrialized countries including the US and Canada who continue to use pounds and
inches.
B. The 11th General Conference on Weights and Measures (1960) adopted the name
Système International d'Unités (International System of Units, international abbreviation
SI), for the recommended practical system of units of measurement. The 11th CGPM laid
down rules for the prefixes, the derived units, and other matters. The base units are a
choice of seven well-defined units which by convention are regarded as dimensionally
independent: the metre, the kilogram, the second, the ampere, the kelvin, the mole, and
the candela. Derived units are those formed by combining base units according to the
algebraic relations linking the corresponding quantities.
1. The metre is the length of the path travelled by light in vacuum during a time interval
of 1/299 of a second.
2. The kilogram is the unit of mass; it is equal to the mass of the international prototype
of the kilogram.
3. The second is the duration of of 1/60th of a minute that is in turn 1/60th of an hour
which is in turn 1/24th of a day of which there are 365.25 in one solar year.
4. The ampere is that constant current which, if maintained in two straight parallel
conductors of infinite length, of negligible circular cross-section, and placed 1 m apart in
vacuum, would produce between these conductors a force equal to 2 x 10–7 newton per
metre of length.
5. The kelvin, unit of thermodynamic temperature, is the fraction 1/273.16 of the
thermodynamic temperature of the triple point of water. Or degrees Celsius + 273.15
6. The mole is the amount of substance of a system which contains as many elementary
entities as there are atoms in 0.012 kilogram of carbon. When the mole is used, the
elementary entities must be specified and may be atoms, molecules, ions, electrons, other
particles, or specified groups of such particles.
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7. The candela is the luminous intensity, in a given direction, of a source that emits
monochromatic radiation of frequency 540 x 1012 hertz and that has a radiant intensity in
that direction of 1/683 watt per steradian.
C. The U.S. Metric Association (USMA), Inc., with headquarters in Northridge CA, is a
national non-profit organization, founded in 1916. It advocates U.S. conversion to the
International System of Units which is known by the abbreviation SI (ess-eye). SI is also
called the modern metric system. The process of changing measurement units to the
metric system (SI) is called metric transition or metrication or conversion.
Fig. 9-20: Metric Conversion
Length:
1000 millimeters = 1 meter
100 centimeters = 1 meter
1000 meters = 1 kilometer
Mass (or weight):
1000 milligrams = 1 gram
1000 grams = 1 kilogram
1000 kilograms = 1 metric ton
Volume:
1000 milliliters = l liter
1000 liters = 1 cubic meter
Area:
10 000 square meters = 1 hectare
100 hectares = 1 square kilometer
Prefixes:
micro means 1/1 000 000
milli- means 1/1000
centi- means 1/100
kilo- means 1000
mega- means 1 000 000
Symbols:
m for meter
mm for millimeter
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cm for centimeter
km for kilometer
g for gram
mg for milligram
kg for kilogram
L for liter
mL for milliliter
m2 for square meter
m3 for cubic meter
km2 for square kilometer
t for metric ton
ha for hectare
Some special relationships:
1 milliliter = 1 cubic centimeter
1 milliliter of water has a mass of approximately 1 gram
1 liter of water has a mass of approximately 1 kilogram
1 cubic meter of water has a mass of approximately 1 metric ton
Legal/official (exact) definitions of inch-pound units as set by U.S. law:
1 inch = 25.4 millimeters
1 pound = 453.6 grams
1 gallon = 3.785 liters
Note: In Canada the inch and the pound are defined identically, but 1 Canadian
gallon = 4.546 liters.
Approximate conversion factors between inch-pound units and the International
System of Units (SI):
Multiply inches by 2.54 to get centimeters (this conversion factor is exact)
Multiply feet by 0.305 to get meters
Multiply miles by 1.6 to get kilometers
Divide pounds by 2.2 to get kilograms
Multiply ounces by 28 to get grams
Multiply fluid ounces by 30 to get milliliters
Multiply gallons by 3.8 to get liters
Temperature Conversions, Kelvin, Celsuis and Fahrenheit
temperature kelvins degrees Celsius degrees Fahrenheit
symbol K °C °F
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boiling point of water 373.15 100. 212.
melting point of ice 273.15 0. 32.
absolute zero 0. -273.15 -459.67
temperature degrees Celsius degrees Fahrenheit
symbol °C °F
boiling point of water 100. 212.
average human body temperature 37. 98.6
average room temperature 20. to 25. 68. to 77.
melting point of ice 0. 32
Temperature conversions between the three temperature scales:
kelvin / degree Celsius conversions (exact):
kelvins = degrees Celsius + 273.15
degrees Celsius = kelvins - 273.15
degree Fahrenheit / degree Celsius conversions (exact):
degrees F = degrees C x 1.8 + 32.
degrees C = (degrees F - 32.) / 1.8
Art. 6 International Organisation
§357 Constitution of WHO
A. The Constitution of the World Health Organization was ratified July 22, 1946 and the
States parties declare, in conformity with the Charter of the United Nations, that the
following principles are basic to the happiness, harmonious relations and security of all
peoples:
1. Health is a state of complete physical, mental and social wellbeing and not merely the
absence of disease or infirmity.
2. The enjoyment of the highest attainable standard of health is one of the fundamental
rights of every human being without distinction of race, religion, political belief,
economic or social condition.
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3. The health of all peoples is fundamental to the attainment of peace and security and is
dependent upon the fullest co-operation of individuals and States.
4. The achievement of any State in the promotion and protection of health is of value to
all.
5. Unequal development in different countries in the promotion of health and control of
disease, especially communicable disease, is a common danger.
6. Healthy development of the child is of basic importance; the ability to live
harmoniously in a changing total environment is essential to such development.
7. The extension to all peoples of the benefits of medical, psychological and related
knowledge is essential to the fullest attainment of health.
8. Informed opinion and active co-operation on the part of the public are of the utmost
importance in the improvement of the health of the people.
9. Governments have a responsibility for the health of their peoples which can be fulfilled
only by the provision of adequate health and social measures.
10. Accepting these principles, and for the purpose of co-operation among themselves
and with others to promote and protect the health of all peoples, the Contracting Parties
agree to the present Constitution of the World Health Organization as a specialized
agency of the United Nations.
B. The WHO Constitution bestows upon the public health researcher the following
functions:
a. To act as the directing and co-ordinating authority on international health work.
b. To establish and maintain effective collaboration with the United Nations, specialized
agencies, governmental health administrations, professional groups and such other
organizations as may be deemed appropriate.
c. To assist governments, upon request, in strengthening health services.
d. To furnish appropriate technical assistance and, in emergencies, necessary aid upon
request.
e. To establish and maintain such administrative and technical services as may be
required, including epidemiological and statistical services.
f. To stimulate and advance work to eradicate epidemic, endemic and other diseases.
1473
g. To promote, in co-operation with other specialized agencies where necessary, the
prevention of accidental injuries.
h. To promote, in co-operation with other specialized agencies where necessary, the
improvement of nutrition, housing, sanitation, recreation, economic or working
conditions and other aspects of environmental hygiene.
i. To promote co-operation among scientific and professional groups which contribute to
the advancement of health.
j. To propose conventions, agreements and regulations, and make recommendations with
respect to international health matters and to perform such duties as may be assigned
thereby to the Organization and are consistent with its objective.
k. To promote maternal and child health and welfare and to foster the ability to live
harmoniously in a changing total environment.
l. To foster activities in the field of mental health, especially those affecting the harmony
of human relations.
m. To promote and conduct research in the field of health.
n. To promote improved standards of teaching and training in health, medical and related
professions.
o. To study and report on, in co-operation with other specialized agencies where
ne.cessary, administrative and social techniques affecting public health and medical care
from preventive and curative points of view, including hospital services and social
security.
p. To provide information, counsel and assistance in the field of health.
q. To assist in developing an informed public opinion among all peoples on matters of
health.
r. To establish and revise as necessary international nomenclatures of diseases, of causes
of death and of public health practices.
s. To standardize diagnostic procedures as necessary.
t. To develop, establish and promote international standards with respect to food,
biological, pharmaceutical and similar products.
u Generally to take all necessary action to attain the objective of the Organization.
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v. Fulfill sanitary and quarantine requirements and other procedures designed to prevent
the spread of disease.
w. Respect nomenclatures with respect to diseases, causes of death and public health
practices;
x. Establish standards with respect to diagnostic procedures for international use.
y. Establish standards with respect to the safety, purity and potency of biological,
pharmaceutical and similar products moving in international commerce.
z. License the advertising and labelling of biological, pharmaceutical and similar
products moving in international commerce.
§358 World Health Organisation
A. WHO is the UN specialized agency for health. It was established 7 April 1948.
WHO is governed by 192 Member States. However at the time of opening of the Fifty-
eighth World Health Assembly, the voting rights of Afghanistan, Argentina, Antigua and
Barbuda, Armenia, Central African Republic, Comoros, Dominican Republic, Georgia,
Guinea-Bissau, Iraq, Kyrgyzstan, Liberia, Nauru, Niger, Republic of Moldova, Somalia,
Suriname, Tajikistan and Turkmenistan remained suspended, until the arrears of the
Member State concerned have been reduced, to a level below the amount that would
justify invoking Article 7 of the Constitution WHA58.7. Director General Lee Jong-
wook said at the Conference of African Health Ministers on 28 June 2005, ―Our common
goal is universal access to safe, affordable and effective medical care.‖
1. 31 December 2004, WHO had a total of 4,017 staff members on either fixed-term
appointments of one year or more, or career service/service appointments (both referred
to hereafter as ―fixed-term/service appointments‖). Of these, 1,565 (39.0%) were in the
professional category, 2,207 (54.9%) in the general services and 245 (6.1%) in the
national professional officer category. The number of staff members holding fixed-
term/service appointments had increased by 175 (4.6%) compared with the number at 31
December 2003 according to the annual human resources report A/58/34..
2. WHA58.4 appropriates for the financial period 2006-2007 an amount of US$995,315,
000 is to be supplemented by voluntary contributions estimated at US$ 2,398,126,000,
leading to a total effective budget under all sources of funds of US$ 3,313,441,000;
The regular budget is administrated as follows:
Fig. 9-21: WHO Budget 2006-2007
a. Essential health interventions 238,343,000
b. Health policies, systems and products 164,913,000
c. Determinants of health 96,156,000
d. Enabling programme delivery 251,770,000
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e. WHO‘s core presence in countries 128,624,000
f. Other 35,509,000
g. Effective working budget 915,315,000
h. Transfer to Tax Equalization Fund 80,000,000
i Total 995,315,000
3. World Health Day is held every 7 April.
B. WHO reports that 57,029,155 people died in 2002.
C. Director-General Lee Jong-wook died in Geneva on Monday May 22, 2006 at
7:43 pm after undergoing emergency surgery for a blood clot, subdural hematoma,
in his brain as noted in the Will of Lee Jong-wook HA-22-5-06
1. The timing of Lee‘s death, the day before the World Health Assembly, indicates
foul play on the part of the International Criminal Tribunal for the Former
Yugoslavia whose jail was schedule for condemnation for the murder of their
prisoners Babic and Milosevic HA-25-12-04. The failure of the WHO (a) to
publicise his untimely death and (b) to suspect foul play; undermines all
confidence in the organization that died with the author of their finest World
Health Report 2006: Working Together for Health HA-14-4-06
§359 Director-General
A. WHO is led by a Director-General.who is assisted with a representative of Health
Action in Crisis Polio Eradication 9 departmental Assistant Director-Generals and those
advisors appointed to the highest level of the 3,500 health experts that staff the
Secretariat.
1. Assistant Director-General HIV/AIDS, TB and Malaria
2. Assistant Director-General Communicable Diseases
3. Assistant Director-General Non-communicable Diseases and Mental Health
4. Assistant Director-General Family and Community Health
5. Assistant Director-General Sustainable Development and Health Environments
6. Assistant Director-General Health Technology and Pharmaceuticals
7. Assistant Director-General Evidence and Information for Policy
8. Assistant Director-General External Relations and Governing Bodies
9. Assistant Director-General General Management
§360 Executive Board
A. The Executive Board is composed of 32 elected members technically qualified in the
field of health.
1. The main board meeting is held in January to compose the agenda for the forthcoming
Health Assembly.
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2. The purpose of the Board is to give effect to the decisions of the Health Assembly.
§361 World Health Assembly
A. The Health Assembly (HA) is composed of representatives from WHO‘s Member
States and generally meets annually in May in Geneva. HA held its 58th World Health
Assembly this 2005.
1. The Fifty-eighth World Health Assembly dealt with an extremely heavy agenda,
covering: the review and approval of the Proposed programme budget 2006-2007; the
revision of the International Health Regulations; 21 subitems under Technical and health
matters; financial and management matters; collaboration within the United Nations
system and with other intergovernmental organizations; health conditions of, and
assistance to, the Arab population in the occupied Arab territories, including Palestine;
and staffing matters. In all, the Health Assembly adopted 34 resolutions and two
decisions according to the outcome of the 58th Health Asssembly EB116/2
§362 WHO Regional Offices
A. The 192 WHO Member States are grouped into six regions with a regional
office.
1. Regional Office for Africa
2. Regional Office for the Americas
3. Regional Office for South East Asia
4. Regional Office for Europe
5. Regional Office for the Eastern Meditteranean
6. Regional Office for the Western Pacific
§363 International Narcotics Control Board
A. The International Narcotics Control Board (INCB) is the independent and quasi-
judicial monitoring body for the implementation of the United Nations international drug
control conventions that needs to be brought under the supervision of the WHO. It was
established in 1968 in accordance with the Single Convention on Narcotic Drugs, 1961.
It had predecessors under the former drug control treaties as far back as the time of the
League of Nations.
B. The functions of INCB are laid down in the following treaties:
1. the Single Convention on Narcotic Drugs, 1961;
2. the Convention on Psychotropic Substances of 1971; and
3. the United Nations Convention against Illicit Traffic in Narcotic Drugs and
Psychotropic Substances of 1988
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C. INCB endeavours, in cooperation with Governments, to ensure that adequate supplies
of drugs are available for medical and scientific uses and that the diversion of drugs from
licit sources to illicit channels does not occur. INCB also monitors Governments‘ control
over chemicals used in the illicit manufacture of drugs and assists them in preventing the
diversion of those chemicals into the illicit traffic;
1. INCB identifies weaknesses in national and international control systems and
contributes to correcting such situations. INCB is also responsible for assessing
chemicals used in the illicit manufacture of drugs, in order to determine whether they
should be placed under international control.
D. In the discharge of its responsibilities, INCB:
1. Administers a system of estimates for narcotic drugs and a voluntary assessment
system for psychotropic substances and monitors licit activities involving drugs through a
statistical returns system, with a view to assisting Governments in achieving, inter alia, a
balance between supply and demand.
2. Monitors and promotes measures taken by Governments to prevent the diversion of
substances frequently used in the illicit manufacture of narcotic drugs and psychotropic
substances and assesses such substances to determine whether there is a need for changes
in the scope of control of Tables I and II of the 1988 Convention;
E. Based on its activities, INCB publishes an annual report that is submitted to ECOSOC
through the Commission. The report provides a comprehensive survey of the drug control
situation in various parts of the world. As an impartial body, INCB tries to identify and
predict dangerous trends and suggests necessary measures to be taken. The annual report
is supplemented by technical reports on narcotic drugs and psychotropic substances,
giving a detailed account of estimates of annual legitimate requirements in each country
as well as data, the licit production, manufacture, trade and consumption of these drugs
worldwide.
§364 International Committee of the Red Cross
A. The International Committee of the Red Cross (ICRC) was established in 1863,
the ICRC is the origin of both the International Red Cross and Red Crescent
movement and of international humanitarian law, notably the Geneva Conventions
and Statute of the ICRC of 24 June 1998.
1. The ICRC is an independent, neutral organization ensuring humanitarian protection
and assistance for victims of war and armed violence.
2. The ICRC has a permanent mandate under international law to take impartial action for
prisoners, the wounded and sick, and civilians affected by conflict.
3. With its HQ in Geneva, Switzerland, the ICRC is based in around 80 countries and has
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a total of more than 12,000 staff.
4. In situations of conflict the ICRC coordinates the response by national Red Cross and
Red Crescent societies and their International Federation.
5. The ICRC is at the origin of both the International Red Cross / Red Crescent
Movement and of international humanitarian law, notably the Geneva Conventions.
B. The ICRC is governed by an Assembly (the supreme governing body), an Assembly
Council (a subsidiary body of the Assembly, to which the latter delegates certain of its
powers) and a Directorate (the executive body).
1. The Assembly and the Assembly Council are both chaired by ICRC President.
2. In 2004, ICRC delegates visited 571,503 detainees held in 2,435 places of detention in
more than 80 countries.
3. ICRC water, sanitation and construction projects catered for the needs of around 20
million people;
4. The ICRC supported hospitals and health-care facilities serving some 2.8 million
people;
5. It also provided essential household goods to more than 2.2 million people,
6. ICRC provided food aid to 1.3 million people and
7. ICRC provided assistance to another 1.1 million people in the form of sustainable
food-production and micro-economic initiatives.
§365 International Federation of Red Cross and Red Crescent Societies
A. Founded in 1919, the International Federation of Red Cross and Red Crescent
Societies mission is to improve the lives of vulnerable people by mobilizing the
power of humanity.
1. Together, the National Societies have 97 million members and volunteers, and
300,000 employees, assisting some 233 million beneficiaries each year at a cost
estimated between $250 and $350 billion.
B. 8 May is World Red Cross Red Crescent Day in honor of the founder Jeane-
Henry Dunant‘s birthday.
1. Henry Dunant was one of two laureates for the first Nobel Peace Prize in 1901,
that the ICRC has been awarded - in 1917, 1944 and, with the International
Federation of Red Cross and Red Crescent Societies, in 1963.
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§366 International Humanitarian Law
A. The Four Original Geneva Conventions and Two Additional Protocols are the pre-
eminent contemporary humanitarian laws of war. As the result of the general acceptance
of these Conventions that are the constitutive documents for the International Committee
on the Red Cross , the ICRC has been awarded the Nobel Peace Prize four times. To
mark their personell they must wear white armbands with a red cross or red crescent. The
Four original Geneva Conventions of 12 August 1949 are;
1. Convention (I) for the Amelioration of the Condition of the Wounded and Sick in
Armed Forces in the Field. Geneva, 12 August 1949
That provides no special agreement shall adversely affect the situation of wounded, sick
and shipwrecked persons, of members of the medical personnel or of chaplains, nor
restrict the rights which it confers upon them nor may they renounce in part or in entirety
the rights secured to them. There shall be no obstacle to the provision of relief by the
ICRC or other impartial organization or their vessels for whom protection shall be
provided. Any attempts upon their lives, or violence to their persons, shall be strictly
prohibited; in particular, they shall not be murdered or exterminated, subjected to torture
or to biological experiments; they shall not wilfully be left without medical assistance
and care, nor shall conditions exposing them to contagion or infection be created. If
wounded, sick or shipwrecked persons are taken on board a neutral warship or a neutral
military aircraft, it shall be ensured, where so required by international law, that they can
take no further part in operations of war.
2. Convention (II) for the Amelioration of the Condition of Wounded, Sick and
Shipwrecked Members of Armed Forces at Sea. Geneva, 12 August 1949.
Military hospital ships, with a view to assisting the wounded, sick and shipwrecked, to
treating them and to transporting them, may in no circumstances be attacked or captured,
but shal1 at all times be respected and protected, on condition that their names and
descriptions have been notified to the Parties to the conflict ten days before those ships
are employed. Hospital ships utilized by National Red Cross Societies, by officially
recognized relief societies or by private persons shall have the same protection as military
hospital ships and shall be exempt from capture. Should fighting occur on board a
warship, the sick-bays shall be respected and spared as far as possible. Merchant vessels
which have been transformed into hospital ships cannot be put to any other use
throughout the duration of hostilities.
3. Convention (III) relating to the Treatment of Prisoners of War Geneva Convention
Geneva, 12 August 1949
In cases of disagreement regarding prisoners of war the parties shall invite the ICRC to
meetings. Prisoners of war shall be humanely treated. Medical personell and chaplains
shall be authorized to periodically visit prisoners of war and ask questions regarding the
treatment at the camp. Should supplies not arrive the ICRC may supply the camp. The
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wounded and sick shall be repatriated immediately. All prisoners of war shall be released
and repatriated after the cessation of hostilities. Deaths certificates shall be provided.
The ICRC shall be respected and have permission to visit and distribute relief supplies.
4. Convention (IV) for the Protection of Civilians, Geneva, 12 August 1949
In conflicts not of an international character the Protecting Powers and ICRC are invited
to lend their good offices for the facilitation of hospitals and safety zones and localities so
organized as to protect from the effects of war, wounded, sick and aged persons, children
under fifteen, expectant mothers and mothers of children under seven. Parties to the
conflict and humanitarian organizations may propose neutralized for the care of the sick
and wounded and civilians not taking part in hostilities. Relief consignment and the
support of the ICRC shall be permitted by the Occupying Power and immune from any
tax or tariff. Internees shall be treated humanely with consideration for the educational,
cultural and social well being. Hospital and safety zones shall be away from military
objectives and shall not be defended by military means.
B. Common Art. 3 of the all four of the original Geneva Conventions, state, Persons
taking no active part in the hostilities, including members of armed forces who have laid
down their arms and those placed hors de combat by sickness, wounds, detention, or any
other cause, shall in all circumstances be treated humanely, without any adverse
distinction founded on race, colour, religion or faith, sex, birth or wealth, or any other
similar criteria. To this end, prohibiting;
(a) Violence to life and perso, in particular murder of all kinds, mutilation, cruel
treatment and torture;
(b) Taking of hostages;
(c) Outrages upon personal dignity, in particular humiliating and degrading treatment;
(d) The passing of sentences and the carrying out of executions without previous
judgment pronounced by a regularly constituted court, affording all the judicial
guarantees which are recognized as indispensable by civilized peoples.
2. The wounded, sick and shipwrecked shall be collected and cared for. An impartial
humanitarian body, such as the International Committee of the Red Cross, may offer its
services to the Parties to the conflict.
C. The Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to
the Protection of Victims of International Armed Conflicts (Protocol I) of 8 June 1977;
reinforced the basic principles.
The protection to which civilian medical units are entitled shall not cease unless they are
used to commit, outside their humanitarian function, acts harmful to the enemy.
Protection may, however, cease only after a warning has been given. The occupying
1481
power has the responsibility to care for the medical needs of the civilian population.
Civilian medical personell and their vehicles and facilities shall be respected and
protected. The wounded and sick, even of the enemy, shall be respected and the ICRC
may be called to collect them. Missing people may be reported to the ICRC. Non
defended localities and the civilian population shall not be attacked and relief operations
shall be permitted.
D. Art. 4 of the Protocol Additional to the Geneva Conventions of 12 August 1949, and
relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II),
Geneva, 8 June 1977.
All the wounded, sick and shipwrecked, whether or not they have taken part in the armed
conflict, shall be respected and protected. In all circumstances they shall be treated
humanely and shall receive, to the fullest extent practicable and with the least possible
delay, the medical care and attention required by their condition. There shall be no
distinction among them founded on any grounds other than medical ones. Medical and
religious personnel shall be respected and protected and shall be granted all available
help for the performance of their duties. They shall not be compelled to carry out tasks
which are not compatible with their humanitarian mission. Under no circumstances shall
any person be punished for having carried out medical activities compatible with medical
ethics, regardless of the person benefiting therefrom.
E. Protocol (III) Additional to the Geneva Conventions relating the Adoption of a
New Distinctive Emblem of 8 December 2005 is unnecessary and unjustified without
making reference to the Geneva Protocol of 1925 for the Prohibition of the Use in War of
Asphyxiating, Poisonous or other Gases, and of Bacteriological Methods of Warfare, in
Art. 6 of Protorol (III) pertaining to the Prevention and Repression of Misuse. Without
this much needed link to the Hague Conventions the medical forces of the International
Red Cross are merely flying colors of the immunity they enjoy under the Geneva
Conventions, referrng their quackery to medical ethics.
Art. 7 National Affiliates
§367 American Medical Association
A. The American Medical Association (AMA) was founded in 1847 upon the Code of
Medical Ethics that is now updated by the Council on Ethical and Judicial Affairs. The
policy of the AMA is to promote the science and art of medicine and the betterment of
public health. Their primary method of disseminating health information is through the
Journal of the American Medical Association (JAMA).
B. Governance of the Organization is done by the House of Delegates (HoD) who
codifies policy in the Constitution, Governance Policies, Health Policies and Directives.
The House of Delegates elects all officers, Trustees and members of the four councils
who are nominated by the Board of Trustees.
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C. Since 1966 the AMA has published the Current Procedural Terminology (CPT) Code
that is used to report medical procedures for reimbursement.
D. The licensing of physicians is regulated by the State Medical Licensing Boards who
charge licensing fees and administrate Continuing Medical Education (CME). They and
local medical organizations are considered constituent societies of the American Medical
Association (AMA) in Articles III and IV of the Constitution of the AMA.
E. In 2004 the Bureau of Labor Statistics reported that there were 6,359,380 health care
practitioners and technical occupations with 3,271,350 health care support occupations.
An estimated 535,660 of these were licensed physicians for the purposes of the AMA.
The total number of health professional is estimated to be 14 million.
F. An attending veterinarian means a person who has graduated from a veterinary school
accredited by the American Veterinary Medical Association's Council on Education, and
has received training and/or experience in the care and management of the species being
attended in accordance with the Principles of Veterinary Medical Ethics of the American
Veterinary Medical Association (AVMA) (Approved by the Executive Board July 1999;
revised November 2003) in the spirit of the Golden Rule.
§368 Health Committees
A. In the Senate there is a Committee on Health, Education, Labor and Pensions (HELP)
that is led by a Committee on Labor and Human Resources for all proposed legislation,
messages, petitions, memorials, and other matters relating to the following subjects:
1. Measures relating to education, labor, health, and public welfare.
2. Aging.
3. Agricultural colleges
4. Arts and humanities.
5. Biomedical research and development.
6. Child labor.
7. Convict labor and the entry of goods made by convicts into interstate commerce.
8. Domestic activities of the American National Red Cross.
9. Equal employment opportunity.
10. Gallaudet College, Howard University, and Saint Elizabeths Hospital.
11. Handicapped individuals.
12. Labor standards and labor statistics.
13. Mediation and arbitration of labor disputes.
14. Occupational safety and health, including the welfare of miners.
15. Private pension plans.
16. Public health.
17. Railway labor and retirement.
18. Regulation of foreign laborers.
19. Student loans.
20 Wages and hours of labor.
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B. In Congress there is a Subcommittee on Health in the House Committee on Energy
and Commerce and in the Ways and Means Committee that is responsible for the social
security related aspects of health. For 208 years, the Committee on Energy and
Commerce, the oldest legislative standing committee in the U.S. House of
Representatives, has served as the principal guide for the House in matters relating to the
promotion of commerce and to the public‘s health and marketplace interests. The
Committee‘s initial achievements involved overseeing the Federal health service for sick
and disabled seaman developed, eventually, into the Public Health Service and National
Institutes of Health. The Committee‘s historic legislative jurisdiction over health, safety,
and commerce as it pertains to contemporary health care generally can be traced to the
Food, Drug and Cosmetic Act. The Health Subcommittee is responsible for:
1. Public health and quarantine;
2. hospital construction;
3. mental health;
4. biomedical programs and health protection in general,
5. Medicaid and national health insurance;
6. Food, drugs and drug abuse.
§369 Department of Agriculture
A.The United States Department of Agriculture (USDA) is 143 years old and employs
more than 100,000. The department has more than 300 programs and annually spends
more than $75 billion.
1.The USDA provides leadership on food, agriculture, natural resources, and related
issues based on sound public policy, the best available science, and efficient management
in a rapidly evolving food and agriculture environment.
2. The plan is to expand markets for agricultural products and support international
economic development, further developing alternative markets for agricultural products
and activities, providing financing needed to help expand job opportunities and improve
housing, utilities and infrastructure in rural America, enhancing food safety by taking
steps to reduce the prevalence of foodborne hazards from farm to table, improving
nutrition and health by providing food assistance and nutrition education and promotion,
and managing and protecting America's public and private lands working cooperatively
with other levels of government and the private sector.
§370 Environmental Protection Agency
A. Since the first Earth Day on April 22, 1970 the Environmental Protection Agency
(EPA) has been working for a cleaner, healthier environment for the American people.
EPA employs 17,000 people across the country, including our headquarters offices in
Washington, DC, 10 regional offices, and more than a dozen labs. The mission of the
EPA is to protect human health and the environment.
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1. The EPA works to develop and enforce regulations that implement environmental laws
enacted by Congress. EPA is responsible for researching and setting national standards
for a variety of environmental programs
§371 State and County Boards of Health
A.The regulation of the medical profession is primarily conducted through the services of
State Medical License Boards. To satisfy the public demand for protection from
increasingly sophisticated fraudulent practitioners many states have expanded what is
considered to be the practice of medicine to address new trends in the medical field that
need to be regulated by medical boards. For example, a number of states have passed
legislation in recent years that empower medical boards to have jurisdiction over the
practice of medicine across state boundaries or treatment decisions made by medical
directors of managed care organizations.
1. Health professionals other than physicians (e.g. dentist, psychologist, optometrist,
podiatrist, nurse, veterinarians etc) are referred to the appropriate professional
association.
B. Although licensure requirements for domestic and international medical graduates
differ somewhat among states, all states will require proof of prior education and training
and proof of the completion of a rigorous licensure examination approved by the board.
Specifically, all physicians must submit proof of successful completion of all three steps
of the United States Medical Licensing Examination (USMLE).
C. As the licensing organization of medical practitioners and corporations state medical
license Boards are the only logical venue for medical malpractice and professional
liability claims. These State Boards are supported by the local Boards of Health. Both
state and local Boards need to develop a reputation for honest medical malpractice,
procedural and product liability settlements in order to be recognized as satisfactory by
the attorneys and petitioners of victims of wrongful death and injury as the proper venue
for such claims.
1.To be considered the place to settle medical liability issues State and local Health
Boards will need to develop a reputation with the public for the fair and speedy financial
settlement of victims of procedural and product claims relating to malpractice in the
medical field. By fully incorporating the grievance procedure into the medical licensing
board the health care system will become more adaptable and in control of its resources
as it responds directly to the complaints of its patients in a fully qualified medical forum.
To achieve this change of venue Boards of Health will need to publicize their malpractice
and product liability settlements on the television and print news.
§372 National Association of Medical Examiners
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A. The Coroner is a democratically elected offical in most counties in the USA and is
regulated by the State. The County Coroner is the only health professional elected on the
public ballot in the USA.
1. The coronor investigates the circumstances surrounding every unnatural death
occuring in the county as a judicial officer.
2. Some natural deaths also come under the coroner's jurisdiction when requested to
investigate by next of kin. The coroner examines the evidence related to the death to
discover the cause, usually by conducting an autopsy of the body.
3. Bodies delivered to medical campuses and hospitals with marks of violence are to be
reported to the Coroner.
4. The coroner or deputy coroner may issue subpoenas for such witnesses as are
necessary, administer to such witnesses the usual oath, and proceed to inquire how the
deceased came to his death, whether by violence to self or from any other persons, by
whom, whether as principals or accessories before or after the fact, and all circumstances
relating thereto.
5. Coroner‘s offices conducts ballistic tests of firearms.
6. The Coroner‘s office conducts the forensic laboratory work for the County relating to
drugs, firearms, toxicology and histology.
B. The National Association of Medical Examiners (NAME) is the national professional
organization of physician medical examiners, medical death investigators and death
investigation system administrators who perform the official duties of the medicolegal
investigation of deaths of public interest in the United States. NAME was founded in
1966 with the dual purposes of fostering the professional growth of physician death
investigators and disseminating the professional and technical information vital to the
continuing improvement of the medical investigation of violent, suspicious and unusual
deaths. Growing from a small nucleus of concerned physicians, NAME has expanded its
scope to include physician medical examiners and coroners, medical death investigators
and medicolegal system administrators from throughout the United States and other
countries.
Art. 8 Public Health Department
§373 Public Health Service
A. The Public Health Service (PHS) is the United States government's principal agency
for protecting the health of all Americans and providing essential human services,
especially for those who are least able to help themselves. The Department includes more
than 300 programs, covering a wide spectrum of activities. Some highlights include:
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1. Health and social science research
2. Preventing disease, including immunization services
3. Assuring food and drug safety
4. Medicare (federal health insurance) and Medicaid (state health insurance)
5. Health information technology
6. Financial assistance and services for low-income families
7. Improving maternal and infant health
8. Head Start (pre-school education and services)
9. Faith-based and community initiatives
10. Preventing child abuse and domestic violence
11. Substance abuse treatment and prevention
12. Services for older Americans, including home-delivered meals
13. Comprehensive health services for Native Americans
14. Medical preparedness for emergencies.
B. The foundation of the public health service is typically attributed to July 16, 1798,
when President John Adams signed a bill into law that created what we now know as the
U.S. Public Health Service by establishing the U.S. Marine Hospital Service, predecessor
to today‘s U.S. Public Health Service, to provide health care to sick and injured merchant
seamen.
1. In 1870, the Marine Hospital Service was reorganized as a national hospital system
with centralized administration under a medical officer, the Supervising Surgeon, who
was later given the title of Surgeon General.
C. Because of the broadening responsibilities of the Service, its name was changed in
1902 to the Public Health and Marine Hospital Service. Another law passed in 1902, the
Biologics Control Act, gave the Service regulatory authority over the production and sale
of vaccines, serums, and other biological products. The increasing involvement of the
Service in public health activities led to its name being changed again in 1912 to the
Public Health Service (PHS).
1. PHS was given clear legislative authority to investigate the diseases of man and
conditions influencing the propagation and spread thereof, including sanitation and
sewage and the pollution either directly or indirectly of the navigable streams and lakes
of the United States as explained in the Annual Report of the Surgeon General of the
Public Health Service of 1912 at p. 9.
D. World War II contributed to expansion in the Services programs and personnel, the
latter doubling in size to sixteen thousand employees between 1940 and 1945. Over the
course of the war, the Malaria Control in War Areas program, based in Atlanta, expanded
its responsibilities to include the control of other communicable diseases such as yellow
fever, dengue, and typhus. By the end of the war, the program had demonstrated its value
in the control of infectious disease so successfully that it was converted in 1946 to the
Communicable Disease Center (CDC). The mission of CDC continued to expand over
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the next half century, going beyond the bounds of infectious disease to include areas such
as nutrition, chronic disease, and occupational and environmental health. To reflect this
broader scope of the institution, its name was changed to the Center for Disease Control
in 1970. It received its current designation, Centers for Disease Control and Prevention
(but retaining the acronym CDC), in 1992.
E. In 1946 two major legislative acts had a significant impact on PHS.
1. The National Mental Health Act was to greatly increase the involvement of PHS,
which administered the programs established by the law, in the area of mental health. The
act supported research on mental illness, provided fellowships and grants for the training
of mental health personnel, and made available to states grants to assist in the
establishment of clinics and treatment centers and to fund demonstration projects. It also
called for the establishment within PHS of a National Institute for Mental Health, which
was created in 1949.
2. The Hospital Survey and Construction Act, more commonly referred to as the Hill-
Burton Act, authorized PHS to make grants to the states for surveying their hospitals and
public health centers and for planning construction of additional facilities, and to assist in
this construction. Over the next twenty-five years, the program disbursed almost $ 4
billion.
F. The Cabinet-level Department of Health, Education and Welfare was created under
President Eisenhower, officially coming into existence April 11, 1953.
1. The agency became fully responsible for the health of American Indians in 1955, when
all Indian health programs of the Bureau of Indian Affairs were transferred to PHS. A
new Division of Indian Health was established to administer these programs.
2. In 1956 the Armed Forces Medical Library became the National Library of Medicine
and was made a part of PHS.
3. St. Elizabeths Hospital, which had begun as the Government Hospital for the Insane in
1855, was brought into PHS in 1967 (although much of the hospitals physical plant and
programs were transferred to the District of Columbia in 1987) and became the
headquarter of the Department of Homeland Security in 2009.
4. The Food and Drug Administration was made a part of PHS in 1968, thus involving
PHS much more heavily and visibly in the area of regulation.
G. The 1968 reorganization transferred the responsibility for directing PHS from the
Surgeon General to the Assistant Secretary for Health and Scientific Affairs (a political
appointee position that had been created originally as an adviser to the Department
Secretary). For the first time, a noncareer official became the top official in PHS.
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1. In the 1960s water pollution control was moved from PHS to the departmental level,
and eventually transferred to the Department of the Interior. The creation of the
Environmental Protection Agency (EPA) in 1970 led to the loss of PHS programs in
areas such as air pollution and solid waste to the new agency.
H. In 1979, the Department of Education Organization Act was signed into law,
providing for a separate Department of Education. HEW became the Department of
Health and Human Services, officially on May 4, 1980. The Public Health Service
remained a component of the Department of Health and Human Services (DHHS), as
DHEW was renamed upon the creation of a separate Department of Education in 1980. It
is not known whether to construe this as being expelled or dropping out, after being tried
for drug abuse by the DEA for a decade, without first achieving the degre of Public
Health Department (PHD).
1. A major reorganization in 1995 led to the independence of the Social Security
Administration.
2. The Centers for Medicare Medicaid and S-CHIP (CMS) needs to change its name to
Medicare, as the condition for the transfer of all Mandatory Benefit Programs, to the
management of the Social Security Adminsitration (SSA).
3. The Drug Enforcement Administration (DEA) needs to be transferred to the FDA on
the condition that it change its name Drug Evaluation Agency (DEA).
4. The Substance Abuse Mental Health Administration (SAMHSA) needs to change its
name to the Social Work Administration (SWA).
5. With the no more confusion regarding the confidentiality of personally identifying
health information in the Department, the Agency for Toxic Substances and Disease
Registry (ATSDR) shall appoint an Education Division (ED) to catalogue the toxic
substances, viruses, and pathogens used in academic and corporate bio-medical research
that cause diagnosable diseases.
6. When the Schedules of the Controlled Substances Act (CSA) have been amended and
the language of the Act amended so Schedule I is deadly poison II possibly deadly torture
III painful and disabling torture IV chemotherapy and hard drugs V prescription drugs VI
over the counter drugs VII alcohol, tobacco, raw opium, coca leaf and marijuana; the
United States will have achieved their Public Health Department (PHD).
§374 Office of the Secretary
A.The Secretary is the leader of the Department, as it was created in 1980, and is
responsible for all of the programs. The Secretary is authorized to accept on behalf of the
United States gifts made unconditionally by will or otherwise for the benefit of the
Service or for the carrying out of any of its functions 42USC(6A)IB§238. The Secretary
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is responsible for updating the list of biological agents that pose a serious risk to society
under 42USC(6A)(2)(F)(1)§262a . The Secretary is responsible for the licensing of
biological products and for their recall under 42USC(6A)(2)(F)(1)§262(d). The
Secretary shall undertake reasonable efforts to inform the public of the availability of
Vaccine Injury Compensation under 42USC(6A)XIX(2)(A)§300aa-10(c) and many other
opportunities provides by the Department.
B.The office of the Secretary is structured as follows;
1. Immediate Office of the Secretary (IOS)
2. Assistant Secretary for Administration and Management (ASAM)
3. Assistant Secretary for Budget, Technology and Finance (ASBTF)
4. Assistant Secretary for Health (ASH)
5. Assistant Secretary for Legislation (ASL)
6. Assistant Secretary for Planning and Evaluation (ASPE)
7. Assistant Secretary for Public Affairs (ASPA)
8. Assistant Secretary for Public Health Emergency Preparedness (ASPHEP)
9. Departmental Appeals Board (DAB)
10. Office of Medicare Hearings and Appeals (OMHA)
11. Office for Civil Rights (OCR)
12. Office of the General Counsel (OGC)
13. Office of Inspector General (OIG)
C. The Department employed a total of 64,609 full time equivalents in 2008 with
revenues of $720,639 billion and outlays of $698,847 billion. Excluding Medicare,
Medicaid, SCHIP and all other mandatory benefit programs, total revenues of the
Department were only $92,439 million. In 2009 and 2010 Congress administered an
extra $64,165 million and $44,351 million respectively under the Recovery Act of 2009,
that can be easily repealed.
Fig. 9-22 HHS Budget by Operating Divisions 2008-2010
2010
2008 2009 2010 +/- 2009
Food & Drug Administration:
Program Level 2,420 2,668 3,178 511
Budget Authority 1,150 2,058 2,353 295
Outlays 1,150 2,045 2,218 173
Health Resources & Services
Administration:
Budget Authority 6,943 7,352 7,250 -102
Recovery Act - 2,500 - -
Outlays 7,044 6,915 8,535 1,620
Indian Health Service:
Budget Authority 3,497 3,731 4,185 454
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Recovery Act - 500 - -
Outlays 3,248 3,984 4,297 313
Centers for Disease Control &
Prevention:
Budget Authority 6,181 6,414 6,446 32
Recovery Act - 300 - -
Outlays 5,880 6,322 6,699 377
National Institutes of Health:
Budget Authority 29,607 30,545 30,988 443
Recovery Act - 10,400 - -
Outlays 29,123 32,921 35,394 2,473
Substance Abuse & Mental
Health Services:
Budget Authority 3,234 3,335 3,394 59
Outlays 3,129 3,377 3,343 -34
Agency for Healthcare Research
& Quality:
Program Level 335 372 372 -
Budget Authority - 3 -3
Recovery Act - 700 - -
Outlays -101 66 235 169
Centers for Medicare &
Medicaid Services:
Budget Authority 619,102 669,085 720,405 51,320
Recovery Act - 35,932 43,083 -
Outlays 597,705 700,847 756,700 55,853
Administration for Children &
Families:
Budget Authority 48,220 51,455 48,962 -2,493
Recovery Act - 10,930 1,268 -
Outlays 48,469 56,052 56,053 1
Administration on Aging:
Budget Authority 1,411 1,488 1,491 3
Recovery Act Budget
Authority - 100 - -
Outlays 1,398 1,505 1,520 15
Office of the National
Coordinator:
Budget Authority 42 24 42 18
Recovery Act - 2,000 - -
Outlays 57 212 1,229 1,017
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Medicare Hearings and Appeals:
Budget Authority 64 65 71 6
Outlays 81 65 71 6
Office for Civil Rights
Budget Authority 35 41 42 1
Outlays 36 41 42 1
Departmental Management:
Budget Authority 356 406 419 13
Recovery Act - 5 - -
Outlays 415 353 409 56
Public Health Social Service
Emergency Fund:
Budget Authority 729 1,398 2,678 1,280
Recovery - 50 - -
Outlays 1,858 1,993 2,405 412
Office of Inspector General:
Budget Authority 68 95 75 -20
Recovery Act - 48 - -
Outlays 40 117 112 -5
Program Support Center
(Retirement Pay, Medical
Benefits, Misc. Trust Funds):
Budget Authority 520 552 593 41
Outlays 558 581 616 35
Offsetting Collections:
Budget Authority -1,243 -1,352 -1,102 250
Outlays -1,243 -1,352 -1,102 250
Total, Health & Human
Services:
Budget Authority (excl.
Recovery Act) 720,639 776,695 828,292 +51,597
Total Recovery Act Budget
Authority 64,165 44,351 -19,814
Total Budget Authority 720,639 840,860 872,643 +31,783
Outlays 698,847 816,198 879,196 +62,998
Total Budget Authority inc.
Recovery Act (excl.
Mandatory Programs) 92,439 106,699 82,742 -23,957
Full-Time Equivalents 64,509 67,403 69,919 +2,516
Source: HHS Budget Office
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D. It is being considered, in this Act, to transfer the Medicare, Medicaid , S-CHIP and all
mandatory benefit programs to the management of the Social Security Administration
(SSA). This would reduce the threat of bio-terrorism in government benefits programs
that is theoretically causing a large gap in the life expectancies of the rich and poor.
There must be a separation of power between the Public Health Service and private
confidential medical and individually identifying records. The Welfare Department head
would need to approve periodic check ups and demands forany statistical epidemiologic
cohort research into the welfare rolls.
Fig 9-23 Mandatory Benefit Programs 2008-2010
Mandatory Programs 2010
(Outlays) : 2008 2009 2010 +/- 2009
Medicare 385,782 425,423 452,370 +26,947
Medicaid 201,426 262,389 289,763 +27,374
Temporary Assistance for Needy
Families 17,880 20,283 19,447 -836
Foster Care & Adoption
Assistance 6,750 7,079 7,198 +119
Children 's Health Insurance
Program 6,900 8,566 10,095 +1,529
Child Support Enforcement 4,283 4,472 4,588 +116
Child Care 2,909 2,927 2,938 +11
Social Services Block Grant 1,843 1,909 2,009 +100
Other Mandatory Programs 1,626 2,437 2,601 +164
Offsetting Collections -1,199 -1,324 -1,102 +222
Subtotal, Mandatory Outlays 628,200 734,161 789,907 +55,746
Total, HHS Outlays 698,847 816,198 879,196 +62,998
Source: HHS Budget Office
§375 Office of the Surgeon General
A.The Office of the Surgeon General shall be appointed from the Commissioned Corps to
a four year term. Upon the termination of the term, unless re-elected, the officer reverts
to their rank as it would have been if not for the appointment under 42USC(6A)IA§205.
1. The Commissioned Corps dates back to 1798. Today there are than 6,000 uniformed
officers.
B. Commissioned officers of the Reserve Corps shall be appointed by the President and
commissioned officers of the Regular Corps shall be appointed by him, by and with the
advice and consent of the Senate. The Commissioned officers of the Reserve Corps shall
at all times be subject to call into active duty by the Surgeon General 42USC(6A)IA§204.
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C. The Surgeon General shall assign one commissioned officer from the Regular Corps to
administer the Office of the Surgeon General as Deputy Surgeon General.
D. The Surgeon General shall assign eight commissioned officers from the Regular Corps
who shall each have the title of Assistant Surgeon General under 42USC(6A)IA§206.
1. the Director of the National Institutes of Health,
2. the Chief of the Bureau of State Services,
3. the Chief of the Bureau of Medical Services,
4. the Chief Medical Officer of the United States Coast Guard,
5. the Chief Dental Officer of the Service,
6. the Chief Nurse Officer of the Service,
7. the Chief Pharmacist Officer of the Service, and
8. the Chief Sanitary Engineering Officer of the Service.
E. The Surgeon General Independence Act (H.R.3447) clarifies that the Surgeon
General‘s work must be guided by the best available public health science, provides
budget autonomy for the Surgeon General's Office, stipulates that a Surgeon General can
only be removed from office with good reason, and protects future Surgeon General
Reports and Calls to Action from interference by only allowing the Secretary of Health
and Human Services the authority to block publication.
§376 Centers for Disease Control and Prevention
A. The Centers for Disease Control and Prevention (CDC) was founded in 1946, under
the name of Communicable Disease Center (CDC) to help control malaria, CDC has
remained at the forefront of public health efforts to prevent and control infectious and
chronic diseases, injuries, workplace hazards, disabilities, and environmental health
threats. CDC is globally recognized for conducting research and investigations and for its
action oriented approach. CDC applies research and findings to improve people‘s daily
lives and responds to health emergencies. The two overarching goals of CDC:
1. Health promotion and prevention of disease, injury, and disability: All people,
especially those at higher risk due to health disparities, will achieve their optimal lifespan
with the best possible quality of health in every stage of life.
2. Preparedness: People in all communities will be protected from infectious,
occupational, environmental, and terrorist threats.
B. The National Center for Health Statistics shall be under the direction of a Director who
shall be appointed by the Secretary under 42USC(6A)IIA§242k. The Center shall
conduct and support statistical and epidemiological activities for the purpose of
improving the effectiveness, efficiency, and quality of health services in the United
States. The Center shall collect statistics on -
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1. The extent and nature of illness and disability of the population of the United States (or
of any groupings of the people included in the population), including life expectancy, the
incidence of various acute and chronic illnesses, and infant and maternal morbidity and
mortality,
2. The impact of illness and disability of the population on the economy of the United
States and on other aspects of the well-being of its population (or of such groupings),
3. Environmental, social, and other health hazards,
4. Determinants of health,
5. Health resources, including physicians, dentists, nurses, and other health professionals
by specialty and type of practice and the supply of services by hospitals, extended care
facilities, home health agencies, and other health institutions,
6. Utilization of health care, including utilization of (i) ambulatory health services by
specialties and types of practice of the health professionals providing such services, and
(ii) services of hospitals, extended care facilities, home health agencies, and other
institutions,
7. Health care costs and financing, including the trends in health care prices and cost, the
sources of payments for health care services, and Federal, State, and local governmental
expenditures for health care services, and
8. Family formation, growth, and dissolution.
C. The workforce at CDC/ATSDR totals more than 9,000 employees in 170 occupations
with a public health focus, including physicians, statisticians, epidemiologists, laboratory
experts, behavioral scientists, and health communicators. National headquarters are in
Atlanta although more than 3,000 CDC employees work at other locations throughout the
United States and around the globe.
§377 Agency for Toxic Substances and Disease Registry
A. The Agency for Toxic Substances and Disease Registry (ATSDR) is the lead public
health agency responsible for representing the study of toxicology and implementing the
health-related provisions of Superfund (the Comprehensive Environmental Response,
Compensation and Liability Act of 1980) for which reason it has Environmental Division
(ED). This Act creates an education division to monitor the toxicology of academic bio-
medical research.
1. ATSDR is charged with assessing health hazards at specific hazardous waste sites,
helping to prevent or reduce exposure and the illnesses that result, and increasing
knowledge and understanding of the health effects that may result from exposure to
hazardous substances. The mission is supported by the Agency goals:
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2. Evaluate human health risks from toxic sites and take action in a timely and responsive
public health manner through the study of epidemiology.
3. Ascertain the relationship between exposure to toxic substances and disease provide
for a registry of individuals who are exposed to hazardous waste.
4. Develop and provide reliable, understandable information for affected communities,
tribes, and stakeholders.
5. Build and enhance effective partnerships.
§378 Food and Drug Administration
A. The Food and Drug Administration (FDA) is responsible for protecting the public
health by assuring the safety, efficacy, and security of human and veterinary drugs,
biological products, medical devices, our nation‘s food supply, cosmetics, and products
that emit radiation. The FDA is also responsible for advancing the public health by
helping to speed innovations that make medicines and foods more effective, safer, and
more affordable; and helping the public get the accurate, science-based information they
need to use medicines and foods to improve their health.
B. Beginning as the Division of Chemistry and then (after July 1901) the Bureau of
Chemistry, the modern era of the FDA dates to 1906 with the passage of the Federal
Food and Drugs Act; this added regulatory functions to the agency's scientific mission.
The Bureau of Chemistry's name changed to the Food, Drug, and Insecticide
Administration in July 1927, when the nonregulatory research functions of the bureau
were transferred elsewhere in the department. In July 1930 the name was shortened to the
present version. FDA remained under the Department of Agriculture until June 1940,
when the agency was moved to the new Federal Security Agency. In April 1953 the
agency again was transferred, to the Department of Health, Education, and Welfare
(HEW). Fifteen years later FDA became part of the Public Health Service within HEW,
and in May 1980 the education function was removed from HEW to create the
Department of Health and Human Services, FDA's current home.
1. The agency grew from a single chemist in the U.S. Department of Agriculture in 1862
to a staff of approximately 9,100 employees and a budget of $1.294 billion in 2001,
comprising chemists, pharmacologists, physicians, microbiologists, veterinarians,
pharmacists, lawyers, and many others.
§379 Drug Enforcement Agency
A.The Drug Enforcement Administration (DEA) was founded in 1970 ultra vires the
Controlled Substances Act (CSA) 21USC Chapter 13. The CSA was undermined by
placing the haplessly named DEA in the Department of Justice. To add insult, ―drug
pusher‖ to injury, ―drug slavery‖ the name of the agency is offensive to the fundamental
medical principle of informed consent. The Office of Diversion Control that Registers
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(breeches the confidentiality of) 1,195,309 (2005) medical and pharmaceutical
practitioners and corporations must be transferred to the FDA for the regulation of;
1. Import and Export of Controlled Substances
2. Registration of Pharmaceutical Drug Retailers
B. The DEA Office of Diversion Control must change its name to Drug Evaluation
Agency (DEA) and be transferred to serve as a consumer protection and laboratory
security arm of the Food and Drug Administration (DEA) and in cooperation with
ATDSR prohibit the malevolent use of controlled laboratory supplies by the National
Institutes of Health research programs, grants and fully regulate academic and corporate
bio-medical research. The name change and transfer will greatly enhance legitimate
government control over dangerous and potentially harmful scientifically controlled
biological products, diversion and abuse of prescription drugs, adverse drug reactions,
and international trade.
§380 National Institutes of Health
A. The National Institutes of Health (NIH) is an agency of the Public Health Service
established in 42USC(6A)IIIA§281 to (i) provide for a broad range of research and
education activities relating to biomedical, epidemiological, psychosocial, and
rehabilitative issues, including studies of the impact of such diseases in rural and
underserved communities; (ii) identify priorities among the programs and activities of the
National Institutes of Health regarding such diseases; and (iii) reflect input from a broad
range of scientists, patients, and advocacy groups that focuses on (a) providing for
research on matters that have not received significant funding relative to other matters,
responding to new issues and scientific emergencies, and acting on research opportunities
of high priority; (b) supporting research that is not exclusively within the authority of any
single agency of such Institutes; NIH is comprised of the following national research
institutes:
1. The National Cancer Institute.
2. The National Heart, Lung, and Blood Institute.
3. The National Institute of Diabetes and Digestive and Kidney Diseases.
4. The National Institute of Arthritis and Musculoskeletal and Skin Diseases.
5. The National Institute on Aging.
6. The National Institute of Allergy and Infectious Diseases.
7. The National Institute of Child Health and Human Development.
8. The National Institute of Dental and Craniofacial Research.
9. The National Eye Institute.
10. The National Institute of Neurological Disorders and Stroke.
11. The National Institute of General Medical Sciences.
12. The National Institute of Environmental Health Sciences.
13. The National Institute on Deafness and Other Communication Disorders.
14. The National Institute on Alcohol Abuse and Alcoholism.
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15. The National Institute on Drug Abuse.
16. The National Institute of Mental Health.
17. The National Institute of Nursing Research.
18. The National Institute of Biomedical Imaging and Bioengineering.
19. The National Library of Medicine.
20. The National Center for Research Resources.
21. The John E. Fogarty International Center.
22. The National Center for Human Genome Research.
23. The National Center for Complementary and Alternative Medicine.
24. The National Center on Minority Health and Health Disparities.
B. The Office of the Director (OD) shall (1) advise the agencies of the National Institutes
of Health on medical applications of research; (2) coordinate, review, and facilitate the
systematic identification and evaluation of, clinically relevant information from research
conducted by or through the national research institutes.
1.There shall be in the National Institutes of Health an Associate Director for Prevention.
The Director of NIH shall delegate to the Associate Director for Prevention the functions
of the Director relating to the promotion of the disease prevention research programs of
the national research institutes and the coordination of such programs among the national
research institutes and between the national research institutes and other public and
private entities, including elementary, secondary, and post-secondary schools.
2. In FY 2007 the NIH had a discretionary Budget of $29,236,204,000 that was
administered to the 24 Institutes, the Director‘s Office, and some random programs.
Fig. 9-24 Budget of the National Institutes of Health, In Thousands, 2007-2009
FY 2008
Enacted
FY 2007 (Post FY 2009 Dollar Percent
Institute/Center Enacted Recission) /1 Enacted Change Change
NCI $4,797,639 $4,805,088 $4,968,973 $163,885 3.4%
NHLBI 2,922,929 2,922,928 3,015,689 92,761 3.2%
NIDCR 389,703 389,703 402,652 12,949 3.3%
NIDDK 1,705,868 1,705,868 1,761,338 55,470 3.3%
NINDS 1,535,545 1,543,901 1,593,344 49,443 3.2%
NIAID 4,417,208 4,560,655 4,702,572 141,917 3.1%
NIGMS 1,935,808 1,935,808 1,997,801 61,993 3.2%
NICHD 1,254,707 1,254,708 1,294,894 40,186 3.2%
NEI 667,116 667,116 688,480 21,364 3.2%
NIEHS 642,002 642,253 662,820 20,567 3.2%
NIA 1,047,260 1,047,260 1,080,796 33,536 3.2%
NIAMS 508,240 508,586 524,872 16,286 3.2%
NIDCD 393,668 394,138 407,259 13,121 3.3%
NIMH 1,404,494 1,404,493 1,450,491 45,998 3.3%
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NIDA 1,000,621 1,000,700 1,032,759 32,059 3.2%
NIAAA 436,259 436,259 450,230 13,971 3.2%
NINR 137,404 137,476 141,879 4,403 3.2%
NHGRI 486,491 486,779 502,367 15,588 3.2%
NIBIB 296,887 298,645 308,208 9,563 3.2%
NCRR 1,133,240 1,149,446 1,226,263 76,817 6.7%
NCCAM 121,576 121,577 125,471 3,894 3.2%
NCMHD 199,444 199,569 205,959 6,390 3.2%
FIC 66,446 66,558 68,691 2,133 3.2%
NLM 320,850 320,962 330,771 9,809 3.1%
OD Total 1,096,401 1,109,099 1,246,864 137,765 12.4%
OD (483,000) (495,608) (541,133) (45,525) 9.2%
B&F 81,081 118,966 125,581 6,615 5.6%
Subtotal, Labor/HHS $28,998,887 $29,228,541 $30,317,024 $1,088,483 3.7%
Department of Interior
79,117 77,546 78,074 528 0.7%
Appropriations
Total NIH Discretionary
$29,078,004 $29,306,087 $30,395,098 $1,089,011 3.7%
BA
Type 1 Diabetes 150,000 150,000 150,000 -- 0.0%
Total NIH Budget
$29,228,004 $29,456,087 $30,545,098 $1,089,011 3.7%
Authority
NLM Program
8,200 8,200 8,200 -- 0.0%
Evaluation
Total Program Level $29,236,204 $29,464,287 $30,553,298 $1,089,011 3.7%
Source: National Institutes of Health Budget Office
§381 National Library of Medicine
A. In order to assist the advancement of medical and related sciences and to aid the
dissemination and exchange of scientific and other information important to the
progress of medicine and to the public health, there is established the National
Library of Medicine in 42USC(6A)III(D)(1)§286. The Secretary may, after
obtaining the advice and recommendations of the Board of Regents, prescribe rules
under which the Library will -
1. provide copies of its publications or materials,
2. will make available its facilities for research, or
3. will make available its bibliographic, reference, or other services, to public and private
entities and individuals.
B. To support and enhance the development of new information technologies to aid in the
understanding of the molecular processes that control health and disease, there is
established the National Center for Biotechnology Information in the National Library of
Medicine under 42USC(6A)III(D)(3)§286c. To;
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1. design, develop, implement, and manage automated systems for the collection, storage,
retrieval, analysis, and dissemination of knowledge concerning human molecular biology,
biochemistry, and genetics;
2. perform research into advanced methods of computer-based information processing
capable of representing and analyzing the vast number of biologically important
molecules and compounds;
3. coordinate, as much as is practicable, efforts to gather biotechnology information on an
international basis.
C. There is established within the Library an entity to be known as the National
Information Center on Health Services Research and Health Care Technology under
42USC(6A)III(D)(4)§296d. The purpose of the Center is the collection, storage,
analysis, retrieval, and dissemination of information on health services research, clinical
practice guidelines, and on health care technology, including the assessment of such
technology.
1.The Director of the Center shall ensure that information concerning clinical practice
guidelines is collected and maintained electronically and in a convenient format.
2. The Center, shall coordinate the activities carried out under this section through the
Center with related activities of the Director of the Agency for Healthcare Research and
Quality.
§382 Agency for Healthcare Research and Quality
A. The mission of the Agency for Healthcare Research and Quality (AHRQ) is to
improve the quality, safety, efficiency, and effectiveness of health care for all Americans.
The agency was founded December 1989 as the Agency for Health Care Policy and
Research (AHCPR) and reports to the HHS Secretary. Not less than 0.2% or more than
1% of program costs shall be used to evaluate the effectiveness of the program under
42USC(6A)IB§238j.
B. AHRQ improves the quality of healthcare by:
1. Coordinating, conducting, and supporting research, demonstrations, and evaluations
related to the measurement and improvement of healthcare quality.
2. Developing annual reports to the Nation on trends in healthcare quality and trends in
healthcare disparities.
3. Disseminating scientific findings about what works best and facilitating public access
to information on the quality of and consumer satisfaction with healthcare.
C. AHRQ promotes patient safety and reduces medical errors by:
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1. Developing research and building partnerships with healthcare practitioners and
healthcare systems to reduce medical errors.
2. Establishing the Centers for Education and Research on Therapeutics (CERTs) to
reduce adverse drug events by conducting state-of-the-art clinical and laboratory research
to increase awareness of both the uses and risks of new drugs and drug combinations,
biological products, and devices as well as of mechanisms to improve their safe and
effective use.
3. Advancing the use of information technology (IT) for coordinating patient care and
conducting quality and outcomes research by:
a. Promoting the use of information systems to develop and disseminate individual
provider- and plan-level comparative performance measures.
b. Creating effective linkages between various sources of health information to enhance
the delivery and coordination of evidence-based healthcare services.
c. Promoting the protection of individually identifiable patient information used in health
services research and healthcare quality improvement.
d. Expand the Agency's existing commitment to research on the cost and use of
healthcare services and access to services by:
4. Establishing an Office of Priority Populations to ensure that the needs of these
populations are addressed throughout the Agency's intramural and extramural research
portfolio.
5. Supporting research on the cost and utilization of and the access to healthcare.
6. Maintaining a Center for Primary Care Research and supporting the work of the U.S.
Preventive Services Task Force.
§383 Health Resources and Services Administration
A. The Health Resources and Services Administration (HRSA) provides national
leadership, program resources and services needed to improve access to culturally
competent, quality health care. As the Nation‘s Access Agency, HRSA focuses on
uninsured, underserved, and special needs populations in its goals and program activities:
1. Improve Access to Health Care.
2. Improve Health Outcomes.
3. Improve the Quality of Health Care.
4. Eliminate Health Disparities.
5. Improve the Public Health and Health Care Systems.
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6. Enhance the Ability of the Health Care System to Respond to Public Health
Emergencies.
7. Achieve Excellence in Management Practices
§384 Program Support Center
A. The Program Support Center (PSC) was created in 1995 to provide a wide range of
administrative support within the Department of Health and Human Services (HHS),
allowing the Department Operating Divisions to concentrate on their core functional and
operational objectives. PSC provides products and services on a competitive ―fee-for-
service‖ basis to customers throughout HHS and other executive branch departments and
Federal Agencies. PSC is designed to reduce Government spending and duplication of
efforts in administrative support services, the PSC realizes significant savings through
partnering, standardization, streamlining, prudent acquisition strategies, reorganization,
economies of scale, or consolidation, and an overall sound business approach to the
delivery of products and services. PCS
1. Measures and shares customer service statistics.
2. Implements customer relationship management initiatives.
3. Continually trains employees in customer service.
4. Incorporates customer service objectives into performance plans throughout the
organization.
§385 Indian Health Services
The Indian Health Service (IHS) is responsible for providing federal health services to
American Indians and Alaska Natives. The provision of health services to members of
federally-recognized tribes grew out of the special government-to-government
relationship between the federal government and Indian tribes. This relationship,
established in 1787, is based on Article I, Section 8 of the Constitution, and has been
given form and substance by numerous treaties, laws, Supreme Court decisions, and
Executive Orders. The IHS is the principal federal health care provider and health
advocate for Indian people, and its goal is to raise their health status to the highest
possible level. The IHS currently provides health services to approximately 1.5 million
American Indians and Alaska Natives who belong to more than 557 federally recognized
tribes in 35 states.
§386 Administration on Aging
A. The Administration on Aging (AoA), is one of the nation's largest providers of home-
and community-based care for older persons and their caregivers. The mission is to
develop a comprehensive, coordinated and cost-effective system of long-term care that
helps elderly individuals to maintain their dignity in their homes and communities and
prepare society for an aging population.
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B. Created in 1965 with the passage of the Older Americans Act (OAA), AoA is part of a
federal, state, tribal and local partnership called the National Network on Aging. This
network, serving about 7 million older persons and their caregivers, consists of 56 State
Units on Aging; 655 Area Agencies on Aging; 233 Tribal and Native organizations; two
organizations that serve Native Hawaiians; 29,000 service providers; and thousands of
volunteers. These organizations provide assistance and services to older individuals and
their families in urban, suburban, and rural areas throughout the United States.
C. While all older Americans may receive services, the OAA targets those older
individuals who are in greatest economic and social need: the poor, the isolated, and
those elders disadvantaged by social or health disparities. There are six core services
funded by the OAA including:
1. Supportive services, which enable communities to provide rides to medical
appointments, and grocery and drug stores. Supportive services provide handyman, chore
and personal care services so that older persons can stay in their homes. These services
extend to community services such as adult day care and information and assistance as
well.
2. Nutrition services, which include more than a meal. Since its creation, the Older
Americans Act Nutrition Program has provided nearly 6 billion meals for at-risk older
persons. Each day in communities across America, senior citizens come together in
senior centers or other group settings to share a meal, as well as comradery and
friendship. Nutrition services also provide nutrition education, health screenings, and
counseling at senior centers. Homebound seniors are able to remain in their homes
largely because of the daily delivery of a hot meal, sometimes by a senior volunteer who
is their only visitor. March 2002, marked the 30th anniversary of the OAA Nutrition
Program, and AoA will be celebrating this successful community-based service
throughout the year.
3. Preventive health services, which educate and enable older persons to make healthy
lifestyle choices. Every year, illness and disability that result from chronic disease affects
the quality of life for millions of older adults and their caregivers. Many chronic diseases
can be prevented through healthy lifestyles, physical activity, appropriate diet and
nutrition, smoking cessation, active and meaningful social engagement, and regular
screenings. The ultimate goal of the OAA health promotion and disease prevention
services is to increase the quality and years of healthy life.
4. The National Family Caregiver Support Program (NFCSP), which was funded for the
first time in 2000, is a significant addition to the OAA. It was created to help the millions
of people who provide the primary care for spouses, parents, older relatives and friends.
The program includes information to caregivers about available services; assistance to
caregivers in gaining access to services; individual counseling, organization of support
groups and caregiver training to assist caregivers in making decisions and solving
problems relating to their caregiving roles; and supplemental services to complement care
provided by caregivers. The program also recognizes the needs of grandparents caring for
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grandchildren and for caregivers of those 18 and under with mental retardation or
developmental difficulties and the diverse needs of Native Americans.
5. Services that protect the rights of vulnerable older persons, which are designed to
empower older persons and their family members to detect and prevent elder abuse and
consumer fraud as well as to enhance the physical, mental, emotional and financial well-
being of America's elderly. These services include, for example, pension counseling
programs that help older Americans access their pensions and make informed insurance
and health care choices; long-term care ombudsman programs that serve to investigate
and resolve complaints made by or for residents of nursing, board and care, and similar
adult homes.
6. AoA supports the training of thousands of paid and volunteer long-term care
ombudsmen, insurance counselors, and other professionals who assist with reporting
waste, fraud, and abuse in nursing homes and other settings; and senior Medicare patrol
projects, which operate in 47 states, plus the District of Columbia and Puerto Rico. AoA
awards grants to state units on aging, area agencies on aging, and community
organizations to train senior volunteers how to educate older Americans to take a more
active role in monitoring and understanding their health care.
§387Administration for Children and Families
A. The Administration for Children and Families (ACF), within the Department of Health
and Human Services (HHS) is responsible for federal programs that promote the
economic and social well-being of families, children, individuals, and communities. ACF
programs aim to achieve the following:
1. Families and individuals empowered to increase their own economic independence
and productivity;
2. Strong, healthy, supportive communities that have a positive impact on the quality of
life and the development of children;
3. Partnerships with individuals, front-line service providers, communities, American
Indian tribes, Native communities, states, and Congress that enable solutions which
transcend traditional agency boundaries;
4. Services planned, reformed, and integrated to improve needed access;
5. Strong commitment to working with people with developmental disabilities, refugees,
and migrants to address their needs, strengths, and abilities.
§388 Social Work Administration
A. The Substance Abuse and Mental Health Services Administration (SAMHSA) was
established by an act of Congress in 1992 under Public Law 102-321 that abolished the
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Alcohol, Drug Abuse, Mental Health Service Administration (ADAMHA) that was itself
established May 4, 1974 when President Nixon signed P.L. 93-282. The vision is
consistent with the President‘s New Freedom Initiative that promotes a life in the
community for everyone. This Act abolishes SAMHSA and establishes a Social Work
Administration (SWA) so that the social worker is not dominated by the professional
persecution of psychiatrists and lawyers and so that people are referred to the appropriate
professional in every case. Social workers are the mental professionals.
1. The Center for Mental Health Services (CMHS) seeks to improve the availability and
accessibility of high-quality community-based services for people with or at risk for
mental illnesses and their families. While the largest portion of the Center‘s appropriation
supports the Community Mental Health Services Block Grant Program, CMHS also
supports a portfolio of discretionary grant programs, called Programs of Regional and
National Significance, to apply knowledge about best community-based systems of care
and services for adults with serious mental illnesses and children with serious emotional
disturbances. Issues of stigma and consumer empowerment are also on the Center‘s
program and policy agenda. The Center collects, analyzes, and disseminates national data
on mental health services designed to help inform future services policy and program
decision-making.
2. The mission of the Center for Substance Abuse Prevention (CSAP) is to bring effective
substance abuse prevention to every community, nationwide. Its discretionary grant
programs – whether focusing on preschool-age children and high-risk youth or on
community-dwelling older Americans – target States and communities, organizations and
families to promote resiliency, promote protective factors, and reduce risk factors for
substance abuse. Further, this SAMHSA Center supports the National Clearinghouse for
Alcohol and Drug Information (NCADI), the largest Federal source of information about
substance abuse research, treatment, and prevention available to the public.
3. The Center for Substance Abuse Treatment (CSAT) promotes the availability and
quality of community-based substance abuse treatment services for individuals and
families who need them. It supports policies and programs to broaden the range of
evidence-based effective treatment services for individuals who abuse alcohol and other
drugs and that also address other addiction-related health and human services problems.
The Center administers the Substance Abuse Prevention and Treatment Block Grant
Program. While engaging with States to improve and enhance existing services under the
block grant program, CSAT also undertakes significant professional and lay education
programs and initiatives to promote best practices in substance abuse treatment and
intervention.
4. SAMHSA‘s Office of Applied Studies (OAS) gathers, analyzes, and disseminates data
on substance abuse practices in the United States. OAS is responsible for the annual
National Household Survey on Drug Abuse, the Drug Abuse Warning Network, and the
Drug and Alcohol Services Information Services System, among other studies. OAS also
coordinates evaluation of the service-delivery models within SAMHSA's knowledge
development and application programs.
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B. The reason that the SWA abolishes SAMHSA and is not immediately appointed
supervisor for the Agency on Family and Children and Agency on Aging is because the
social worker is the only ethical mental health professional and has a considerable
amount of opression to alleviate before being put in charge of otherwise integral
agencies. The primary duties of the SWA are to:
1. Close all state mental institutions and private psychiatric hospitals.
2. Assume responsibility for the administration of State and County Boards of Mental
Health and Addiction.
3. Assume responsibility for the adjudication of mental illness from the Mental Health
court so the slavery free Probate Court could assume the mantle of Justice of the Peace.
4. Develop a plan to end drug slavery.
Art. 9 Health Economics
§389 Health Care Finance
A.The Bureau of Labor Statistics reports that health care was the largest industry in 2006,
providing 14 million jobs (the same number of people who are unemployed under the
heatlh care agenda and bailout) - 13.6 million jobs for wage and salary workers and about
438,000 jobs for the self-employed. About 5.3 million of the jobs are in hospitals the
others primarily work in free-standing medical clinics, private practices and for health
insurance corporations. There were an estimated 633,000 physicians and surgeons
making between $156,000 and $350,000. Registered nurses constitute the largest health
care occupation, with 2.5 million jobs, 58% in hospitals. There are an estimated 2.5
million administrative and health insurance staff. There are also numerous specialties
such clinical laboratory technician, audiologist, genetic counselor etc. Nursing assistant,
medical assistant, receptionist, secretary and positions require little education. There are
nearly 450,000 home health aids, for which a high school degree is not necessarily
required. Home health aid is one of the fastest growing fields.
1.Health care is promoted as one of the fastest growing fields however common sense
indicates that the United States has exceeded demand for most health care professionals,
who justify their employment making the population sick. The extortion racket of
medical b(k)illing is fairly unique to the United States, the only industrialized nation that
perpetuates a private health insurance system.One to two million administrative and
insurance positions would become superfluous, as the result of administrative
simplification, if the US evolved to a single payer system. Millions more would be laid
off were medical malpractice, torture and bio-terrorism prevented and punished by a
hundred thousand Ethics Committees employees. The supply of aspiring young torturers
from medical campus animal laboratories and accredited health schools is neverending.
2. Health care tends to defy the law of supply and demand because supply side bio-
terrorist commands cause distortionate increases in demand and effective preventive
1506
medicine reduces profits therefrom, wherefore the medical establishment and corrupt
government tend to finance bio-terrorism and related specialties heavily and effective
medicine, like family practice, little, or, like ethics, not at all. This must be reversed by
effective legislation so that the poor are adequately insured by the government to see
general practitioners who act as gatekeepers and preventive medical counselors for
shadier medical specialties, who have censured the bio-terrorist causes of the diseases the
treat. Conversely, reimbursements for high priced cardiologists, oncologists and other
specialties reliant on the censureship of modern bio-terrorism for their business, should
go down, so that physicians are paid more or less the same, depending on how much they
work and how much good they do.
3. Between 1993 and 2003, the population of the United States grew by 12 percent and
hospital admissions increased by 14 percent, yet emergency department visits rose by
more than 25 percent during this same period of time, from 90,300,000 visits in 1993 to
113,900,000 visits in 2003. The demand for emergency care in the United States
continues to grow at a rapid pace. In 2003, hospital emergency departments received
nearly 114,000,000 visits, which is more than 1 visit for every 3 people in the United
States. However, between 1993 and 2003, the number of emergency departments
declined by 425. There is clearly demand for both emergency departments to treat the
traumatically injured and general practitioners for check ups and chronic disease
prevention, to adequately treat the population.
B. According to the American Hospital Association there were a total of 5,708 hospitals
in the United States in 2007. 4,897 were community hospitals, 2,913 were
nongovernment not for profit hospitals,873 were investor owned for profit hospitals,
1,111 were state or local government owned community hospitals, 213 were federal
government hospitals, 444 were nonfederal psychiatric hospitals, 136 were nonfederal
long term care hospitals, and there 18 hospitals units of institutions such as prison
hospitals and college infirmaries. Of the community hospitals 1,997 were rural, 2,900
were urban, 2,730 were in a system and 1,472 were in a network. In 2007 there were a
total of 945,199 hospital beds, of which 800,892 were staffed beds in community
hospitals. There were a total of 37,120,387 hospital admissions, 35,345,986 to
community hospitals and a total of 34,667,000 discharges. The average length of an
inpatient stay has gone down from 7.2 days in 1987 to 5.5 days in 2007. The number of
outpatient surgeries has increased from 9.1 million in 1987 to 17.2 million in 2007. The
total expenses of all hospitals were $641 billion, $588 billion for community hospitals.
1. Hospitals can be found in nearly every community in the developed world. The
construction of large hospitals was however not undertaken until university medical
programs had established a system for the accreditation and communalization of
physicians beginning in the 1500‘s. Previously the sick were cared for in smaller hospices
and by physicians who regularly made house calls. The university education facilitated
the levy of the large sums of money from the government and wealthy patrons needed for
construction and operation of hospitals and for the care of the poor. St. Bartholomew‘s
Hospital in London reported that in 1723 4,163 patients were treated and 3,381 were
discharged, cured. In the USA Hospital construction was federally funded under the
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1946 Hill-Burton Hospital Survey and Construction Act, P.L. 79-725, and subsequently
over $4 billion has been administrated. Health corporations are however primarily reliant
upon private loans to pay for the construction of hospitals. The burden of proof is that
there is an unmet demand for hospital care in the geographic region and that qualified
staff can be employed. With 3.1 hospital beds per 1,000 people the United States has the
fewest beds per 1,000 among the world's 30 largest economies, except for Mexico, where
there are 1.7 beds per 1,000.
2. Founded in 1898, the mission of the American Hospital Association (AHA) is to
advance the health of individuals and communities. The AHA leads, represents and
serves hospitals, health systems and other related organizations that are accountable to
the community and committed to health improvement. Founded in 1951 the Joint
Commission on Accreditation of Healthcare Organizations (JACO) evaluates and
accredits more than 15,000 health care organizations and programs in the United States.
An independent, not-for-profit organization, the Joint Commission is the nation's
predominant standards-setting and accrediting body in health care. Since 1951, the Joint
Commission has maintained state-of-the-art standards that focus on improving the quality
and safety of care provided by health care organizations. The Joint Commission's
comprehensive accreditation process evaluates an organization's compliance with these
standards and other accreditation requirements.
C. Total health expenditures were estimated at $2.24 trillion in 2007, 16.2% of the total
economy. As a share of the economy, health care has risen from 7.2% of GDP in 1965
when the Medicare program was conceived, to 8.8% of GDP in 1980, to 11.8% in 1991,
to 13.4% in 2000, to over 16% of GDP in 2007, and it is projected to be 20% of GDP just
10 years from now, unless cost containment methods are effective. Despite the high cost,
the U.S. does not appear to provide greater health resources to its citizens or achieve
substantially better health benchmarks compared to other developed countries.
Fig. 9-25 Health Expenditure as % of the U.S. GDP, 1965-2005
20.00%
15.00%
10.00%
5.00%
0.00%
1965 1970 1975 1980 1985 1990 1995 2000 2005
% GDP 5.70% 7.10% 8.00% 8.90% 10.30% 12.20% 13.70% 13.50% 15.50%
Source: Source: Center for Disease Control. Gross Domestic Product and National Health
Expenditure
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1.Health spending per capita in the US is the highest in developed countries, 24% higher
than in the next highest spending country in 2003, and over 90% higher than in many
other countries that would be considered global economic competitors. Between 1985-
1997 government healthcare spending increased at an annual rate of 8%. Private sector
spending grew at an annual rate of 7.3% between 1985-1997. As a share of the economy,
health care has risen from 7.2% of GDP in 1965, to 8.8% of GDP in 1980, to 11.8% in
1991, to 13.4% in 2000, to over 16% of GDP today, and it is projected to be 20% of GDP
just 10 years from now. Health spending continues to increase much faster than the
overall economy. Since 1970, health care spending has grown at an average annual rate
of 9.9%, or about 2.5 percentage points faster than GDP.
Fig. 9.26 Health Expenditures Per Capita 1970, 1980, 1990, 2003 (inc. % GDP)
in Major Industrialized Nations
1970 1980 1990 2003 % GDP
Australia $252 $691 $1,306 $2,886 9.2
Austria 193 770 1,328 2,958 9.6
Belgium 148 636 1,341 3,044 10.1
Canada 299 783 1,737 2,998 9.9
Denmark 384 927 1,522 2,743 8.9
Finland 191 590 1,419 2,104 7.4
France 205 697 1,532 3,048 10.4
Iceland 163 703 1,593 3,159 10.5
Ireland 117 519 794 2,455 7.2
Italy NA NA 1,387 2,314 8.4
Japan 149 580 1,116 2,249 8.0
Luxembourg 163 640 1,533 4,611 7.7
Netherlands NA 755 1,435 2,909 9.1
Norway 141 665 1,393 3,769 10.1
Sweden 312 944 1,589 2,745 9.3
Switzerland 351 1,031 2,029 3,847 11.5
United Kingdom 163 480 987 2,317 7.8
United States 352 1,072 2,752 5,711 15.2
Source: Exhibits 2 & 4. Kaiser Family Foundation Health Care Spending in the
United States and OECD Countries. January 2007
D. After 3 years of declining costs the 2006 growth rate of 6.9% was the lowest since
1999. Health spending share of gross domestic product (GDP) in 2005 was 16.0 percent,
slightly higher than the 15.9 percent share in 2004. Health expenditure tends to be
1509
counter-cyclical and in times of recession health spending, particularly Medicaid, tends to
increase. In 2005, governments financed 40 percent, $902.7 billion, of all health services
and supplies while private sources financed the remaining 60 percent ($1,085 billion).
Private health insurance premium growth also slowed in 2005, increasing 6.6 percent to
$694.4 billion, compared with 7.9 percent in 2004. This was the third straight year that
premium growth decelerated and the slowest rate of growth since 1997. The employer
share of private health insurance was 74.4 percent in 2005, with employees paying the
remaining 25.6 percent. Out-of-pocket spending for health care reached $249.4 billion in
2005.
1.Medicare: In 2006, total Medicare spending grew to $401.3 billion. The introduction of
the Part D benefit, which provided beneficiaries with coverage for prescription drugs,
accelerated total Medicare spending; it grew 18.7 percent in 2006 compared to 9.3
percent in 2005. A 25 percent increase in Medicare Advantage enrollment in 2006
influenced a dramatic 48 percent increase in Medicare Advantage spending. At the same
time, traditional fee-for-service enrollment declined 3.8 percent and its share of total
Medicare spending fell from 86 to 82 percent. In 2003 Medicare paid for about 20
percent of all physician and clinical services, about 30 percent of hospital costs and home
health care and 25 percent of all durable medical equipment.
2. The expenditures for Medicare have increased from $7.7 billion in 1970 to $74.1
billion in 1986 to $159.3 billion in 1994 to $342 billion in 2005. Between 1980 and 1985
Medicare out of pocket costs for hospital services covered by the program increased by
49% and for physician and outpatient services by 31%. By 1984 the elderly paid as much
in out of pocket health costs as a percentage of their income 15% as they had in 1965
when Medicare was enacted. Inadequate Medicare coverage encourages a market for
supplemental health insurance. In 1999 this gap was filled by employer-sponsored
coverage for 33 percent of beneficiaries, by private policies, called Medigap, for 27
percent, and by Medicaid for 11 percent.
Fig. 9-27 National Health Expenditures and Growth by Source of Funds 1970-2007
1510
Source: Catlin, Aaron; Cowan, Cathy; Heffler, Stephen; Washington, Benjamin. National
Health Spending in 2005. Health Affairs 26:1 (2007)
3.Medicaid: Total Medicaid spending declined for the first time since the program s
inception, falling 0.9 percent to $308.6 billion. The introduction of Part D, which shifted
drug coverage for dual eligibles from Medicaid into Medicare, contributed to the decline.
Other reasons for the decline include continued cost containment efforts by states and
slower enrollment growth, due to more restrictive eligibility criteria and a stronger
economy. Payments to Medicaid recipients have increased rapidly, rising from $41.1
billion in 1985 to $107.9 billion in 1994.
4.Private Health Insurance: Private health insurance premiums grew 5.5 percent in 2006
to $723.4 billion. This is the slowest rate of growth since 1997. This slowdown reflects a
decline in private health insurance spending for prescription drugs, as well as a slowdown
in underlying benefits. Benefit payment growth slowed, from 6.9 percent in 2005 to 6.0
percent in 2006, reaching $634.6 billion. The ratio of net cost of private health insurance
(the difference between premiums and benefits) to total private health insurance
premiums was 12.3 percent in 2006, slightly lower than 12.7 percent in 2005.
5.Out-of-Pocket: Out-of-pocket spending grew 3.8 percent to $256.5 billion, a
deceleration from 2005. This slowdown is attributable to the negative growth in out-of-
1511
pocket payments for prescription drugs, mainly due to the introduction of Medicare Part
D benefit. Out-of-pocket spending accounted for 12 percent of national health spending
in 2006; this share has steadily declined since 1998, when it accounted for 15 percent of
health spending. Out of pocket spending for seniors is higher than it was before
Medicare. In 1965, before Medicare, older adults spent 19 percent of their personal
income on health care. In 1968, the percentage dropped to 11 percent. In 2002, the
typical senior on Medicare spent 22 of income on health care, an average of $3,757 per
year. For those in poor health, 10 percent of Medicare beneficiaries pay an average of
$9,174 or more out of pocket. More than $9,000 per year obviously has greater impact
on lower-income households.
Fig: 9-28 Pie Chart of Health Care Finance, 2006
1512
Source: CMS National Health Expenditure Accounts
6. Hospitals: Hospital spending continued a gradual deceleration (from 8.2 percent
growth in 2002), growing 7.0 percent in 2006 to $648.2 billion. The 2006 trend was
partially driven by a lower utilization of hospital services, especially within Medicare, as
fee-for-service inpatient hospital admissions declined.
7. Physician and Clinical Services: Spending on physician and clinical services also
slowed, growing 5.9 percent in 2006 to $447.6 billion; this is the slowest rate of growth
since 1999. The slowdown was driven by a deceleration in price growth, fueled by a near
freeze on Medicare physician payments (the fee schedule update was 0.2 percent in 2006)
which influenced private payers as well.
8. Other Professional Services: Spending on other professional services, which include
therapists, chiropractors, optometrists, and podiatrists, decelerated in 2006, growing 4.9%
to $58.9 billion.
9. Dental Services: Spending on dental services also slowed in 2006, growing 5.7 percent
to $91.5 billion.
10. Other Personal Health Care: Spending for other personal health care services
accelerated in 2006, growing 9.5 percent to $62.2 billion.
1513
11. Home Health: Spending for freestanding home health care services decelerated from
12.3 percent in 2005 to 9.9 percent in 2006, partially due to a reduction in price growth.
Despite the 2006 deceleration, home health care continues to be the fastest growing
component of Personal Health Care spending. Expenditures were $52.7 billion in 2006.
Fig. 9-29 National Health Expenditures by Spending Category, 1970-2005
Source: Catlin, Aaron; Cowan, Cathy; Heffler, Stephen; Washington, Benjamin. National
Health Spending in 2005. Health Affairs 26:1 (2007)
12.Nursing Homes: Spending for freestanding nursing homes reached $124.9 billion in
2006. Growth was 4.9 percent in 2005 and decelerated to 3.5 percent in 2006, which is
the slowest rate of growth since 1999. This deceleration is partially attributable to a
reduction in nursing home price growth.
13.Prescription Drugs: Prescription drug spending accelerated for the first time in six
years, from a low of 5.8 percent in 2005 to 8.5 percent in 2006. Spending reached $216.7
billion. Roughly half of this growth was due to increased use of prescription drugs (partly
1514
a result of coverage now available under Part D), as well as new indications for existing
drugs, growth in therapeutic classes, and increased use of specialty drugs. A higher
generic dispensing rate in 2006 helped to restrain spending growth, which despite the
acceleration still remained well below the average annual growth of 13.4 percent per year
between 1995 and 2004.
13.Durable Medical Equipment: Spending on durable medical equipment, which includes
items such as eyeglasses and hearing aids, accelerated in 2006, growing 2.3 percent and
reaching $23.7 billion.
14.Other Non-durable Medical Products: Spending on other non-durable medical
products, such as over-the-counter medicines, slowed in 2006, growing 3.5 percent to
$35.6 billion.
E. Health care costs in the United States are increasing at an alarming rate, much greater
than the consumer price index. National health expenditure as a percent of GDP
increased from 12.6 percent in 1990 to more than 16 percent in 2000. Many employers
have found that the cost of providing health coverage for their employees has taken an
ever increasing percentage of their pre-tax profits.
Fig. 9-30 Annual Inflation in Public and Private Health Care Costs, 1970-2005
1515
Source: Potetz, Lisa. Financing Medicare: An Issue Brief. Health Policy Alternatives,
Inc. Kaiser Family Foundation. January 2008
1.One way for employers to reduce costs is by limiting coverage or implementing other
programs that provide more cost-effective forms of health care. Individual purchasers of
health insurance also share the burden of increasing costs, and premiums have risen
dramatically over the past several years.
2.Since the 1970s, national health care spending has on average grown about 2.5
percentage points faster than the economy, and this trend is expected to continue. In
2005, national health expenditures totaled $2 trillion or 16 percent of the GDP, and is
projected to double to $4 trillion and 20 percent of the GDP by 2016.
§390 Health Insurance
A.The United States is the only industrialized country in the world without a universal
health insurance system. Almost 20% of the non-elderly population lacks health
insurance at any given time. In 2007 15%, 45 million people, including 9 million
children, were considered uninsured in the United States. They did not pay any health
insurance premiums beyond the 2.9% federal Medicare tax, if they earned a taxable
income at all. 54%, 162 million were insured through their employers. 5%, 15 million
were insured individually. 13%, 39 million were insured through Medicaid. 12%, 36
million were insured through Medicare. 1%, 3 million are insured through other public
insurance. 80% of the uninsured were employed. They either were not offered benefits
from their employer or could not afford to purchase it. The remaining 20% were either
unemployed or self-employed and not willing to pay high individual and family rates.
Fig. 9-31 Uninsured Americans, 2001-2005
1516
Source: Center on Budget Policies and Priorities. The Number of Uninsured Americans
is at an All Time High. August 29, 2006
1.In its Concluding Observations of 2001, the Committee on the Elimination of Racial
Discrimination recommended that the U.S. take appropriate measures to ensure that the
right to access health care is non-discriminatorily afforded to all. The most practical
method of achieving universal coverage, that would least impact the existing statutory
regime, is clearly to expand state Medicaid coverage to the uninsured on the basis of
income.
B. In 2006 an estimated $723.4 billion was collected in health insurance premiums.
Benefit payment reached $634.6 billion. The ratio of net cost of private health insurance
(the difference between premiums and benefits) to total private health insurance
premiums was 12.3 percent in 2006, 34% of total health care spending. The fundamental
premise of private insurance is that each insurance contract has a price, called a premium
rate. The premium rate is the amount of money that the insured pays the insurer for the
coverage promised in the contract. Premiums are usually paid monthly, but may be paid
less frequently, such as semi-annually or annually. The actuary must consider many
factors to ensure that the premium rate is both adequate and reasonable. The basic
components of the gross premium rate for health insurance are expressed:
Premium = Claims + Reserves + Expenses + Margin + Profit – Investment Income
1.The largest component of the gross premium rate is the cost of benefits, also known as
the claim cost or expected claim. To estimate claim costs the concept of morbidity is
used to explain the frequency and severity of insured events. An individual health
insurance policy usually is not issued to a person in poor health who could be expected to
become disable or hospitalized soon. The law allows different premium rates to be
charged based on demographics, but no individual can be charged a different premium
rate based on his or her own health history. There are also limits on what an insurer can
charge a small employer. For individual coverage most states require that an insurance
company return a percentage, such a 50%, of the policy‘s expected premium income to
insureds in the form of paid benefits.
C. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the
first major health insurance legislation enacted at the federal level. The act expands
access to health insurance by requiring individual health insurers to provide coverage to
people who lost their group coverage because they changed or lost their job; limits the
pre-existing condition exclusion; requires all small group insurers to accept every small
employer who applies; increases the health insurance tax deduction to 80% in 2006. A
group policy usually permits a 31 day grace period for the payment of premiums. Claims
incurred after the end of the grace period are not paid unless the policy is reinstated
1.Because the tax system heavily subsidizes employer-sponsored insurance (ESI), most
non-elderly Americans get their health insurance at work. Employer contributions to
employee health insurance are treated as nontaxable fringe benefits and are not
1517
considered part of total compensation for income or payroll tax purposes. The tax
subsidies for ESI reduced income and payroll tax receipts by as much as $200 billion in
fiscal year 2007. Section 125 of the Internal Revenue Code allows employers to
administer certain employee benefits. Employees choose to receive part of their
compensation either as cash wages or as one or more nontaxable fringe benefits,
including health insurance. The self-employed may deduct their health insurance
premiums from income tax. There are limitations to using tax credits to expand health
insurance coverage. A program of health insurance tax credits combined with reforms of
the market for non-group health insurance could significantly expand coverage, but at a
very high cost. The most cost-effective approach to expanding health insurance coverage
is not a tax subsidy at all, but an expansion of an existing public program, such as
Medicaid, SCHIP, or Medicare.
D. Health benefit costs have increased from 0.6 percent of GDP in 1960 to 4.1 percent in
2006. The amount grew over twenty-fold from $23 billion in 1960 to $537 billion in
2006. Except for a short period between 1995 through 1998, this growth has been
constant. Fringe benefits other than health care and payroll taxes have also increased over
this period, ranging from 3.8 percent of GDP in 1960 to 6.7 percent in 2006. Wages,
meanwhile, have fallen from 51.8 percent of GDP in 1960 to 45.6 percent in 2006. The
percentage of workers with health insurance coverage is estimated to have slipped from
66 percent in 1979 to 54 percent in 1998. When sorted by hourly wage, 80 percent of
workers in the highest brackets had health benefits in 1998, whereas only 26 percent of
the lowest wage earners were so fortunate. The US Bureau of Labor statistics reported
similarly that the percentage of covered workers in private industry dropped from 63
percent in 1993 to 45 percent in 2003, while employee contributions grew an average of
75 percent to $229 a month for a family and $60 for an individual.
1.Public and private sector enrollment in HMOs grew from 2.8 percent in 1976 to 13.4
percent in 1990 to 30 percent in 2000 and then decreased to about 26 percent in 2002.
Enrollment increased in the 90s because of the proliferation of for profit plans and the
Clinton plan for social mandated insurance. HMO enrollment declined in 2002 because
Prudential closed many of its plans and because of drops in Medicare+Choice enrollment.
2.Over 150 million individuals received health insurance through an employer in 2005,
making employer-sponsored coverage the most popular form of health insurance
coverage for the non-elderly in the United States. However, in recent years, there has
been concern about erosion in the availability of employer-based health benefits for
workers, and especially low-income workers. From 1998 to 2005, the offer rate fell
across the board, with an overall drop of 3 percentage points from 80% to 77%. In
addition, the analysis found that the likelihood of families having a job-based insurance
offer varies significantly with family income in all three years, ranging from 34% of
families with income below the poverty level to 91% for more-affluent families with
income at least four times the federal poverty level.
3.The number of uninsured Americans increased by 3.4 million between 2004 and 2006,
despite improving economic conditions. In the first four years of the decade, during a
1518
period of economic recession, the number increased by 6.0 million. The dominant factor
in both periods was a decline in employer-sponsored insurance coverage. Although the
recent decline was less than that experienced from 2000 to 2004, growth in public
coverage was small, and the number of uninsured people increased by 1.0 million
children and 2.4 million adults.
Fig. 9-32 Increases in Health Insurance Premiums Compared, 1988-2007
Source: Kaiser Family Foundation. Employer Health Benefits Summary of Findings 2007
4.Since 2000, premiums for family health coverage have increased by 87%, compared
with cumulative inflation of 18% and cumulative wage growth of 20%. During this same
period, the percentage of employers offering health benefits has fallen from 69% to 61%,
and the percentage of workers covered by their own employer also has fallen. The current
employer-based system offers little choice in health plans to employees: 88 percent of
American firms offer only 1 health plan type. 2007 was the fourth consecutive year of a
lower rate of growth for health insurance premiums, the lowest since 1999. However, as
in prior years, the average premium increase continues to outpace workers‘ earnings and
inflation. Premiums for employer-sponsored health coverage rose twice as fast as the
3.8% increase in wages or 3.5% increase in inflation at an average 7.7% in 2006. This
was less than the 9.2% increase recorded in 2005 and the recent peak of 13.9% in 2003.
The average annual total premium cost is $4,479 for single coverage and $12,106 for
family coverage.
5.In 2007, the average percentage of the premium paid by covered workers is 16% for
single coverage and 28% for family coverage, similar to the percentages reported for the
last several years. However, for single coverage, over one-fifth of workers pay greater
than 25% of the total premium while another fifth pay no contribution. The average
general annual deductibles (for workers with a deductible) for single coverage are $461
for workers in PPOs, $401 for workers in HMOs, $621 for workers in POS plans, and
1519
$1,729 for workers in HDHP/SOs (who by definition have high deductibles). The
majority of workers have co-payments or coinsurance for physician office visits. Among
the 79% of workers with co-payments for in-network office visits, 75% have a co-
payment of $15, $20, or $25 per visit with a primary care physician.
6.Prices for non-group policies vary considerably: for example, over the 2006-2007
period, annual premiums for single coverage varied by age from $1,163 to $5,090, and
between $2,325 and $9,201 for family coverage depending on the age and number of
family members covered. As the result of the high cost relatively few people at lower
incomes purchase non-group coverage, with one in 20 purchasing it among those with
incomes at the federal poverty level ($18,660 for a family of four in 2003 dollars). As
income increases, the coverage rate increases, though even at four times the poverty
level, only about a quarter of individuals purchased coverage. And among those with
incomes at least 10 times the poverty level, only about half purchased coverage in the
non-group market.
Fig. 9-33 Average Annual Firm and Worker Premium Contribution, 2007
Source: Kaiser Family Foundation Employer Health Benefits Summary of Findings 2007
7. Medicare premiums are competitive with affordable employer based health insurance
plans and much cheaper than individual and family plans. Beneficiaries pay monthly
premiums that finance about 25 percent of cost. Supplementary Medical Insurance (SMI)
Trust Fund Part B premiums and transfers from general revenues are established each
year to match the following year‘s estimated costs, the Part B account will remain in
financial balance under present law, so that if there is a deficit an equivalent amount is
withdrawn from the general revenues. As a result of the higher spending levels and
1520
reduced assets, it is expected that the Part B monthly premium rate will be increased by
roughly 11 percent for 2007, to $98.20.
Fig. 9-34 Medicare Part B Premiums and Deductibles, 2007
2006 2007
Part B Monthly Premium $88.50 $93.50
Part B Annual Deductible $124.00 $131.00
Part A Hospital Deductible - First $952.00 $992.00
60 Days
Hospital Co-payment per day for days $238.00 $246.00
61-90
Hospital Co-payment per day for 60 $476.00 $496.00
lifetime reserve days
Skilled Nursing Facility Co-payment $119.00 $124.00
per day for days 21-100
Part A Monthly Premium if purchased $393.00 $410.00
less than 30 quarters of Medicare
coverage
Part A Monthly Premium if purchased $216.00 $226.00
with 30-39 quarters of Medicare
coverage
Source: CMS
8.The new prescription drug benefit has been described as having a ―doughnut hole‖
because there is a gap in coverage that must be filled by out of pocket spending before a
patient becomes eligible for catastrophic coverage. Specifically, in addition to the
monthly premium for Part D coverage, estimated to be $35 in 2006, the standard benefit
will require the beneficiary to pay every year. The first $250 in drug costs (a deductible).
25 percent of total drug costs between $2,250 and $5,100 and the greater of $2 for
generics or $5 for brand name drugs or 5 percent coinsurance for each prescription.
Fig. 9-35 Distribution of Assets of Health Insurance Companies, 2006
1521
Source: National Association of Insurance Commissioners. Statistical Compilation of
Annual Health Insurance Information. STA-HB. 2006
F.The insurance industry has been dynamic. In 1998 Aetna which had previously
acquired US Health care and NYL Care merged with Prudential Insurance Company of
America to become the nation‘s largest health insurer with 21 million enrollees. The
other big players were CIGNA Health Care with 14 million policyholders, United Health
Care with 8.6 million, Kaiser Permanente with 8 million, Well-Point-UniCare with 7.5
million and Humana with 5.9 million. Of these only Kaiser was nonprofit. The Blue
Cross and Blue Shield Association covered more policyholders than any other insurer,
but its affiliates operated independently (Coombs 2005: 225). The National Association
of Insurance Commissioners reports that in 2006 health insurers invested $157 billion in
assets after investing $127 billion in 2005. It is estimated that health insurance
corporations have between $2 and $3 trillion in assets. These funds are invested in a
diverse portfolio much like a bank or trust fund.
1.Insurance corporations and their state insurance commissioners are tight lipped about
the total amount of assets. NHI threatens to not only to abolish health insurance
premiums and policies in both private and public health insurance programs, but will
potentially nationalize health insurance assets to offset program costs. Any
nationalization of these savings would need to be undertaken gradually with utmost
consideration for the just compensation and retraining of the displaced insurance workers.
§391 History of Health Insurance
A.Historians trace the concept of prepaid health care to the 1800s, when railroads,
lumber, mining and textile firms hired company doctors to treat their injured employees.
Relatively few American bought health insurance in the early 1900s because medical
services were inexpensive and patients often found home remedies just as effective.
Several companies offered indemnity politics that reimbursed policyholders for some
portion of their medical care, but most people paid their doctor and hospital bills with
cash or charity. Early insurance legislation in the United States was concerned largely
1522
with taxation, licensing and solvency but was too limited to adequately protect the
insurance buying public. During the 1850s states began to establish special departments
to look after insurance matters. The first state insurance department was created in New
Hampshire in 1851, within the next ten years most states had insurance departments. In
1871 the National Convention of Insurance Commissioners was formed.
1. For centuries religious orders had provided an embryonic form of hospital care. Some
health care was also provided publicly by local parish and municipal government. The
state was also increasingly involved in the accreditation or licensing of doctors, as
signaled by the UK‘s Medical Act 1858. Germany is viewed as the pioneer in national
health care by virtue of Otto van Bismakr introducing a public, compulsory system of
health and sickness insurance and for industrial workers in 1883. In France a system of
medical assistance established a right to medical care for the poor in 1893 and legislation
to support and encourage social insurance provision by mutualist societies in 1898.
Health insurance was made compulsory for all employees in 1930 and extended to
farmers and the self-employed in the 1960s. Health care in the UK has been shaped by a
series of milestone reforms, beginning with the New Poor Law of 1834. The health
insurance system instituted in 1911 was a contributory scheme for working men. In 1946
it was replaced by the tax funded and universalist National Health Service. Further
reform brought some organization consolidation in 1974 and more radical restructuring
again 1991.
2.A system of salaried district physicians was established in Sweden as early as the
eighteenth century, reflecting a powerful and highly developed public administration.
County councils were formed in the 1860s charged with operating somatic hospitals.
Public subsidies helped to finance voluntary sickness funds from 1891, their membership
increasing after 1931 once they were required to provide medical as well as cash benefits
to their members. It was not until the mid-twentieth century that a universal national
health insurance scheme was implemented in Sweden in the mid 1950s. Fee for service
payment for hospital physicians were abolished in 1959 and all other private activity in
public hospitals prohibited by the Seven Crowns Reform of 1970 which made hospital
doctors fully salaried civil servants. County councils were made responsible fro planning
all health services in 1983.
B.In the United States the system of benefits introduced after the Civil War for veterans
and their survivors was, in important ways, a forerunner to Social Security. The
campaign for national health insurance in the United States commenced during the
Progressive era. The Populist platform of 1896 called for a progressive income tax and
public works programs to provide jobs in times of depression, very similar to what FDR
would do forty years later. Nor was America too poor a country to afford such programs.
The US in the 1920s was substantially richer than European countries, yet France,
Germany and the United Kingdom all had substantial program of public aid several times
as large as those in America. In 1912 the Public Health and Marine Hospital Service
changed its name to the Public Health Service (PHS) in 37 Stat. L. 309.
1523
1.The American Association for Labor Legislation (AALL) founded in 1906 as a
Progressive political group of academic social scientists, labor activists and lawyers led
the movement for health insurance. Within its first decade the group successfully pressed
states to adopt workmen‘s compensation legislation. Workers' compensation was the
first form of social insurance in the United States. The first U.S. workers' compensation
law was enacted in 1908 to cover federal civilian employees engaged in hazardous work.
The rest of the federal workforce was covered in 1916. Nine states enacted workers'
compensation laws in 1911. By 1921, all but six states and the District of Columbia had
workers' compensation laws. Workers' compensation provides cash benefits and medical
care to employees who are injured on the job and survivor benefits to the dependents of
workers whose deaths result from work-related incidents. In 1915 the organization
drafted a model bill for compulsory health insurance to submit to state legislatures.
Buoyed by a 1916 editorial in the Journal of the American Medical Association that
praised national health insurance, ―no other social movement in modern economic
development is so pregnant with benefit to the public‖. By 1920 the movement for
compulsory health insurance stalled because the AMA influenced by a revolt from
conservative segments of its membership against the national leadership. The opposition
lasted for over a half a century.
2.In 1927 the Committee on the Cost of Medical Care, composed of about sixty
prominent health professionals and laypersons, was organized to address the needs of
Americans who could not afford the new, improved standards of medical care. After five
years the Committee issued a final report which concluded, ―as the result of our failure to
utilize fully the results of scientific research the people are not getting the service they
need, first because in many cases its cost is beyond their reach and second because in
many parts of the country it is not available. The report recommended that doctors and
other health professionals form groups so that they could provide a comprehensive array
of preventative and therapeutic services. Funding for these services should come from
periodic insurance payments and taxes, which would distribute the financial burden of
illness evenly throughout the population .
3.In 1930 the Randsall Act, P.L. 71-251, 46 Stat. L. 379 renamed the Hygienic
Laboratory the National Institute of Health (NIH). President Franklin Delanor
Roosevelt‘s Federal Emergency Relief Administration (FERA) formally recognized
medical care a basic human right in 1933, declaring, ―conservation and maintenance of
the public health is a primary function of our Government.‖ FERA used that mandate to
fund medical services to indigent patients through existing state and local agencies.
Against the opposition of the AMA health insurance provisions of the Social Security Act
of 1935 were removed. The nation was therefore pushed into the private work related
health insurance system that prevails today.
4.In 1936 Isidore S. Falk and the American Medical Association disagreed. The greatest
need is not to find more money for the purchase of medical care, but to find newer and
better ways of budgeting the costs and spending the money wisely and effectively. The
AMA condemned any form of corporate medical practice that would be financed through
private or public intermediary agencies. Such measures would limit patient‘s choice,
1524
increase the cost and lower the standards of medical care, encourage illness, degrade the
medical profession and lead to a compulsory system of care. Organized medicine
continued to use these arguments to oppose nearly every health care reform proposed
during the next six decades.
5.In 1942 the War Labor Board provided incentives for companies to offer fringe
benefits. When the war ended 1 in 4 Americans was covered by an on the job policy that
helped pay for hospital bills. The Taft-Hartley Act further expanded coverage for
workers and their dependants, as did a Supreme Court ruling against Inland Steel in the
late 1940s that gave labor unions the right to negotiate benefit plans as a condition of
employment.
6. Some insurers felt state regulation was too burdensome. Congress therefore passed the
McCarran-Ferguson Act in 1945 where it was declared that ―the continued regulation and
taxation by the several states of the business of insurance is in the public interest and that
silence on the part of the Congress shall not be construed to impose any barrier to the
regulation or taxation of such business by the several states‖. Most states adopted fair
trade practice laws to prohibit unfair methods of competition and unfair practices. The
insurance department is usually vested with broad powers to: license insurance
companies and agents, examine companies, liquidate or rehabilitate insurance companies
in financial difficulties and approve policy forms, certificates, booklets and rate manuals.
C.In 1946 the National Mental Health Act, P.L. 79-487, 60 Stat. L. 421, founded the
National Institute of Mental Health (NIMH). The 1946 Hill-Burton Hospital Survey and
Construction Act, P.L. 79-725, revolutionized medical care for the poor. In exchange for
federal assistance hospital administrators would offer free and reduced- price care for the
poor. Since 1946, more than $4.6 billion in Hill-Burton grant funds as well as $1.5
billion in loans have aided nearly 6,800 health care facilities in over 4,000 communities.
838 facilities are still obligated by the Hill-Burton Act.
1.The Cooperative Health Federation of America was organized in 1946 to establish
standards for prepaid organizations and to promote cooperative health care. After joining
with other like minded organizations the federation emerged as the Group Health
Association of America (GHAA) and moved its national office to Washington DC in
1965. The organization represented 21 prepaid health care plans and 75 supporting
organizations, but not Kaiser Permanente. Between 1941 and 1946 the number of rural
health cooperatives more than doubled to eighty six programs with 140,000 members.
2.Kaiser Permanente began when the steel maker Henry J. Kaiser arranged for a few
doctors to provide prepaid care to his workers and their dependants at the Grand Coulee
Dam construction site in the late 1930s. By the late 1960s the Kaiser Foundation Health
Plan, Kaiser Foundation Hospitals and Permanente Medical Groups had six regional
divisions operating and was the largest prepaid organization in the nation, serving more
than half of the prepaid subscribers in the nation.Henry J. Kaiser said in 1971, ―Of all the
things I‘ve done, I expect to be remembers only for the Hospitals and Health plan.
1525
They‘re the things that are filling the people‘s greatest need- the need for good health
care at a cost that the average family can afford‖.
3.The growing availability of private health care insurance for workers and their families
during the late 1950s and early 1960s spawned what some have called the ―golden age of
American medicine‖. Consumer expectation and demand for medical services reach an
all time high. Blue Cross and Blue Shield plans that set reimbursement standards for the
industry, were controlled by hospital boards and physicians, who compensated
themselves generously.
D.In the 1950s many western industrialized nations nationalized their health services so
that all citizens would have access to care. But in 1953 Congress and the IRS
institutionalized the link between private health insurance and work by making company
contributions to employee benefit plans tax deductible. Health insurance became a
massive subsidy for the employed.
1.In 1958 older people reported spending more than double what younger people spent on
their health care each year. As age increased, income decreased and health declined,
making it even harder to pay medical bills. In 1962 only 38 percent of retired Americans
had health insurance. Data from the National Health Survey for the years 1958 through
1960 show that half of elderly‘s short hospital stays were not covered by health
insurance. Even so, older adults with insurance used about two and a half times as much
hospital care as uninsured older adults, indicating a positive correlation between
availability of insurance and health care use.
2.P.L. 88-164, the Mental Retardation Facilities and Community Mental Health Centers
Construction Act, provided for grants for assistance in the construction of community
mental health centers nationwide. 1965--P.L. 89-105, amendments to P.L. 88-164,
provided for grants for the staffing of community mental health centers. Before this time
mental institutions had been used to warehouse elderly people.
3.In 1964 a Blue Cross spokesman testified before Congress that ―insuring everyone over
the age sixty-five is a losing business that must be subsidized‖. President Lyndon B.
Johnson signed the amendment to the Social Security Act in 1965 that created Medicare
and Medicaid that subsidized medical care for millions of elderly and low income
Americans. Concessions to the AMA and American Hospital Association were however
costly. Federal and state costs for Medicare and Medicaid rose about 20 percent each
year between 1966 and 1970. The federal government quickly became the largest
purchaser of health care services.
4.The final bill extended Medicare to nearly three million seniors who were not eligible
for social security. Lyndon Johnson signed the bill on July 30, 1965 in the presence of
Harry Truman in Independence, Missouri declaring that the enactment of Medicare meant
that ―no longer will older Americans be denied the healing miracle of modern medicine.
No longer will illness crush and destroy the savings they have so carefully put away over
a lifetime so that they might enjoy dignity in their latter years. No longer will young
1526
families see their own incomes and their own hopes eaten away simply because they are
carrying out their deep moral obligations‖.
5.Medicare is unique among international health insurance programs. ―No other
industrial democracy‖ Theodore Marmor observes, ―has compulsory health insurance for
its elderly citizens alone and none started its program with such a beneficiary group‖.
Medicare was created by amendments to the Social Security Act in 1965 which
established two health care programs for person aged 65 or older, a hospital benefit plan
and a medical benefits plan. Medicare benefits are also payable to persons receiving
Social Security disability benefits and can begin after 29 months of disability. The act
also provides government financed medical care of the poor, for inpatient and outpatient
hospital services, laboratory and x-ray services, skilled nursing home services, physicians
services, home health services, screening and diagnosis for children under age 21 and
family planning.
E.The Health Maintenance Organization Act of 1973 transformed medical care from a
cottage industry of private practitioners and benevolent community hospitals into a for-
profit corporate enterprise whose officers care more about rewarding investors than
helping the sick. Most reformers agree that by the late 1960s the passage of Medicare
and Medicaid in 1965 has created an immense national health care crisis. Before the
Health Maintenance Act of 1973 120 new prepaid health plans were started, afterwards
only 40 more were created 1974-1978. HMOs generally assumed one of three
organization forms: a staff model, a group practice model or an independent practice
association.
1.The White House and Congress responded to rapidly rising public and private health
care costs by introducing more than two-dozen bills between 1970 and 1973. The
legislative process pitted Democratic proposals for nationalized health care against
Republican solutions that promoted free enterprise and competition. Prepaid health plans
lobbied for conditions that would enable them to compete successfully in the
marketplace. Organized medicine on the other hand opposed any legislation that might
alter its traditional fee for service system. The HMO Act that Nixon signed in December
1973 was less comprehensive than the bills circulated, instead of $3.9 billion in
appropriations the final bill allocated a mere $325 million over five years, to assist new
HMOs with marketing, initial operating costs and planning, construction and renovation
of facilities.
2.Few HMOs enrolled public beneficiaries in the 1970s and 80s. Inconsistent public
policies, inflexible government staff and procedures, late reimbursements and worst of
all, low compensation levels made long term participation impossible. In 1976 the HMO
Act was amended to require federal certification of HMOs serving Medicare and
Medicaid beneficiaries and to limit the enrollment of public beneficiaries in HMOs to no
more than 50% whereas private subscribers were thought to motivate health plans to
provide better services (Coombs 2005: 88).
1527
3.In 1977 Secretary of Health, Welfare and Education Joseph Califano moved Medicare
administration out of the SSA and merged it with Medicaid administration in a new
agency the Health Care Financing Administration (HCFA). In 1980 HEW was divided
into the Department of Education and the Department of Health and Human Services
(HHS).
4.Before the formation of the Italian National Health Service (Servicio Sanitario
Nazionale, SSN) in 1978 health care in Italy was financed by a variety of social insurance
schemes based on employment and administered by autonomous, quasi-governmental
funds. A general scheme covering private sector employees was established in 1943,
while other schemes for public employees the self-employed and particular occupational
groups were set up during the 1950s and 60s. The Italian health system then looked
much like Germany‘s. The new SSN modeled on the UK‘s replaced these diverse
arrangements with a unitary and universal scheme.
E.Different approaches to managed care developed in the 1980s in an effort to control the
unsustainable inflation in health care costs. HMOs exist in three main forms, with some
variations. Managed care organizations (MCOs) represent systems that combine finance
and health care delivery. Preferred provider organizations (PPOs) represent agencies that
develop and sell the services of broad provider networks (usually physician dominated).
Provider sponsored organizations (PSOs) represent providers capable of bearing risk and
providing a full range of services, they deal directly with purchasers, without an
insurance carrier or intermediary. One new direction was based on the longstanding
example of nonprofit HMOs, like Kaiser Permanente (established in the 1950s). The idea
of ―health maintenance‖ derived from the premise that capitation (as opposed to Fee for
service) created both an incentive and the flexibility to invest in keeping people healthy
rather than treating them only after they become ill.
1.Beginning in 1982, several federal laws were enacted or amended to make Medicare
the secondary payer to certain employers‘ group health plans. Each state was permitted
to establish its own concept of medical indigence or need (HIAA 1997: 155).
2.Employer spending on health benefits in the United States nearly doubled, from $49
billion in 1980 to $93 billion (11 percent of the nation‘s payroll) in 1984. Many large
firms bypassed insurance carriers entirely, developing self-funded plans and negotiating
directly with providers for services at discounted rates. The number of employees
enrolled in company operated plans doubled, from 21 percent in 1981 to 42 percent in
1985. The Employment Retirement and Income Security Act of 1974 (ERISA) exempted
them from burdensome state insurance laws. At the same time hospital occupancy
dropped from a long time average of 75 percent to 67 percent in 1984.
3.In the 1980s researchers began to identify problems associated with providing too
much, but talk of reducing medical services continued to raise concerns about quality. At
this time of recession there was an explosion in the growth of prepaid plans, especially of
Preferred Provider Organizations (PPO). Public offerings for various types of for profit
HMOs began to attract interest on Wall Street in the early 1980s. Ninety nonprofit and
1528
three hundred for profit HMOs organized during the last half of the 1980s. HMO market
share nearly tripled from 4 percent in the early 1980s to 11.5 percent in 1987 because of
growing employer demand for less expensive medical care and increasing familiarity
with prepaid care.
4.The locus of health care shifted from hospitals to outpatient settings in the 1980s. By
the end of the decade patients were nine times more likely to see a doctor in an office
than in a hospital. Many services formerly performed in hospitals were moved into less
expensive, freestanding, outpatient clinics. Nearly one fifth of all surgeries were
performed on an outpatient basis by 1985. To cope with revenue loss hospitals
discouraged physicians from admitting unprofitable patients on Medicare or Medicaid,
uninsured or seriously ill with a number of complicated health problems. Large urban
hospitals generally fared well under the Medicare prospective payment system but some
small inner city and many rural hospitals had to close. Institutions belonging to multi-
hospital systems increased from 10 percent in 1970 to 44 percent in 1987. Managed care
organizations created a demand for primary care physicians, who were supposed to
coordinate patient care and restrict unnecessary referrals to specialists. Medical schools
responded to market forces reluctantly, refusing to teach cost effective care and
producing an unduly high proportion of specialists, who had to advertise to create
demand for their services.
5.The proportion of health care plans charging deductibles and co-payments doubled
from 30 percent in 1982 to 63 percent in 1984. More than two thirds of plans required
beneficiaries to pay a deductible of at least $100. Employers justified such out of pocket
charges as a way to reduce utilization. The Congressional Budget Office reported that
families who had to pay 25 percent of their bill spent 19 percent less on services than
those with full coverage. Low-income groups showed the greatest reduction in
utilization. As the 1980s ended thirty five million Americans were uninsured. The
importance of health care to all people is too essential to a nation‘s well being and to the
people‘s welfare to be left wholly to the marketplace.
F.By the late 1980s HMOs were serving only about 11 percent of the nation‘s Medicaid
population. President Bill Clinton‘s administration proposed several health care reforms
that would have extended health care services to all Americans by changing funding
mechanisms and requiring government compensation to insurers that incurred extra costs
when accepting high risk patients. The failure of his proposals marked the fifth time in
sixty years that Congress had refused to accept a presidential call for universal health
care. The Clinton bill would have required employers to finance health insurance for their
workers.
1.Although medical costs in the United States were at least 50 percent more per person
that in Switzerland, Germany and France, and twice as much as in all other industrialized
nations, American health care standards ranked a lowly thirty-seventh among the world‘s
nation. Of the ten most technologically advanced countries, the United States had the
highest infant mortality, lowest life expectancy and largest uninsured population. While
other industrialized countries have national health systems that provide care to all
1529
citizens, 44.3 million Americans, including 11.1 million children younger than eighteen,
had no health insurance in 1998 and 45 million more lacked adequate coverage. Millions
of poor and elderly Americans benefited from Medicare and Medicaid in 2000, but many
were worse off than their counterparts forty years earlier before those programs began.
2.The nation‘s uninsured population had increased rapidly in the early 1980s because
rising health care costs forced employers to drop health benefits and competition among
insurers reduced the availability of affordable coverage for patients with serious health
problems. Despite a strong economy in the late 1990s more than half of the uninsured
lived in families headed by full-time workers who lacked on the job benefits and could
not afford private policies. Traditional safety nets for the uninsured deteriorated or
entirely disappeared during this period as financial pressures from competition reduced
opportunities for doctors and hospitals to provide charity care.
3.In his State of the Union Address on January 26, 1994, President Clinton made it clear
that the major goal of his health plan is to guarantee universal health insurance coverage
for all Americans. To achieve this goal the Clinton plan relies primarily on a mandate
requiring all employers to pay up to 80 percent of the cost of health insurance premiums
for their workers. About 66 million wage and salary workers received insurance benefits
from their employers in 1994. Under the Clinton plan another 45 million workers would
be covered, although all but 18 million were already covered in some other way such as
through a spouses benefit. The plan intended to finance health care, not by raising taxes,
but by sending a bill to employers.
4.On September 14, 1995 Republican congressional leaders unveiled their plan to
overhaul Medicare, the federal health insurance program for elderly and disabled
Americans. They sought to end Medicare‘s status as a budgetary entitlement by
imposing a cap on program spending. They called for a reduction in Medicare
expenditures of $270 billion over seven years, a 30% decrease that represented the largest
spending cut in Medicare‘s history. They proposed transforming Medicare into a
competitive market by expanding beneficiaries‘ options to leave the traditional Medicare
system for private health insurance plans. Newt Gingrich, Speaker of the House of
Representatives, promoted Medicare reform as the, ―heart of this fight‖ to balance the
federal budget. Republican National Committee chairman Haley Barbour warned that
Medicare was ―the Achilles heel‖ of the Republican revolution and urged the party to
leave it alone until after the 1996 national elections.
5.In 1996, a compromise measure, the Mental Health Parity Act (MHPA) (P.L. 104-204),
was enacted which provided partial parity for the private health insurance marketplace. It
prohibited separate annual and lifetime dollar limits for mental health care, but did not
stop group plans from imposing restrictive treatment limits or cost sharing. In addition,
the MHPA was specifically not applicable to substance abuse treatment. As a
consequence, mental health and substance abuse treatment are still not on parity with
physical health care. Revenue losses forced the closure of four hundred emergency
departments between 1992 and 1997, mostly in inner city and rural communities, where
medically indigent patients used them as a regular and sole source of outpatient care.
1530
Even with fewer emergency rooms, emergency visits increased from 95 million in 1997
to 108 million in 2000. Wait time increased 33 percent.
G.The Balanced Budget Act of 1997 mandated a wide variety of key policy changes,
including a balanced federal budget 2002. Among the BBA provisions was a series of
Medicare reforms and substantial cuts, of $115 billion over five years, in the rate of
growth in Medicare spending. The BBA established a National Bipartisan Commission
on the Future of Medicare. The State Children‘s Health Insurance Program (SCHIP) was
also enacted as part of the Balanced Budget Act of 1997 (BBA). The original state
children‘s health insurance program (SCHIP) was financed by an increase in the federal
excise tax on cigarettes. Current estimates indicate that the average annual cost per child
of SCHIP coverage is approximately $1,700. In 1998, for the first time in three decades,
the Congressional Budget Office, announced a federal budget surplus, forecasting a
surplus of $131 billion for 2000 and $381 billion by 2009.
1.In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services (CMS).
It financed health care and social services to more than one in every seven Americans,
including twenty four million children, fourteen million adults and thirteen million
disabled and elderly individuals. It was the nation‘s largest purchaser of long term care
services, paying for more than half of all nursing home expenditures. In 2002 the federal
government provided 57 percent of $259 billion paid out by Medicaid while the other 43
percent came from state budgets.
§392 National Health Insurance
A.The United States is the only industrialized nation that does not have universal health
insurance. Although the US spends more on health, as a percentage of gross domestic
product (GDP), than any other nation, there are 47 million uninsured people, including 9
million children and health outcomes for the general population are inferior to those of
other developed nations. The Medicare Amendments to the Social Security Act did
create a rudimentary national health insurance program however Medicare only covers
disabled and retired social security beneficiaries and although Medicaid technically
coveres all people below 150% of the poverty line it does not insure most poor people
and many other employed and self-employed individuals are deterred by the prohibitive
cost of private health insurance from purchasing health insurance. There are serious bio-
security issues that the federal government must answer to before a national health
service could be allowed. Namely, changing the name of the Centers for Medicare,
Medicaid and S-CHIP (CMS) to National Health Insurance (NHI) and transferring all
mandatory benefit programs to the management of the Social Security Administration
(SSA) to prevent the threat of bio-terrorism from the public health service, who shall be
retained to conduct periodic epidemiologic studies of the welfare rolls.
Fig. 9-36 Pie Chart of $389 billion U.S. Government Healthcare Expenses, 2000
1531
9% 5%
5% Defense Health
Medicare
Medicaid
30% 51% Veteran's
SAMHSA
Source: Executive Office of the President Fiscal Year 2002 Historic Tables
1.The government has played a major role in the finance of health care since colonial
times. Today the government finances health care through a wide variety of programs,
primarily the Medicare Medicaid amendments to the Social Security Act and the
enforcement of workman‘s compensation. In 2002 the major financers were Medicare
$219 billion, less $21.9 billion in premiums, $197.1 billion. Medicaid accounted for
$117.9 billion. Defense Health $17.8 billion. Veterans medical care for $19.5 billion.
$19.6 billion was spent on federal employee health benefits offset by $19.7 billion in
income. $36.8 billion was spent on other medical expenses mostly mental health and
substance abuse treatment. Workers' compensation programs in the 50 states and the
District of Columbia and federal programs together paid $56.0 billion in medical and
cash benefits in 2004, $26.1 billion was for medical care and $29.9 billion was for cash
benefits. Employers' costs for workers' compensation in 2004 were $87.4 billion.
Together Medicare and Medicaid serve 87 million people at a combined cost of $602
billion in 2006. States served 52 million Medicaid beneficiaries at a cost of $305 billion.
The Medicare program served 42 million people at a cost of $295 billion. Medicaid pays
approximately 1 in 5 health care dollars and 1 in 2 nursing home dollars.
2.In 2002 the federal budget was estimated at $1,789 billion. Gross health expenditure
by the federal government was estimated at $389 billion, 21.7% of the federal budget, 4%
of the $9,824.4 billion U.S. Gross Domestic Product. The private sector was expected to
contribute another $626.4 billion for a medical total of $1,005.4 billion, 13.4% of the
United States GDP. Medicare alone represented 2.5 percent of the gross domestic
product (GDP) in 1996, a share that grew to 3.0 percent in 2006 and at current trends the
Congressional Budget Office (CBO) estimates it will reach 6 percent of GDP by 2030,
even when only outlays net of beneficiary premiums are considered.
Fig. 9-37 Government Health Expenditure as a % of the GDP, 1965-2000
4.50%
4.20%
4.00% 4.00%
3.50%
3.00% 3.10%
2.80%
2.50% 2.40%
2.00% 1.90%
1.50% 1.40%
1.00%
0.50% 0.40%
0.00%
1965 1970 1975 1980 1985 1990 1995 2000 1532
Source: Center For Disease Control. Gross Domestic Product and National Health
Expenditure. 2002
B. The Social Security Act of 1965 H.R. 6675 established both Medicare and Medicaid.
Medicare was a responsibility of the Social Security Administration (SSA) and State
Medicaid programs were administrated by the Social and Rehabilitation Service (SRS).
Secretary Califano created the Health Care Financing Administration (HCFA) on March
8, 1977. Secretary Thompson renamed HCFA to the Centers for Medicare & Medicaid
Services (CMS) on June 14, 2001. In 1980 HEW was divided into the Department of
Education and the Department of Health and Human Services (HHS). SCHIP was
founded in the Balanced Budget Act of 1997 to cover otherwise under or uninsured
children and now serves over 5 million. In 2001, HCFA was renamed the Centers for
Medicare & Medicaid Services (CMS). CMS national headquarters are located in
Baltimore, Maryland and there are 10 field offices around the nation. CMS is led by an
Administrator. CMS finances directly or indirectly 6,359,380 health care practitioners
and technical occupations and 3,271,350 health care support occupations.
2. The basic principle for the provision of medical relief to beneficiaries (1) will be
provided economically and only when, and to the extent, medically necessary; (2) will be
of a quality which meets professionally recognized standards of health care; and (3) will
be supported by evidence of medical necessity and quality in such form and fashion and
at such time as may reasonably be required by a reviewing peer review organization in
the exercise of its duties and responsibilities 42USC(7)XI-B§1320c-5.
3.In brief explanation of Medicare benefits, within 30 days from the receipt of the claim
Medicare shall notify the patient of the claims. The claim shall then be paid at, or before,
the end of the quarter 42USC(7)XVIII§1395b-7. Should the claim go unpaid until the
end of a fiscal year after the medical treatment, the medical billing agency shall file the
claims as tax deductible expenses to the full amount of the bill.
4. Hospital insurance, Part A of Chapter XVIII of the Social Security Act, is provided for
all people insured under old age and Otherwise uninsured people who suddenly meet the
requirements of disability insurance as the result of both poverty and injury, accident or
disease are also entitled to transitional hospital insurance whether or not they are US
1533
citizens under 42USC(7)II§426a. 42USC(7)XVIII-A§1395i-2 makes provisions for the
uninsured by guaranteeing that all hospital claims are paid, giving priority to the aged and
disabled, by reducing the share of the federal government to 45% of the total cost of
hospital claims payable so long as the patient continues to have the disabling physical or
mental impairment on the basis of which the individual was found to be under a
disability. The Federal Hospitals Insurance Trust Fund is paid for with a 2.9% payroll tax
under 42USC(7)XVIII-A§1395i. The scope of entitlement to the payment of benefits in
Medicare Part A under 42USC(7)XVIII-A§1395d is for inpatient hospital services, post-
hospital extended care services, home health services, and hospice care during any spell
of illness;
a. inpatient hospital services or inpatient critical access hospital services up to 150 days
b. psychiatric hospitalization is limited to 21 days of reimbursement;
c. post-hospital extended care services for up to 100 days
d. hospice care with respect to the individual during up to two periods of 90 days each
and an unlimited number of subsequent periods of 60 days.
5. In the case of a hospital that has a hospital emergency department, if any individual,
whether or not eligible for benefits, comes to the emergency department and a request is
made on the individual's behalf for examination or treatment for a medical condition, the
hospital must provide for an appropriate medical screening examination within the
capability of the hospital's emergency department, including ancillary services routinely
available to the emergency department, to determine whether or not an emergency
medical condition exists 42USC(7)XVIII-D§1395dd.
6. The Federal Supplemental Medical Insurance Trust Fund as provided for under
42USC(7)SVIII-B§1395t and may receive funds from other federal social security trust
funds to retain its solvency. The SMI Trust bears the brunt of the burden presented in the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 without any
significant increases in funding and is therefore operating on a deficit with a reserve of
less than 20% requiring notification to Congress under 42USC(7)VII§910 to provide for
receipts to bring the reserve to a secure level above 20% of operating costs. The scope of
benefits covers both Medicare Part B Supplemental Medical Insurance and part D that
has been interpreted to provide drug benefits. Part B covers the cost of physicians, in
home care and medical services;
1. Clinical laboratory services.
2. Physical therapy services.
3. Occupational therapy services.
4. Radiology services, including magnetic resonance imaging, computerized axial
tomography scans, and ultrasound services.
5. Radiation therapy services and supplies.
6. Durable medical equipment and supplies (including eyeglasses).
7. Parenteral and enteral nutrients, equipment, and supplies.
8. Prosthetics, orthotics, and prosthetic devices and supplies.
9. Home health services.
1534
10. Outpatient prescription drugs.
11. Inpatient and outpatient hospital services.
12. Physicians for preventative yearly check ups and diagnostic laboratory tests.
13. Dental care, yearly check up and decay treatment.
C. The Medicare program is the second-largest social insurance program in the United
States, with 42 million beneficiaries and total expenditures of $309 billion in 2004.
In 2004, 41.7 million people were covered by Medicare: 35.4 million aged 65 and older,
and 6.3 million disabled. Total benefits paid in 2004 were $303 billion. Income was $318
billion, expenditures were $309 billion, and assets held in special issue U.S. Treasury
securities grew to $289 billion.HI and SMI have separate trust funds, sources of revenue,
and categories of expenditures.
1. The largest category of HI expenditures is inpatient hospital services, while the largest
SMI expenditure category is physician services. For HI, the primary source of financing
is the payroll tax on covered earnings. Employers and employees each pay 1.45 percent
of earnings, while self-employed workers pay 2.9 percent of their net income. Other HI
revenue sources include a portion of the federal income taxes that people pay on their
Social Security benefits, and interest paid on the U. S. Treasury securities held in the HI
trust fund.
2. For SMI, transfers from the general fund of the Treasury represent the largest source of
income, currently covering roughly 75 percent of program costs. Beneficiaries pay
monthly premiums that finance about 25 percent of Part B costs. As with HI, interest is
paid on the U. S. Treasury securities held in the SMI trust fund. With the additional
benefits provided in the new Part D program, total Medicare spending is projected to be
3.3 percent of GDP in 2006.
Fig. 9.38 Medicare Trust Funds Operations, 2004
HI SMI Total
Assets at end of 256.0 24.0 280.0
2003 (billions)
Total income $183.9 $133.8 $317.7
Payroll taxes 156.7 N/a 156.7
Interest 15.0 1.5 16.5
Taxation of benefits 8.6 N/a 8.6
Premiums 1.9 31.4 33.4
General Revenue 0.6 100.4 101.0
Other 1.2 0.4 1.6
Total Expenditures 170.6 138.3 308.9
Benefits 167.6 135.4 302.5
Hospital 116.2 20.1 136.3
Nursing facility 16.9 N/a 16.9
Home health care 5.8 5.9 11.6
Physician fee N/a 53.8 53.8
1535
Managed Care 20.8 18.7 39.5
Drug card subsidy N/a 0.4 0.4
Other 7.9 36.4 44.3
Administrative 3.0 2.9 6.4
Assets end of 2004 269.3 19.4 288.8
Net change in 13.3 -4.5 8.8
assets
Enrolled 41.2 38.8 41.7
(millions)
Aged 34.9 33.3 35.4
Disabled 6.3 5.5 6.3
Average 4,064 3,489 7,553
benefit
Source: HI and SMI Trustee Report 2005 pg.4
Note: Totals do not necessarily equal the sums of rounded components.
D.Originally designed as a Federal-State program to pay for medical expenses as an
extension of public assistance for the aged, blind, and dependent children, Medicaid has
grown over the last four decades into the Nation‘s largest health care program and a
source of assistance to over 52 million Americans. In 2003, Medicaid provided health
insurance coverage to 39 million children and adults in low-income families, health and
LTC assistance to 8 million low-income people with disabilities, and supplementary
coverage and LTC assistance to 7 million elderly and disabled Medicare beneficiaries.
Medicaid now covers one in four American children, 18 percent of Medicare
beneficiaries, and 60 percent of nursing home residents.
1.To finance these multiple roles, the Federal and State governments combined spent
$275 billion in 2003, accounting for 17 percent of overall personal health spending. The
Federal share of Medicaid spending ranges from 50 to 77 percent, with a higher Federal
share in poorer States. Medicaid financing has helped move many low-income families
from dependence on charity and free care to financial access to both public and private
providers. Medicaid‘s greatest achievement for low-income families has been its
sustained growth in covering a higher proportion of the low-income population,
especially our Nation‘s youngest and poorest children.
Fig. 9-39 Medicaid Enrollees and Expenditures by Group, 2003
1536
Source: Smith, Vernon PhD; Gifford, Kathleen; Ellis, Eileen; Rudowitz, Robin;
O‘Mallory, Molly; Marks, Caryn. As Tough Times Wane, State Act to Improve Medicaid
Coverage and Quality. Results from a 50 State Medicaid Budget Survey for State Fiscal
Years 2007-2008. Kaiser Commission on Medicaid and the Uninsured. October 2007
2. In 2001, Medicaid‘s per enrollee cost was $749 for children‘s coverage and $1,752 for
non-disabled adults compared to $1,098 and $2,253, respectively, for the low-income
privately insured. Medicaid‘s low payment rates coupled with administrative burdens for
providers have resulted in limited access for some services, especially specialty care.
From 1994 to 2004, the percent of enrollees in managed care has grown from 23 to 61
percent of Medicaid. Almost 7.5 million Medicaid beneficiaries, about 5 million elderly
and 2.5 million non-elderly disabled, are dually eligible beneficiaries with joint
enrollment in both programs (Rowland 2006-2007). Seniors and people with disabilities
comprise only 24% of enrollees, yet they account for 70% of program spending. The
average per-person cost of caring for persons with disabilities in 2004 was $12,364
compared to $1,474 for non-disabled children and $1,942 for non-disabled adults.
Fig. 9-40 Percent Change in Medicaid Spending and Enrollment, 1998-2008
1537
Source: Smith, Vernon PhD; Gifford, Kathleen; Ellis, Eileen; Rudowitz, Robin;
O‘Mallory, Molly; Marks, Caryn. As Tough Times Wane, State Act to Improve Medicaid
Coverage and Quality. Results from a 50 State Medicaid Budget Survey for State Fiscal
Years 2007-2008. Kaiser Commission on Medicaid and the Uninsured. October 2007
3.The Medicaid program, which provides health coverage and long-term care support
services to 58 million individuals, has been faced with some enormous challenges over
the last few years. A severe economic downturn beginning in 2001 put Medicaid at the
center of budget debates at the state and federal levels of government. Medicaid spending
and enrollment growth peaked at the same time state revenues plummeted in 2002
forcing states to implement an array of measures to control Medicaid spending growth.
As this period of fiscal stress abated, two major pieces of federal legislation with
significant implications for Medicaid were implemented. The Medicare Modernization
Act (MMA) was implemented in January 2006, causing over 6 million low-income
seniors and individuals with disabilities who previously received their drug coverage
through Medicaid to transition to Medicare Part D plans. The Deficit Reduction Act
(DRA) enacted in February 2006 presented states with new Medicaid requirements as
well as some new options.
4.Total Medicaid spending growth hit a record low of just 1.3 percent for FY 2006 and
states reported that total Medicaid spending growth continued at a higher but still
relatively slow pace of 2.9 percent in FY 2007. Lower Medicaid spending growth
occurred at the same time revenue growth in most states was strong in 2006 and remained
strong, though somewhat lower into 2007. This picture is dramatically different from the
depth of the economic downturn in 2002 when Medicaid spending growth hit a high of
12.7 percent at the same time state revenues plummeted hitting a low of -10.6 percent.
Moving into FY 2008, state legislatures authorized total Medicaid spending growth that
averaged 6.3 percent as state revenue growth was projected to be still relatively strong
but somewhat less robust than it was in 2007.
5.States continue to expand home and community-based long-term care services. In FY
2007, 35 states expanded LTC services while in FY 2008 a total of 46 states planned to
do so. The most commonly reported LTC expansion in both years was expanding existing
HCBS waivers or adopting new ones. States also continued to add Programs for All-
Inclusive Care for the Elderly (PACE). The DRA presented states with a number of
options intended to give states increased flexibility to deliver long-term care services and
supports. Thirty-one states are using the DRA ―Money Follows the Person‖ initiative
which encourages states to reduce reliance on institutional care by transitioning
individuals from institutions to the community to support HCBS efforts. Nearly half (24)
of states had plans to implement a Long Term Care Partnership Program in 2008 to help
increase the role of private long-term care insurance.
Fig. 9-41 State Population and Medicaid Payment, 1999
Total Resident Population of the USA and Total Medicare Population by State of
Residence, July 1, 1999 in thousands
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State of Residence Residents Medicare Pop. Enrollees% Medicaid $
United States 272,691 38,319 14.1 188,456,539,000
Alabama 4,370 678 15.5 2,426,546,629
Alaska 620 40 6.5 407,574,922
Arizona 4,778 661 13.8 1,977,585,436
Arkansas 2,551 431 16.9 1,472,148,586
California 33,145 3,861 11.6 18,322,124,498
Colorado 4,056 462 11.4 1,840,149,345
Connecticut 3,282 515 15.7 3,106,833,711
Delaware 754 112 14.9 464,675,516
District of 519 76 14.6 812,307,451
Columbia
Florida 15,111 2,793 18.5 5,842,382,222
Georgia 7,755 910 11.7 3,762,757,168
Hawaii 1,185 164 13.8 605,014,726
Idaho 1,252 161 13.0 517,507,218
Illinois 12,128 1,622 13.4 6,755,100,123
Indiana 5,943 838 14.1 2,977,949,366
Iowa 2,869 457 16.6 1,461,173,214
Kansas 2,654 385 14.5 1,106,965,283
Kentucky 3,961 612 15.5 2,770,613,802
Louisiana 4,372 595 13.6 3,384,670,228
Maine 1,253 214 17.1 1,178,880.711
Maryland 5,172 635 12.3 3,014,952,844
Massachusetts 6,175 972 15.4 5,446,127,975
Michigan 9,664 1,385 14.0 6,158,362,777
Minnesota 4,776 647 13.5 3,119,764,555
Mississippi 2,769 414 15.0 1,843,880,902
Missouri 5,468 852 15.6 3,639,967,302
Montana 883 135 15.3 424,328,043
Nebraska 1,666 253 15.2 984,253,204
Nevada 1,809 235 13.0 559,503,198
New 1,201 165 13.7 787,062,321
Hampshire
New Jersey 8,143 1,201 14.7 5,772,631,914
New Mexico 1,740 230 13.2 1,103,690,454
New York 18,197 2,674 14.7 28,673,589,131
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North Carolina 7,651 1,112 14.5 4,967,172,053
North Dakota 634 102 16.1 346,720,664
Ohio 11,257 1,697 15.1 5,908,994,760
Oklahoma 3,358 503 15.0 1,496,145,904
Oregon 3,316 490 14.6 1,962,544,049
Pennsylvania 11,994 2,082 17.4 9,556,752,320
Rhode Island 981 168 17.0 1,063,037,589
South Carolina 3,886 556 14.3 2,472,958,395
South Dakota 733 118 16.1 377,830,154
Tennessee 5,484 815 14.9 4,159,707,338
Texas 20,044 2,226 11.1 10,350,823,295
Utah 2,130 204 9.6 756,590,971
Vermont 514 88 14.6 473,137,876
Virginia 6,173 878 12.8 2,487,100,612
Washington 5,250 724 12.6 3,564,389,167
West Virginia 1,807 336 18.6 1,355,044,060
Wisconsin 5,250 770 14.7 2,738,075,303
Wyoming 480 64 13.3 204,334,030
Statistics from CMS Table 10 Total Resident Population of the United States, and Total
Medicare Population, by State of Residence, July 1, 1999 and CMS Table 86 Medicaid
Expenditure by Provider Type and Area of Residence
E. The State Children‘s Health Insurance Program (SCHIP) was enacted with bi-partisan
support a decade ago as part of the Balanced Budget Act of 1997 (BBA). The original
state children‘s health insurance program (SCHIP) was financed by an increase in the
federal excise tax on cigarettes. Current estimates indicate that the average annual cost
per child of SCHIP coverage is approximately $1,700 (Burman, Kenney & Rueben
2007). The federal government pays an enhanced match for SCHIP relative to Medicaid.
On average, the federal share of Medicaid is 57%, but it is 70% under SCHIP. The
proposed increase in the tobacco tax was unfair but the idea is sound. The Tobacco
corporations are entitled to a seamless transition from the largest civil settlement in the
history of the United States, $206 billion over 25 years, $8 billion a year, from the
Tobacco Master Settlement Agreement of November 23, 1998 to a federal tax that
finances state and federal children‘s health insurance.
1.The number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million
of 65.1 million children in 2005. Since 1998, when SCHIP began, the percentage of
uninsured children has been dropping steadily, from a high of 15.4 percent to 10.8
percent in 2004. Over the last decade, Medicaid and SCHIP together have helped to
reduce the rate of low-income uninsured children by about one-third. Among children
under 18, the number covered by Medicare and SCHIP appeared slightly lower, 19.7
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million, in 2005, than in 2004, 19.9 million. Projections for fiscal year 2007, which began
October 1, reported that children‘s health insurance programs in 17 states faced federal
funding shortfalls totaling an estimated $800 million, equal to the cost of covering more
than 500,000 low-income children.
Fig. 9-42 Health Insurance Coverage of Children, 2001-2005
Source: Center on Budget Policies and Priorities. The Number of Uninsured Americans
is at an All Time High. August 29, 2006
2.The median income for all families with children is $46,700 in 2006. In 2006, the
number of uninsured children in moderate-income families increased, leaving 1.4 million
children from families with incomes from 200%-299% of poverty ($41,228 to $61,842
for a family of four in 2006) uninsured. Although two-thirds of uninsured children are
below 200% of the poverty level, the growing number of uninsured children in these
moderate-income families reflects mounting concerns about the affordability of health
insurance for middle class families. While the majority of children in moderate-income
families have employer-sponsored coverage, one in ten are uninsured and about 20%
depend on public coverage. Employees in construction, agriculture or services are the
least likely to have employer-sponsored coverage. Within moderate-income families,
only 49% of workers in these three industries have employer-sponsored coverage,
compared to 72% of workers in other industries.
3.Of the 8 million uninsured children, about two-thirds are estimated to be eligible but
not enrolled in Medicaid and SCHIP. Participation is generally higher for Medicaid
because SCHIP covers children with slightly higher income levels, so some of those
eligible may not be aware that they might qualify for public coverage, especially if they
are in working families, and others might have access to private health coverage. In the
guidance released on August 17th, the Administration would limit states‘ ability to expand
coverage to children with family incomes above 200 percent of the poverty line. States
would have to make assurances that they had enrolled at least 95 percent of the children
in the state below 200 percent of poverty, as a condition for expansion. Achieving this
level of participation would be very challenging in voluntary program.
4.Current SCHIP financing is $5 billion annually. CBO assumes that this level of funding
would be continued in its ―baseline‖. CBO assumes that the SCHIP baseline will be $25
1541
billion over the next five years, but that these funding levels are not adequate to maintain
current SCHIP programs. To maintain or expand SCHIP coverage, Congress would need
to allocate new funds, above the baseline levels, for SCHIP. An estimated $14 billion, in
addition to the $25 billion in the baseline over the next five years, would be necessary
just to maintain current eligibility levels for SCHIP. The Attorney General‘s Mastes
Tobacco Settlement, estimated to bring in $35 billion over 5 years, would pay for all
SCHIP expenses.
F. In Sustainable health financing, universal coverage and social health insurance
A/58/20 who defined Universal coverage as access to key promotive, preventive, curative
and rehabilitative health interventions for all at an affordable cost, thereby achieving
equity in access and financing where households contribute to the health system on the
basis of ability to pay. The principle of financial-risk protection ensures that the cost of
care does not put people at risk of financial catastrophe. There are two methods of
achieving universal coverage. The first is use of general tax revenue as the main source
of finance for risk pooling, a system also referred to as tax-funded health financing. The
second is introduction of social health insurance, where specific contributions for health
are collected from workers, self-employed people, enterprises and the government, and
are pooled into a single, or multiple, ―social health insurance fund‖.
1. The American private health insurance system is unsustainable. The extortionate
medical b(k)illing is unprofessional and corrupts the health system. As recently as 1981,
only 8% of families filing for bankruptcy did so in the aftermath of a serious medical
problem By contrast, in 2001 illness or medical bills contributed to about half of
bankruptcies. In 200, 69.1% of the debtors met the legacy definition of medical
bankruptcy employed in our 2001 study, a 22.9 percentage point absolute increase
(49.6% relative increase) from 2001, when 46.2% met this definition.
2. So far the best plan for universal health insurance in the United States has been the
National Health Insurance Act (or Expanded and Improved Medicare for All Act) H.R.
676 that would provide all individuals residing in the United States and in U.S. territories
with free health care that includes all medically necessary care, such as primary care and
prevention, prescription drugs, emergency care, and mental health services. It is
estimated that society would save close to $300 billion a year in healthcare costs--by
eliminating private insurers and their wasteful bureaucracies, advertising, commissions,
profiteering and multi-million dollar CEO salaries who would be assisted to find new
work. A Physicians‘ Working Group for Single Payer National Health Care System
(PNHP) was created to support the bill, that failed to garner sufficient support in the
House to pass.
2. It was proposed that a USNHI Trust Fund would finance the Program with amounts
deposited: (1) from existing sources of Government revenues for health care; (2) by
increasing personal income taxes on the top 5% income earners; (3) by instituting a
progressive excise tax on payroll and self-employment income; and (4) by instituting a
small tax on stock and bond transactions. This is flawed, in that there are $3-4 trillion in
health insurance assets that the government must nationalize before raising taxes.
1542
3.The concept of a totally free national health service is very nice. A fully nationalized
health service would theoretically be more disciplined, more affordable to society and
less corrupt. A survey of 2193 AMA physicians found that 83 percent of psychiatrists,
69 percent of emergency specialists, 65 percent of pediatricians, 60 percent of family
physicians and 55 percent of general surgeons favor a national health insurance plan.
Overall more than half of doctors now favor switching to a national health care plan and
fewer than a third oppose the idea. Current overall support 59% increased by 10% from
2002 49%.
4.America‘s Health Insurance Plans (AHIP), an organization that represent more than
1,300 health insurance companies, advocates for universal coverage through subsidies to
existing private insurers estimated at $50 billion annually. Their plan is that the federal
government would provide subsidies for the purchase of private coverage to individuals
and families with incomes under 400 percent of the FPL. Individuals with incomes under
300 percent of the FPL should receive proportionally greater assistance. People at 100
percent of the FPL should be eligible for Medicaid. Insurers would become more reliant
upon taxes but would continue to collect premiums from individuals and employers.
Combined with a single payer health insurance this plan is a good way for Congress to
work with the existing system to immediately realize universal coverage, improve bio-
security by prohibiting medical billing, increase leverage in medical price negotiations
and have the standing to nationalize the health insurance industry when the time is ripe.
Fig. 9-43 Tax Estimate of Nationalizing Health Insurance
2011 2012 2013 2014 2015 2020 2011-
2020
Social Proposal -75 -80 -90 -100 -110 -150 -1,105
Outlays
No Health Ins. 688 709 730 752 774 890 7,813
Deduction Tax
Receipts
NHI Added -1,412 -1,454 - -1,543 -1,589 - -
Government 1,498 1,827 16,037
Health Costs
NHI Health 4,000 2,188 743 0 0 0 4,000
Insurance Assets
(est.)
NHI Private -400
Insurance Golden
Parachute
NHI Medicare 547 585 623 1,452 2,269 2,609 17,671
Tax Revenues
NHI Medicare 2.9% 2.9% 2.9% 6.5% 9.6% 9.6% 2.9% -
Tax Rate 9.6%
Impact on the 688 709 -25 -791 -815 -937 -4,224
Budget
1543
Source: Table 33 Federal Budget in Balance FY 2011: Comparison of Bush and Obama
HA-28-2-10
G. The social universal health insurance plan proposed by American Health Insurance
Programs (AHIP) and Democratic Party would cost $75 to $150 billion annually over the
next decade. It is not practical to implement a new health insurance program until such a
time when the deficit would be less than 3%. The Democratic Party health care agenda
must be censured, they are torturing the economy. Nationalizing health insurance to
create a national health services might be beneficial while the economy is in a recession
and budget in a deficit because for several years the federal government could finance the
extra health care costs by nationalizing an estimated $4 trillion in health insurance
company assets and in this recovery window of two years, the federal government would
be collecting former health insurance premium deductibles as revenues without having to
finance the added cost of health insurance from these revenues, while the people would
neither have to pay for health insurance premiums nor a Medicare tax increase,
theoretically, the economy would flourish, and only one to two million former health
insurance workers and administrators with golden parachutes would be out of work.
These funds would however soon run out, if they could be easily liquidated in the first
place, and the Medicare premium would have to rise dramatically, because the federal
share of health care costs would triple and new revenues would not cover half of the
increase. Although a longer transition could be planned it is estimated that the ultimate
Medicare tax rate would have to be around 9.6%. Exemptions could be given to lower to
middle income workers. The cost of health insurance would be cheaper for all but the
richest, but it would be a mandatory tax. Health care professionals would be salaried
government workers, the government would purchase supplies, patient medical records
would not be used to get reimbursements, health prices and wages would be much easier
to control, administration more simple, health care would be totally free.
Art. 10 First Aid
§393 Cardio Pulmonary Rescuscitation
A. Modern CPR developed in the late 1950s and early 1960s. The discoverers of mouth-
to-mouth ventilation were Drs. James Elam and Peter Safar. Though mouth-to-mouth
resuscitation was described in the Bible (mostly performed by midwives to resuscitate
newborns) it fell out of practice until it was rediscovered in the 1950s. In early 1960 Drs.
Kouwenhoven, Knickerbocker, and Jude discovered the benefit of chest compression to
achieve a small amount of artifical circulation. Later in 1960, mouth-to-mouth and chest
compression were combined to form CPR similar to the way it is practiced today.
B. There are three steps in adult CPR. Remember a person in cardiac arrest may have
abnormal breathing for a couple of minutes. This abnormal breathing is called "agonal
respiration" and is the result of the brain's breathing center sending out signals even
though circulation has ceased. The key point is that the abnormal breathing may sound
like grunting, gasping or snoring. It disappears in 2-3 minutes. If this type of breathing is
noted DO NOT delay CPR. The person desperately needs air.
1544
1. Check the victim for unresponsiveness. If there is no response, Call 911 and return to
the victim. In most locations the emergency dispatcher will assist with CPR instructions.
2. Tilt the head back and listen for breathing. If not breathing normally, pinch nose and
cover the mouth with yours and blow until the chest rises. Give 2 breaths. Each breath
should take 2 seconds.
3. If the victim is still not breathing normally, coughing or moving, begin chest
compressions. Push down on the chest 11/2 to 2 inches 15 times right between the
nipples. Pump at the rate of 100/minute, faster than once per second. In general the chest
should be pushed down 11/2-2 inches. Sometimes you may hear a cracking sound. Do not
be alarmed. The sound is caused by cartilage or ribs cracking. Even if this occurs the
damage is not serious. The risk of delaying CPR or not doing CPR is far greater than the
risk of a broken rib. Continue with 2 breaths and 15 pumps until help arrives.
C. There are four differences for giving CPR to children.
1. If you are alone with the child give one minute of CPR before calling 911
2. Use the heel of one hand for chest compressions
3. Press the sternum down 1 to 1.5 inches
4. Give 1 full breath followed by 5 chest compressions
D. CPR for infants younger than one year of age:
1. Shout and gently tap the child on the shoulder. If there is no response, position the
infant on his or her back.
2. Open the airway using a head tilt lifting of chin. Do not tilt the head too far back.
3. If the baby is NOT breathing give 2 small gentle breaths. Cover the baby's mouth and
nose with your mouth. Each breath should be 1.5 to 2 seconds long. You should see the
baby's chest rise with each breath.
4. Give five gentle chest compressions at the rate of 100 per minute. Position your 3rd
and 4th fingers in the center of the chest half an inch below the nipples. Press down only
1/2 to 1 inches.
5. Repeat with 1 breath and 5 compressions. After one minute of repeated cycles call 911
and continue giving breaths and compressions.
E. The ‗‗Community Access to Emergency Defibrillation Act of 2002‘ found that over
220,000 Americans die each year from cardiac arrest. Every 2 minutes, an individual
goes into cardiac arrest in the United States. The chance of successfully returning to a
1545
normal heart rhythm diminishes by 10 percent each minute following sudden cardiac
arrest. Eighty percent of cardiac arrests are caused by ventricular fibrillation, for which
defibrillation is the only effective treatment. Sixty percent of all cardiac arrests occur
outside the hospital. The average national survival rate for out-of-hospital
cardiac arrest is only 5 percent. Communities that have established and implemented
public access defibrillation programs have achieved average survival rates for out-of-
hospital cardiac arrest as high as 50 percent. According to the American Heart
Association, wide use of defibrillators could save as many as 50,000 lives nationally each
year. Successful public access defibrillation programs ensure that cardiac arrest victims
have access to early 911 notification, early cardiopulmonary resuscitation, early
defibrillation, and early advanced care.
§394 Midwives and Maternity Care
A.The birth of a child marks one of the great events of life in any culture, but in most
societies it carries with it a high probability of death or serious illness for both mother
and child. Neonatal mortality rates- deaths at less than four weeks- vary considerably in
the modern world, particularly in communities that do not employ asepsis in obstetrical
care. Globally mortality among children under 5 fell from 146 per 1,000 lives births in
1970 to 70 in 2003. Universal access to maternal health care requires a sufficiently dense
health care network to supply services.
1. In 2006 there were 4,265,996 births out of nearly 6.6 million pregnancies, a 3 percent
increase from the year before, the largest single-year increase since 1989 and the highest
total number of births since 1961, near the end of the baby boom. The 2006 fertility rate
of 2.1 children is the highest level since 1971. The overall fertility rate increased 2
percent between 2005 and 2006, nudging the average number of babies being born to
each woman to 2.1. That marks the first time since 1971 that the rate has reached a
crucial benchmark of population growth: the ability of each generation to replace itself.
2.The nation's total fertility rate hit a high of nearly 3.8 in the United States in 1957
during the postwar Baby Boom. But it fell sharply through the 1960s and 1970s with the
introduction of the birth control pill, legalization of abortion and other trends, including
women delaying childbearing to attend college and pursue a career. The rate dipped
below replacement level in 1972 and hit a low of 1.7 in 1976, but it started rising again in
the late 1970s, climbed steadily through the 1980s, hovering close to but never hitting the
replacement rate throughout the '90s although the population grew to over 300 million in
2006.
3. The United States‘ under-5 mortality rate (8 per 1,000 live births) is twice that of
Belgium, Czech Republic, Finland, France, Italy, Japan and Norway (4 per 1,000 live
births) and more than twice that of Iceland and Sweden (3 per 1,000 live births). In the
United States, America-Indian and Alaska-Native infants are 1.5 to 2 times more likely to
die than white infants and African-American infants are 2.4 times more likely to die than
white infants. Although the United States spends more money on health care per capita
than nearly any other country in the world the US has the highest rates of child poverty
1546
and the lowest levels of child health and safety of the rich countries. As a result, infant
and child mortality rates in the United States are higher than in any other industrialized
country.
4.Despite substantial reductions in
U.S. infant mortality during the
past several decades, the black-
white infant survival gap has
widened. From 1980-2000, even
as overall infant mortality rates
declined, the black-white ratio of
infant mortality increased 25
percent. From the mid-1960s
through 1980, the poor in the
United States made health gains
and their infant death rates
declined as the survival gap
shrank. Since 1980, however,
disparities between rich and poor
in the U.S. have widened and
infant death rates among the poor
remain higher than among the
rich. One recent study found that
if – between 1965 and 2002 – all
families in the U.S. had enjoyed
the same improvement in infant
mortality rates as the highest
income quintile, 20 percent of all
infant deaths could have been
averted and an estimated 460,000
people might still be alive. And if
all infants had experienced the same yearly infant death rates as the richest white infants,
20 percent of all white infant deaths and 25 percent of deaths among infants of color
could have been prevented in 2000 alone.
B. The World Health Report of 2005 – Make every Mother and Child Count – says there
are an estimated 136 million births every year. Every woman, without exception requires
professiona skilled care while giving birth:
1. Nearly 11 million children under five years of age will die from causes that are largely
preventable. Each year 3.3 million babies, or more, are stillborn. More than 4 million
die within 28 days of coming into the world. A further 6.6 million children die before
they reach 5 years of age
2. More than half a million women, 539,000, died in pregnancy, childbirth or soon
thereafter. 68,000 died as the result of unsafe abortions. Reducing this toll depends
1547
largely upon every mother and every child to have access to health care through
pregnancy to childbirth, the neonatal period and childhood. Only 1% of these deaths
occur in rich countries.
3. For maternal, newborn and child health to be effective a continuum of care is required.
In the 75 countries who comprise the majority of infant mortality will require $52.4
billion in addition to current expenditure, $25 billion for human resources. The $52.4
billion represents a 6% increase in mean health expenditure in these countries rising to
18% by 2015. In the 21 countries facing the greatest constraints health will need to grow
27% this 2005 and 76% by 2015. Implementing this cenario will cost an estimated $1
billion in 2005 increasing coverage to $6 billion by 2015, a total of $39 billion over 10
years.
4. 100,000 new full time multipurpose professionals and 4.6 community support
employees will be needed to fulfill global need. The plan is for 334,000 additional
midwives, the upgrading of 140,000 maternity workers and 27,000 doctors who are not
fully competent to provide backup.
5. Unintended, mistimed or unwnated pregnancies number 87 million globally. More
than half of these women, 46 million resort to abortions. 18 million do so in unsafe
circumstances.
C. If we retroject the worst mortality rates of the modern world back into the Greco-
Roman one, we would estimate that about 5% of all babies born alive would die before
they reached the age of one month, and that among every 20,000 women giving birth,
five would die due to a lack of qualified maternal care for malnourished people. If we
include late fetal and inchildbirth deaths, the probability of infant mortality climbs from
5% to 8%. The dangers of childbirth must have made it an occasion of great anxiety for
everyone concerned. The death of a woman or her baby was an all too common
occurrence.
1. To physician Soranus of the second century BC, the demands of the profession require
a highly competent woman; he implies that some midwives are simply unfit for their
work. "A suitable person," Soranus writes, "will be literate, with her wits about her,
possessed of a good memory, loving work, respectable and generally not unduly
handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust,
sympathetic disposition (though she need not herself have borne a child) and keep her
hands soft, presumably so she would not cause discomfort to either mother or child.
Soranus argues that the best midwives should be literate so that they can be
knowledgeable about obstetrics and pediatric theory.
2. Medical writings indicate that obstetrical practice was not limited to midwives; a male
physician might attend particularly difficult births.
3. In the Eastern end of the Mediterranean basin, some women advanced beyond the
profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal
1548
training was surely required. Moreover, there were some gynecological tracts written by
women with Greek names. It would appear that obstetrical care in the East was a
respectable profession in which respectable women could earn their livelihoods and
enough esteem to publish works read and cited by male physicians.
4. At the onset of labor, the midwife was summoned and the necessary equipment made
ready. During labor, the parturient lay on her back on a hard, low bed with support under
her hips; her feet were drawn up together, her thighs parted. Soranus directs the midwife
to ease the labor pains with gentle massage, with a cloth soaked in warm olive oil laid
over the abdomen and genital area, and with the equivalent of hot-water bottles- bladders
filled with warm oil- placed against the woman's sides.
5. As the cervix begins to dilate, the midwife is to encourage the process of dilation by
gently rubbing the opening with her left forefinger (with its nail cut short); the finger is to
be generously smeared with olive oil. When the cervix is dilated to the size of an egg, the
parturient is moved to the midwife's stool, unless she has become very weak; in the latter
case, the delivery is to be made on the hard bed.
6. For the actual delivery, the midwife needs three assistants to stand on both sides of the
chair and at the back. Soranus stresses that these assistants should be "capable of gently
allaying the anxiety" of the mother. The woman who stood behind the chair had to be
strong enough to keep the parturient from swaying; in addition, she was to hold a small,
flat piece of cloth at the anus to avoid hemorrhoids. The midwife herself, covered by an
apron, sat in front of the mother and throughout the delivery assured her that all was
going well.
7. One of the midwife's duties was to instruct the mother on proper breathing and on how
to push downwards during a contraction.
8. Once the baby had been safely delivered, the midwife carefully inspected it for any
congenital deformities.
9. After inspecting the child and letting it rest a bit, the midwife severs the umbilical
cord. Soranus recommends using a knife and castigates other methods as superstitious
Instead of cauterizing the cord, as many midwives do, Soranus directs her to gently
squeeze the blood from it, to ligate the end with a stout woolen (not linen) thread, and
finally to gently press the bent cord into the umbilicus or navel.
10. With the umbilical cord tied off properly, the midwife is then to cleanse the newborn.
Soranus recommends that the midwife sprinkle the infant with a moderate amount of
"fine and powdery salt, or natron or aphronitre." All these chemicals are mildly
astringent and were recommended primarily for their ability to cut through the residue of
amniotic fluid, vernix, and placenta on the newborn's skin and also to make the skin less
prone to develop rashes; however, astringents would also tend to make the baby's skin
dry out and flake or crack.
1549
11. The emulsion is to be washed away with warm water and the process repeated a
second time. Next, the midwife is to clear any mucus from the nose, mouth, and ears and
to clear the anus of any membranes that might impede regular bowel movements.
12. Galen says that infants present feet first, laterally, or with an arm or leg first in only
one of many thousands of births (de Usu Partium 15.7). We should properly take this
observation with a grain of salt, since neither Galen nor any one else in antiquity ever
tried to make an accurate count of such occurrences. But clearly, Galen thought these
births unusual. Modern statistics suggest that in about five percent of deliveries, the
infant presents in a difficult position- breech, transverse, compound, or face/brow first.
By far the most common, breech occurs in about three to four percent of deliveries.
Breech presentations are especially associated with prematurity and poor nutrition,
conditions at least as likely in the Greco-Roman world as today. As a general rule of
thumb, 85-90% of all births in a generally healthy female population are normal and
uncomplicated. See Harry Oxorn, Human Labor and Birth, 4th ed. (New York: Appleton
Century Crofts, 1980).
§395 Immunization
A. The AMA (1) supports efforts toward the prevention of childhood disease through
immunizations; (2) favors using its position in international health organizations to
promote appropriate immunization programs for children throughout the world,
especially in such critical and cost-effective areas as the prevention of poliomyelitis and
measles; and (3) expresses the need for private and public research institutions to help
develop more technically advanced products, such as new heat stable vaccines, necessary
for the effective immunization of children throughout the world H-440.991 Health and
Ethics Policies of the AMA House of Delegates. The AMA believes the following
principles are required components of a national immunization program and should be
given high priority by the medical profession and all other segments of society interested
and/or involved in the prevention and control of communicable disease:
1. All US children should receive recommended vaccines against diseases in a continuing
and ongoing program. An immunization program should be designed to encourage
administration of vaccines as part of a total preventive health care program, so as to
provide effective entry into a continuous and comprehensive primary care system. There
should be no financial barrier to immunization of children. Existing systems of
reimbursement for the costs of administering vaccines and follow-up care should be
utilized. Any immunization program should be either (a) part of a continuing
physician/patient relationship or (b) the introductory link to a continuing
physician/patient relationship wherever possible. Professionals and allied health
personnel who administer vaccines and manufacturers should be held harmless for
adverse reactions occurring through no fault of the procedure. Provision should be made
for a sustained, multi-media promotional campaign designed to educate and motivate the
medical profession and the public to expect and demand immunizations for children and
share responsibility for their completion. An efficient immunization record-keeping
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system should be instituted. (Res. 44, A-77; Reaffirmed: CLRPD Rep. C, A-89;
Reaffirmed: Sunset Report, A-00)
Fig. 9-45 Recommended Immunization Schedule Ages 0-6 Years, US, 2009
Source: Centers for Disease Control
B. WHO and UNICEF jointly formulated a draft global strategy on immunization A/58/
12 in response to expected developments and trends over the next 10 years. In response to
the challenges of a rapidly changing and increasingly interdependent world, WHO and
UNICEF have jointly drafted a global immunization vision and strategy for the years
2006-2015.
1. The goal of vaccination is to protect more people against more diseases, by expanding
the reach of immunization to every eligible person, including those in age groups beyond
infancy, within a context in which immunization is high on every health agenda. It aims
to sustain existing levels of vaccine coverage, extend immunization services to those who
are currently unreached and to age groups beyond infancy, introduce new vaccines and
technologies, and link immunization with the delivery of other health interventions and
the overall development of the health sector.
2. The establishment of strong national immunization services in many countries over
recent years has ensured that today more than 70% of the world‘s targeted population is
reached by those services.
3. Alarmed that globally and in some regions immunization coverage has increased only
marginally since the early 1990s, and that in 2003 more than 27 million children
worldwide were not immunized during their first year of life;
4. Recognizing that each year 1.4 million children under five years of age die from
diseases preventable by currently available vaccines;
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5. Further recognizing that each year an additional 2.6 million children under five years
of age die because of diseases potentially preventable by new vaccines;
6. Emphasizing the need for all countries to strive towards achieving the United Nations
Millennium Development Goal of reducing by two-thirds, between 1990 and 2015, the
under-five child mortality rate;
7. Recalling the target of the United Nations General Assembly‘s twenty-seventh special
session on children (2002) to ensure full immunization of children under one year of age,
with at least 90% coverage nationally, and at least 80% coverage in every district or
equivalent administrative unit;
8. Efforts are under way to develop new vaccines against major infectious diseases
(including malaria, HIV/AIDS and tuberculosis).
9. The global Children's Vaccine Initiative aims to develop affordable new and improved
vaccines to be used in the United States and in the developing world that will increase the
efficacy and efficiency of the prevention of infectious diseases. To the extent practicable,
the program shall develop and make available vaccines that require fewer contacts to
deliver, that can be given early in life, that provide long lasting protection, that obviate
refrigeration, needles and syringes, and that protect against a larger number of diseases.
C. To achieve optimal prevention of human infectious diseases through immunization
and to achieve optimal prevention against adverse reactions to vaccines under
42USC(6A)IIIA§283d the US the Secretary, acting through the Director of the National
Vaccine Program in consultation with Directors of the National Institute for Allergy and
Infectious Diseases, the National Institute for Child Health and Human Development, the
National Institute for Aging, and other public and private programs under subchapter
XIX of Public Health Service, shall include information with respect to activities and the
progress made achieving the goals of the program.
1. The Director of the Program shall ensure that the governmental and non-governmental
production and procurement of safe and effective vaccines by the Public Health Service,
the Department of Defense, and the Agency for International Development. The Director
of the Program shall prepare and issue a plan on 1 January of every year for the
implementation of the responsibilities of the program, the plan shall establish priorities in
research and the development, testing, licensing, production, procurement, distribution,
and effective use of vaccines, describe an optimal use of resources to carry out such
priorities,
2. To this end the program is required under 42USC(6A)XIX(1)§300a-2 (a) to develop
the techniques needed to produce safe and effective vaccines (b) meet the needs of the
United States population and fulfill commitments of the United States to prevent human
infectious diseases in other countries. (c) coordinate and provide direction and assistance
to States, localities, and health practitioners in the distribution and use of vaccines,
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including efforts to encourage public acceptance of immunizations and to make health
practitioners and the public aware of potential adverse reactions and contraindications to
vaccines.
3.To prevent adverse reaction and compensate those people who are victims of adverse
reactions to vaccines there is established a National Vaccine Injury Compensation
Program to be administered by the Secretary under 42USC(6A)XIX(2)(A)§300aa-10
Whereas the Vaccine Injury Table is somewhat outdated most claims are directed to the
Secretary to revise the Table under 42USC(6A)XIX(2)(A)§300aa-14(c)(1). A civil
action against a vaccine manufacturer for damages for a vaccine-related injury or death
associated with the administration of a vaccine, shall be tried in three stages.
(a) Liability: The first stage of such a civil action shall be held to determine if a vaccine
manufacturer is liable.
(b) General damages: The second stage of such a civil action shall be held to determine
the amount of damages (other than punitive damages) a vaccine manufacturer found to be
liable to pay.
(c) Punitive damages: If sought by the plaintiff, the third stage of such an action
shall be held to determine the amount of punitive damages a vaccine manufacturer found
to be liable to pay. If in such an action the manufacturer shows that it complied, in all
material respects, with all requirements under the Federal Food, Drug, and Cosmetic Act
[21 U.S.C. 301 et seq.] and this chapter applicable to the vaccine and related to the
vaccine injury or death with respect to which the action was brought, the manufacturer
shall not be held liable for punitive damages unless the manufacturer engaged in -
(i) fraud or intentional and wrongful withholding of information from the Secretary
during any phase of a proceeding for approval of the vaccine.
(ii) intentional and wrongful withholding of information relating to the safety or efficacy
of the vaccine after its approval, or
(iii) other criminal or illegal activity relating to the safety and effectiveness of vaccines,
which activity related to the vaccine-related injury or death for which the civil action was
brought.
§396 Fractures, Dislocations and Bandaging
A. In the 48 Part Treaties on Fractures translated by Francis Adams, Hippocrates treats
upon fractures and dislocations and the application of bandages.
1. The physician must take the extension as straight as possible, for this is the most
natural direction. Those, then, who act in such cases without deliberation, for the most
part do not fall into any great mistake of necessity.
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2. If one will extend a broken arm, he will turn the bone, situated at the extremity of the
little finger, into the straight line, and also the one at the elbow, and the tendons which
stretch from the carpus to the extremity of the humerus will be placed in the straight line;
and when the arm is suspended in a sling, it will be in the same attitude as that in which it
was bound up, and will give no pain to the patient when he walks about, nor when he lies
reclined, and will not become fatigued.
3. The prominence of a broken bone could not escape being detected by the hand of an
experienced person, when applied for this purpose, and, moreover, the projecting part is
particularly painful to the touch.
4. When the patient‘s arms are extended, the physician should apply the palms of the
hands, and adjust the fractured parts and then having rubbed the parts with cerate, but not
in large quantity so that the bandages may not come off, it is to be bound up in this state,
care being taken that the hand be not lower than the elbow, but a little higher, so that the
blood do not flow toward the extremity, but may be determined to the upper part; and
then it is to be secured with the bandage, the head of which is to be placed at the fracture,
and the bandage should impart firmness to the parts without occasioning strong
compression.
5. When you have carried the bandage twice or thrice round at the seat of the fracture, it
is to be carried upward, so that the afflux of blood into it may be stopped, and the
bandage should terminate there, and the first bandages ought not to be long.
6. The head of the second bandage is also to be placed upon the seat of the fracture, and a
single round of it being made there, it is then to be carried downward, and is not to be
applied so tight as the other, and there should be greater distances between the turns, so
that the bandage may prove sufficient to revert to the spot where the other terminated.
7. The bandages may be rolled to the left hand or to the right, or to whatever side suits
best with the position of the fractured arm, or according to the inclination which it may
have.
8. Afterward we must place along the arm, compresses, smeared with a little cerate, for
thus they occasion less uneasiness, and are more easily arranged.
9. Then we must apply the bandages crossways, sometimes to the right hand, and
sometimes to the left, for the most part beginning below and terminating above, but
sometimes commencing above and ending below.
10. The parts which are thinly covered with flesh should be wrapped round with
compresses, and inequalities should be made up, not by a number of folds at once, but by
degrees.
11. These two bandages are sufficient at first.
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B. When the third day arrives, that is to say, the seventh from the first dressing, if
properly done, the swelling in the hand should be not very great; and the part which has
been bandaged should be found more slender and less swelled at each time, and on the
seventh day the swelling should be quite gone, and the broken bones should be more
readily moved, and admit of being easily adjusted.
1. If, then, you see that the bones are properly adjusted by the first dressings, and that
there is no troublesome pruritus in the part, nor any reason to suspect ulceration, you may
allow the arm to remain bandaged in the splints until after the lapse of more than twenty
days. The bones of the fore-arm generally get consolidated in thirty days altogether; but
there is nothing precise in this matter, for one constitution differs from another, and one
period of life from another.
2. When you remove the bandages, you must pour hot water on the arm and bind it up
again, but somewhat slacker, and with fewer bandages than formerly: and again on the
third day you undo the bandages, and bind it still more loosely, and with still fewer
bandages.
C. The human foot is composed of several small bones like the hand. These bones
therefore are scarcely ever broken, unless the skin at the same time be wounded by some
sharp and heavy body.
1. If any bone be moved from its place, or a joint of the toes be luxated, or any of the
bones of the part called the tarsus be displaced, it must be forced back again to its place
as described with regard to the hand; and is to be treated with cerate, compresses, and
bandages, like the fractures, with the exception of the splints; and is to be secured tightly
in the same way, and the bandages renewed on the third day; and the patient thus
bandaged should return the same answers as in fractures, as to the bandages feeling tight
or slack. All these bones recover perfectly in twenty days.
2. Fractures involving the bones of the leg take longer to heal. It is advantageous to lie in
bed during the whole of this time; but the patients, thinking light of the complaint, have
not perseverance to do this, and they walk about before they get well; wherefore many of
these do not make a perfect recovery.
3. When the parts are adjusted, you should apply the bandages while the limb is in a
stretched position, making the first turns to the right or to the left, as may be most
suitable; and the end of the bandage should be placed over the fracture, and the first turns
made at that place; and then the bandage should be carried up the leg, as described with
regard to the other fractures.
4. The bandages should be broader and longer, and more numerous, in the case of the leg
than in that of the arm. And when it is bandaged it should be laid upon some smooth and
soft object, so that it may not be distorted to the one side or the other, and that there may
be no protrusion of the bones either forward or backward;
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5. A canal may be used to keep the leg elevated.
6. Bandaging should be renewed on the third day; and the bandaged part should be found
reduced in swelling; and the new bandagings should be more tightly put on, and more
pieces of cloth should be used; and the bandages should be carried loosely about the foot,
unless the wound be near the knee.
7. Extension should be made and the bones adjusted at every new bandaging; for, if
properly treated, and if the swelling progress in a suitable manner, the bandaged limb will
have become more slender and attenuated, and the bones will be more mobile, and yield
more readily to extension. On the seventh, the ninth, or the eleventh day, the splints
should be applied as described in treating of the other fractures.
8. Attention should be paid to the position of the splints about the ankles and along the
tendon of the foot which runs up the leg. The bones of the leg get consolidated in forty
days, if properly treated.
D. In those cases of fracture in which the bones protrude and cannot be restored to their
place, the following mode of reduction may be practiced:- Some small pieces of iron are
to be prepared like the levers which the cutters of stone make use of, one being rather
broader and another narrower; and there should be three of them at least, and still more,
so that you may use those that suit best; and then, along with extension, we must use
these as levers, applying the under surface of the piece of iron to the under fragment of
the bone, and the upper surface to the upper bone; and, in a word, we must operate
powerfully with the lever as we would do upon a stone or a piece of wood. The pieces of
iron should be as strong as possible, so that they may not bend.
E. Luxations and subluxations at the knee are much milder accidents than subluxations
and luxations at the elbow. For the knee-joint, in proportion to its size, is more compact
than that of the arm, and has a more even conformation, and is rounded, while the joint of
the arm is large, and has many cavities. And in addition, the bones of the leg are nearly of
the same length, for the external one overtops the other to so small an extent as hardly to
deserve being mentioned, and therefore affords no great resistance, although the external
nerve (ligament?) at the ham arises from it;
F. The bones of the fore-arm are unequal, and the shorter is considerably thicker than the
other, and the more slender (ulna) protrudes, and passes up above the joint, and to it (the
olecranon) are attached the nerves (ligaments) which go downward to the junction of the
bones; and the slender bone (ulna) has more to do with the insertion of the ligaments in
the arm than the thick bone (radius). Dislocations at the elbow are more troublesome
than those at the knee, and, owing to the inflammation which comes on, and the
configuration of the joint, are more difficult to reduce if the bones are not immediately
replaced. For the bones at the elbow are less subject to dislocation than those of the knee,
but are more difficult to reduce and keep in their position, and are more apt to become
inflamed and ankylosed.
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1. Such dislocations, to whatever side, are easily reduced, and the extension is to be made
in the line of the arm, one person making extension at the wrist, and another grasping the
armpit, while a third, applying the palm of his hand to the part of the joint which is
displaced, pushes it inward ward, and at the same time makes counterpressure on the
opposite side near the joint with the other hand.
2. In dislocations of this kind, extension should be made in the manner described when
treating of the bandaging of fractured bones of the arm, extension being made upward at
the armpit, while the parts at the elbow are pushed downward, for in this manner can the
humerus be most readily raised above its cavity; and when so raised, the reduction is easy
with the palms of the hand, the one being applied so as to make pressure on the
protuberant part of the arm, and the other making counter-pressure, so as to push the bone
of the fore-arm into the joint.
G. In bandaging, the head of the first bandage should be placed at the seat of the injury,
whether it be a case of fracture, of dislocation, or of diastasis (separation), and the first
turns should be made there, and the bandages should be applied most firmly at that place,
and less so on either side.
§397 Traditional Medicine
A.There is much to learn from traditional medicine and much to be afraid of regarding
modern medicine. Traditional medicine is cost-effective, prevents unnecessary surgery
and prevents undesirable effects of potent drugs. For instance―Laying of hands‖ has been
ignored previously due to prevalence of Victorian mindset making the West a ―no touch‖
culture with the exception of in the nursing field. Nurses use touch naturally in their
work to calm and quiet their patients. Healing Touch is A Recent Development
developed by American nurse in 1970‘s that has spread worldwide. More than 2,000
people have learned the technique that has been endorsed by the American Holistic
Nurses Association (AHNA).
1. Many of skeletal remains prove without doubt that Neanderthal man was often
afflicted with arthritis. During the last centuries of the Ice Age and the first of the Old
Stone Age, Neanderthal man was replaced by a new race, the direct ancestor of homo
sapiens. And, judging by his remains he too was plagued by a multitude of bone disease
such as arthritis, tumours, spinal tuberculosis, sinusitis, congenital dislocation of the hip-
joint, osteomyelitis and deformities such as cleft spine. Rickets probably also existed.
There is evidence dating back to those times of well-healed fractures which would seem
to indicate experiences in setting at rest or in splints. A surprisingly large number of
prehistoric skulls with bored holes have been found in New Stone Age excavations in
France, Spain, Germany, Austria, Russia and Poland, occasional examples have also
come to light in England and Peru. Probably these early doctors tackled such an
operation by boring a series of small holes in a circle to that they eventually met and
made it possible for a circular disc of bone to be lifted out. After its removal, this disc
was often given an additional hole and worn round the neck as an amulet. The oldest
known scripts appear on clay tablets and clay fragments which were found in Abraham‘s
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town, the Chaldean town of Ur in Mesopotamia, during excavations made after the First
World War.
B. According to the teachings of Ancient Chinese pathology, illness develops as a result
of alienation from the natural order of the universe. Legend tells of three emperors, who
are said to have lived during the first half of the third millennium BC. All three, the
legend relates, were not merely rulers but also scholars, doctors, discoverers and
inventors, all three took a high measure of interest in physiological and medical affairs.
The oldest of them, Fu His, who is said to have lived around 3000 BC is supposed to
have put forward the view that every event is the result of antagonism between two
opposing moving principles. One of these, Yang, is the masculine, illuminating, creative,
firm, constructive principle, the other, called Yin, is the feminine, soft, receptive, dark
and empty one. Man‘s health depends upon the existence of harmony between both. The
next emperor, Shen Nung, so the legend says, was born around the year 2820 BC and
died about 2697 BC. According to tradition, he studied the human intestines and their
functions with true passion and, in particular, the action on the body of a variety of herbs.
It is said that he had a transparent stomach and abdominal wall and so could observe
everything that happened inside his abdomen, so he was able to make numerous
experiments with poisons and their antidotes until he was gathered to his ancestors at the
age of one hundred and twenty-three. Huang Ti was the third legendary emperor. He
only managed to live ot the age of a hundred and is said to have reigned over the Middle
Kingdom from 2697 to 2597 BC. Among other discoveries, he is credited with the
invention of the Ancient Chinese system of pathology according to which illness is the
result of alienation form the natural order of the universe. He studies the influence of the
weather on the human body and is thought to have been the author of the famous book,
The Theory of the Body‘s Interior, known as Nei-ching. This work which was later
furnished with detailed examples and commentaries, dealt with all the branche of
medicine, surgery, it is true, was given pretty niggardly treatment. All discussion of
Ancient Chinese pathology, however, culminates in the view that it is the doctor‘s chief
task to restore his patient‘s natural balance which has been disturbed.
1.The Ancient Chinese recorded their texts on bones and sometimes on strips of bamboo.
Illnesses of the head, the sensory organs, the limbs, the intestines, the kidneys and
bladder were described. Infectious disease and epidemics also took up a lot of room on
the oracle bones. Magic and demonology also held sway. The most famous of all
Ancient Chinese doctors, Pien Ch‘io by name, lived during the time of the Chou dynasty,
between 500 and 600 BC. Tradition has it that he practiced his art while wandering about
the country. He was particularly experienced in the treatment of women‘s and children‘s
diseases. Pien Ch‘io is regarded as the author of the famous medical work Nan-ching. It
was he, too, who founded the extremely complicated old Chinese system of
sphygmology, according to which a doctor was supposed to be able to diagnose and
illness solely by the condition of the pulse. The classification of people who, in Pien
Ch‘io‘s view, cannot be treated, seems extremely shrewd and sensible. This includes,
among other, those vainglorious and arrogant people with whom no conversation is
possible, those who value their money more than they do their bodies, those who are
addicted to overeating and dissipation, and finally, those patients who believe more in
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magicians and enchanters than they do in doctors. Every general practitioner will
instantly recognize that these classifications are still completely valid today – two-and-a-
half thousand years later.
2. A surprisingly extensive number of drugs was used in Ancient Chinese medicine
according to a pharmacopoeia whose sources date from the second millennium BC. The
sea-grap (Ephedra) whose alkaloid, Ephedrine, is still in favour today as a treatment for
asthmas and allergies, was already in use during the third millennium BC against lung
diseases, coughs, repsiratoyr disorders and inflammation of the eyes. Of the numerous
other vegetable remedies, the most important are euphorbinum, aconite, clamus, shestnut,
aloe, angelica, wormwood, ginsing, vetch, bamboo, senna, clematis, spurge-laurel,
fennel, gentian, nutmeg, lotus, knot-grass, pomegranate, black alder, rhubarb, castor oil,
sage and ginger. Poppy juice was given to soothe crying children. Fresh blood and liver
were recommended in cases of anaemia. Under the Manchu or Tsing dynasty which
lasted from 1644 to 1912, Chinese mediince made little progress for, as a result of the
autopsy prohibition the most mistaken ideas about the anatomy of the human body
prevailed. Yet even before this, news of the great achievements in Western medicine had
penetrated to China, so that interest in Euro-American medical science grew steadily
keener. Furthermore, with the destruction of the monarchical/patriarchal system of
government on 12 February 1912, when the son of heaven abdicated his throne and the
Republic of China was established under Sun Yat-Sen, the founding of Western-style
medical schools began. Unlike the two types of civilization mentioned in the preceding
chapters, those of Mesopotamia and Egypt, the culture of Ancient Chinan and whith it her
medical science, still flourish, the Middle Kingdom now has two systems of medicine,
that founded on truly Chinese origins and the Western one. The present rulers intend that
both systems shall remain equally valid. In Peking there is an Institute of Ancient Chiens
and Modern medicine, whoever falls ill and is sent to hospital can himself decide, of his
own free will, whether to be treated by the old Chinese folk methods or in accordance
with Euro-American principles.
3. The primary concept of Traditional Chinese Medicine is that there are Yin and Yang:
Life Forces. Yin represents all that is dark, cool, negative, and feminine. Yang is
associated with light, warm, positive, and masculinity. These two forces sustain the
universe, and the human balance as well as the human is a microcosm of the universe
(macrocosm). ―If Yin and Yang are not in harmony, it is as though there were no autumn
opposite the spring, no winter opposite the summer. When yin and yang part from each
other, the strength of life wilts and the breath of life is extinguished. If such a body is
exposed to the dew and the wind, then colds and fever will set in…If yang is
predominant, then the body will grow hot; the pores close and the patient begins to
breather heavily and gasp for breath. Fever will arise; the palate will become dry; the
person becomes tense and irritable.‖ --from book, Nei Chin Su Wen
4. Five elements: fire, wood, earth, metal, and water are at the core of a network of
associated senses, forces, phases, anatomies, and states that correspond to one another.
These elements are all inter-related in a simultaneous sequence of regeneration and
consumption. They guides the physician in identifying body/mind energies and their
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representations in harmony of universal forces.Qi: a bodily life force that must be in
balance for good health. Yin and Yang forces may influence its path, direction, and
linkage with certain body organs. Qi is circulated by techniques of massage: using the
hands to press, rub, push, pull, knead, rotate, roll, or shake parts of the body. Pain after
injury is due to blockage of Qi. Applications of massage to free Qi relieves pain after
injury strengthens the circulation to favor the absorption of edema and relaxes the
muscles. Modern medicine utilizes Traditional Chinese medicine (TCM) including the
use of massage, herbal medicine, and acupuncture. In the Preventive model of medicine:
patients see practitioner of regular basis Recognizes the importance of physical,
nutritional, psychological, and spiritual factors in relationship to health: HOLISTIC. The
Practitioner of Chinese Medical Philosophy weaves a comprehensive picture of
patient/conditions (zhreng); diagnosis is used to find the bodily state of Qi.
C. Ayurveda is made up of two Sanskrit words: Ayu which means life and Veda which
means the knowledge of. Ayurveda is a wholistic system of medicine from India that uses
a constitutional model. Its aim is to provide guidance regarding food and lifestyle so that
healthy people can stay healthy and folks with health challenges can improve their health.
There are several aspects to Ayurveda that are quite unique: Its recommendations will
often be different for each person regarding which foods and which lifestyle they should
follow in order to be completely healthy. This is due to the use of a constitutional model.
Everything in Ayurveda is validated by observation, inquiry, direct examination and
knowledge derived from the ancient texts. It understands that there are energetic forces
that influence nature and human beings. These forces are called the Tridoshas. Because
Ayurveda sees a strong connection between the mind and the body, a huge amount of
information is available regarding this relationship. Ayurvedic procedure involves
questioning the patient, inspection, touch, examination. Pulse-taking: attributed to Indian
medicine: one of techniques applied to patient.
1. Two time periods in Indian History particularly contributed to the development of
contemporary medical practice the Vedic Age (until 800 BC) Brahmamic Age (800-1000
BC). Ayurvedic medicine-- ―the knowledge needed for longevity‖--emerges from the
Vedic age. Around 1500 B.C., Ayurveda was delineated into eight specific branches of
medicine. There were two main schools of Ayurveda at that time, Atreya- the school of
physicians; and Dhanvantari- the school of surgeons. These two schools made Ayurveda
a more scientifically verifiable and classifiable medical system. Swami Sada Shiva Tirtha
History of Ayurveda explains passages related to Ayurveda from the various Vedas were
compiled to make separate books, dealing only with Ayurveda. Among the Rik Veda‘s
10,572 hymns, are found discussions on organ transplants, and artificial limbs, the use of
herbs to heal the diseases of the mind and body and to foster longevity. Within the
Atharva Veda's 5,977 hymns, are discussions of anatomy, physiology and surgery. The
Brahmamic Age occurred after Indian was submitted to Islamic Rule and Arab doctors
had taken over practice. It was based on the caste of Hindu priests. There was a highly-
developed sense of hygiene in the Vedic and Brahmin science of medicine in ancient
India. Anatomy and surgery reached a higher level of development in Ancient Indian
than in other ancient civilizations. However with colonial intervention in the 1800s
1560
people abandoned the Ayervedic ―no open defecation laws‖ to develop slums at low cost
and cholera epidemics are common and the Ganges is source of the world‘s epidemics.
2. The Indus Valley civilization, according to most recent discoveries, reached its peak
around the year 2000 BC. The cities of that time, which were excavated after the Second
World War, bear witness to the surprisingly highly developed system of hygiene which
far surpasses any similar arrangements brought to light in Egypt and Mesopotamia. Tiled
drainage canals and drainpipes carried away waste water and excrement, magnificent
bathing establishments, whose swimming pools survived undamaged for four thousand
years, steam baths, changing and rest rooms, show the highly civilized level which had
been reached in those far-off times. About the middle of the twentieth century BC, the
Indus Valley kingdom, that thosuands of years earlier had anticipated so many of the
hygienic achievements or our own day,k began to decline. Light-skinned Indo-Germanic
invaders were responsible. They called themselves Hindu, and penetratd into the river
valleys of the Indus and Ganges. The Vedic era begins in about 1500 BC with the
intermingling of dark skinned inhabitants and light skinned invaders, and owes its name
to the Veda, the four holy Sanskrit books of the Indians, which represent the earliest
record of Indian literature to come down to us. The Veda are of special interest to the
history of medicine because, as the oldest Indian literary monuments, they transmit the
earliest information about the diseases of Ancient India and their medical treatment. We
encounter the view that disease is a punishment for sins committed and confession is a
healing measure.
3.Epidemic diseases such as malaria, bubonic plague, cholera, leprosy and smallpox play
an important part in the ancient texts. The Vedic books provide evidence of the existence
of a highly developed science of healing in Ancient India. The Vedicv doctors knew
about many healing herbs, they knew how to cauterize wounds and cases of snake-bite,
they used an instrument like a catheter to treat cases of urine retention and they even
constructed artificial limbs and eyes. A further text contains descriptions of tuberculosis,
rheumatism, arthritis, epilepsy, the swelling of elephantiasis, dropsy and numerous other
afflictions, as well as the plagues of tropical infections. The Vedic era of Indian meidicne
continued until about 800 BC. It was superseded by the Brahmin era, which was to last
until the end of the first millennium AD. This era is named aft erht e caste of wise men,
or Brahmins who determined the whole cultural trend and, with it, that of medical
science.
4.Brahma represented the ever-present, godlike, true and unchanging essence of all
things, the world-soul, this all-one essence was, above all, inherent in the priestly man,
the Brahmin. The doctors stood far below them. Below even the caste of warriors and
they were awarded none of the usual honours. Doctors were not trained in temples and
schools of priesthood but had to pass through regular years of apprenticeship. Such a
training, based on practical experience, necessarily meant that the science of healing was
predominantly organized on a rational basis. A student‘s apprenticeship lasted from his
twelfth to his eighteenth year during which time he had not only to read medical texts but
also to acquire practical experience in nursing, surgical treatment, visiting patients and
preparing medicines. Alexander the Great‘s expedition to India, between 327 and 325
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BC, created additional points of contact between India and Europe. During the first
centuries AD, medical knowledge in Ancient India attained glittering heights and the
position of doctor, which had once been so low, now acquired great prestige. Three
doctors stand out in particular: Charana, who lived at about the beginning of the Christian
era, Susruta, who practiced about five hundred years after Christ‘s birth,and Vaghbata,
who lived during the seventh century AD.
5.One principle highly regarded by the doctors of Ancient India was giving as much
attention to the prevention of illness as to its cure. Accordingly, certain diets prescribed
for various illnesses, breathing exercise, general cleanliness and brushing of teeth
recommended. However the rules of health did not just restrict themselves to the
physical plane, there was even a regular psychohygiene of rules of the health of the soul,
which rested on the modern premise that without peace of mind or inner harmony there
can be no true state of health. No fewer than 1,120 different diseases were known to the
Ancient Indian doctors. They were familiar with diabetes, which they recognized by the
sweet honey taste of the patient‘s urine. They pondered the causes of epidemics, in a
land of epidemics. They suspected that malaria was transmitted by mosquitoes, that food
contaminated by flies could bring about intestinal diseases, and they observed,quite
correctly, that the appearance of bubonic plague was always preceded by mass death of
rats. The great number of plants used for medicinal purposes is conspicuous in the
Ancient Indian system, where more than seven hundred different herbs were used. In
addition, there were also numerous medicines made from animal and mineral products,
quite extraordinary healing powers were ascribed to mercury. One of the healing plants
of Ancient India Rauwolfia serpentine, has acquired a high reputation in modern
medicine. Its askaloid, reerpin, was rediscovered as recently as 1949, as a successful
remedy for high blood pressure. The Ancient Indians also use this plant, which, because
of its crescent-shaped fruit, was called ‗moon plant‘ as a sedative in cases of anxiety.
This treatment experienced a remarkable resurrection in 1954 when it was realized that
reserpin could be used to alleviate many psychotic conditions.
6. The moral code governing the practice of the doctor‘s profession was exemplary, ―a
doctor must care for the curing of his patient with his whole heart even if his life should
be in jeopardy. He may not move too near another man‘s wife, even in thought, he may
not treat women unless their master or supervisor is present. In his clothing and general
outward appearance he must be simple and modest and he must keep himself free of bad
company. The extremely thorough and conscientious doctor‘s training ended with the
swearing of an oath which, in several respects, resembled Hippocrates, in fact to such an
extent that some people think the oath of the sage of Kios bears some kind of relationship
to that sworn by Ancient Indian doctors. Espcial mention was made of the doctor‘s
obligation to preservef silence about the patient‘s affaris and not to tell the patient if his
death was imminent, never to boast of his knowledge but tuse every opportunity to
extend his skills and during examinations, to preserve all the rules of decency, always to
be more solicitous for the patient‘s welfare than his own gain, the precepts remind one
strongly of the Hippocratic Oath. The establishment of hospitals took place about a
thousand years earlier in India than it did in the lands of the West. When the prophetism
of Gautama Buddha, who lived from about 560 to about 480 BC, a wave of religious
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fervor swept through India, hospitals were founded as a result of his teaching as they
were later, during the Middle Ages, to be found in Europe by the Christian orders.
Modern Western-oriented medical practices are only very gradually gaining a foothold
among the broader strata of people living in the Indian sub-continent.
D. Excavations prove, beyond all doubt, that there were doctors in this river valley
civilization of 2000 BC. The existence of an indigenous medical profession in
Mesopotamia is proved by the discovery of medical roll-seals containing descriptions of
healing divinities and medical instruments, which were found in the innumerable mounds
of potsherds excavated in Mesopotamia. The most important part of this medical text
was a collection of prescriptions, together with a list of drugs and chemical substances
which, in those days thousands of years ago, were used for medical purposes. All in all
the doctors of Ancient Mesopotamia recognized hundreds of medicinal plants of which
many are still in use today, as for example, opium poppy, mandragora, henbane, linseed,
licorice roots, myrrh, thyme, cassia, colocynth, asafetida, Indian hemp and belladonna.
These vegetable medicines were augmented by such minerals as alum, sulphur, saltpeter
and copper.
1. The first list of medical fees and punishments for malpractice is contained in the Codex
of Laws of King Hammurabi of Babylon known as the Hammurapi Code (2500BC). The
codex, which evidently incorporated most of the Ancient Sumerian body of ideas, then
more than a thousand years old, is chiseled in a cuneiform script approximately seven-
and-a-half feet high, into a block of diorite. Apart from the criminal and civil laws, the
laws regarding official duties, marriage and divorce, jurisdiction, farming trade and
shipping, it contains the oldest tariff of charges to survive, amongst which can be found
fixed fees for various services, including nine paragraphs devoted to medical fees These
do not merely deal with the fee which the medical practitioner received for work of one
kind or another, they also lay down the penalties fo rhte doctor‘s mistakes, and expressly
take into account whether the doctor had been treating a man with a metal knife for a
severe wound, and has cured the man, or has opened a man‘s tumour with a metal knife
and cured a man‘s eye, then he shall receive ten shekels of silver However, if he
performed the same operation on the son of a plebian, the doctor was paid five shekels
and if on a slave only two shekels. If a doctor has treated a man with a mental knife for a
severe wound, and has caused the man to die, or has opened a man‘ tumour with a mental
knife and destroyed the man‘s eye, his hands shall be cut off. The doctor was awarded
the same punishment if, as a result of an operation, the patient lost his eyesight. If a
doctor has treated the slave of a plebieian with a mental knife for a severe and caused him
to di, he shall render slave for slave. If he has opened his tumour with a metal knife, and
destroyed his eye, he shall pay half his price in silver. The treatment of broken limbs or
intestinal compaints cost five shekels for a master, three shekels for a plebian and two
shekels for a slave.
2. Most of the information available to modern scholars comes from cuneiform tablets.
There are no useful pictorial representations that have survived in ancient Mesopotamian
art, nor has a significant amount of skeletal material yet been analyzed. Unfortunately,
while an abundance of cuneiform tablets have survived from ancient Mesopotamia,
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relatively few are concerned with medical issues. Many of the tablets that do mention
medical practices have survived from the library of Asshurbanipal, the last great king of
Assyria. The library of Asshurbanipal was housed in the king's palace at Nineveh, and
when the palace was burned by invaders, around 20,000 clay tablets were baked (and
thereby preserved) by the great fire. In the early 1920's, the 660 medical tablets from the
library of Asshurbanipal were published by Cambell Thompson. Other medical texts have
been published more recently. For example, Franz Kocher has published a series of
volumes called Die Babylonishch-Assyrische Medizin. The first four of these contain 420
tablets found from sites other than Assurbanipal's library, including the library of a
medical practitioner (an asipu) from Neo-Assyrian Assur, as well as Middle Assyrian and
Middle Babylonian texts. The remaining two volumes of Kocher's work augment
Campbell Thompson, providing new joins of broken fragments and much material
uncovered in the British Museum. At least one more volume of Nineveh texts has been
announced. In addition, the series Spaet Babylonische Texte aus Uruk contains some 30
medical texts not included in Kocher's work. The vast majority of these tablets are
prescriptions, but there are a few series of tablets that contained entries that were directly
related to one another, and these have been labeled "treatises." The largest surviving such
medical treatise from ancient Mesopotamia is known as "Treatise of Medical Diagnosis
and Prognoses." The text of this treatise consists of 40 tablets collected and studied by the
French scholar R. Labat. Although the oldest surviving copy of this treatise dates to
around 1600 BCE, the information contained in the text is an amalgamation of several
centuries of Mesopotamian medical knowledge. The diagnostic treatise is organized in
head to toe order with separate subsections covering convulsive disorders, gynecology
and pediatrics.
3. By examining the surviving medical tablets it is clear that there is a historical
background for two distinct types of professional medical practitioners in ancient
Mesopotamia. When treating wounds the asu generally relied on three fundamental
techniques: (1) washing, (2) bandaging, and (3) making plasters and soaps. The first type
of practitioner was the ashipu, in older accounts of Mesopotamian medicine often called a
"sorcerer." One of the most important roles of the ashipu was to diagnose the ailment. In
the case of internal diseases, this most often meant that the ashipu determined which god
or demon was causing the illness. The ashipu also attempted to determine if the disease
was the result of some error or sin on the part of the patient. The ashipu could also
attempt to cure the patient by means of charms and spells, regimens, designed to entice
away or drive out the spirit causing the disease. The ashipu could also refer the patient to
a different type of healer called an asu. He was a specialist in herbal remedies, and in
older treatments of Mesopotamian medicine was frequently called "physician" because he
dealt in what were often classifiable as empirical applications of medication.
4. The majority of health care was provided at the patient's own house, with the family
acting as care givers in whatever capacity their lay knowledge afforded them. Outside of
the home, other important sites for religious healing were nearby rivers. The
Mesopotamian believed that the rivers had the power to care away evil substances and
forces that were causing the illness. Sometimes a small hut was set up for the afflicted
person either near the home or the river to aid in the family centralized home health care.
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Herodotus (born 490 BC) visited Babylon, and set down his impressions for posterity.
He wrote, having no use for physicians, they carry the sick into the marketplace, then
those who have been afflicted themselves by the same ill as the sick man‘s, or seen others
in like case, come near and advise him about his disease and comfort him, telling him by
what means they have themselves recovered of it or seen others so recover. None may
pass by the sick man without speaking and asking what is his sickness. Herodotus was
however prone to exaggeration.
5. The Ancient Mesopotamians also knew how to make a kind of soap thousands of years
before soap factories were thought of in the civilized countries of Europe. Ashes of
plants noted for their soda content were mixed with fats and the result was an ointment of
a soapy nature. When in about the thirteenth century BC, the Assyrian kingdom gained
supremacy in the land between the two rivers, surprisingly modern ideas and a sometimes
quite remarkable gift for observation turned up in Mesopotamian medicine. Assyrian
doctors knew there was a connection between some general illnesses and some dental
disease, that the appearance of plague was preceded by a mass-death of rats, they
suspected the connection between mosquitoes and several different kinds of fever, and
even the infrequent appearance of oriental boils, whose virus is transmitted by flies,
established the belief that the flies were identified with harmful demons. The doctors
also knew the clinical aspects of tuberculosis, pellagra, pneumonia, jaundice,
inflammation of the gastric mucosa, intestinal obstructions, strokes, abscesses of the
middle ear, lithiases and urogenital diseases. They knew, too, that cancer of the breast
was a destructive illness. Mesopotamian doctors certainly carried out operations for
cataract using bronze needles as long ago as 2000 BC. Catheters have also been found.
Most surprising of all seems the extensive pharmacopoeia. Enemas, suppositories and
advice on diets completed the medical panoply. In addition to a mass of demon-worship,
magic and enchantment, those ancient practitioners also developed thoroughly rational
methods of treating illness.
D. The curtain first rises on the history of Ancient Egypt in 3400 BC when King Menes
united the two kingdoms of Upper and Lower Egypt and founded the fortified town of
Memphis where they met. Memphis was to become one of the most famous
distinguished and populated cities of the ancient world. Memphis reached its peak as the
political center of Egypt during the period of the Old Kingdom, which dates from about
2980 to 2475 BCV Pharaoh Zoser was born in this city of the white walls, not
surprisingly he ordered that his tomb, the stepped pyramid, should be erected not far from
his birthplace. The man whom he commissioned to build it in about 2800 BC must have
been an all-round genius by our standards, he was an architect, a versatile scholar, poet,
artist, astronomer, priest, master of ceremonies, administrator, reader to the king and
doctor. His name, Imhotep, means literally ―giver of inner peace‖. Imhotep is the first
doctor figure to emerge in clear outline from the shadows of history, what history tells us
about hi establishes him as one of the most model members of his profession. He
combined wisdom and constant helpfulness with kindness of heart, the great value which
the Pharaoh and his people placed on him outlasted his lifetime and caused Zoser to have
his gifted vizier buried near his own tomb in the necropolis of Memphis. However, the
people venerated him so much that a temple was built over his grave and, year after year,
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the sick came on pilgrimage to be cured. As time went on, Imhotep came to be regarded
as a god, this doctor, who had shown in his work such a perfect combination of wisdom
and humanity, became the Ancient Egyptian‘s god of healing almost two thousand five
hundred years before the birth of the great Hippocrates of Greece.
1.Arthritis was an extremely common complaint. Most surprising of all, is probably the
fact that paradentosis, tooth-root decay, which we life to blame on modern processed
food, was common throughout the pyramid era, that is to say, during the first half of the
third millennium BC. In addition, according to American Egyptologists who have
examined thousands of skulls, caries were just as common during the early days of the
Nile Valley civilization as they are today. Arteriosclerosis is most frequentl discovered in
mummies of high officials and those of the Pharaohs themselves. Tutankhamen and
Remases V both died of a heart infection, as the English doctor, Peter Gray, was able to
establish when he examined X-rays of the mummies of these two Pharaohs. Stomach and
intestinal troubles, appendicitis, gall-stones and kidney stones were not uncommon, the
worst toll, however was exacted by the infectious diseases, especially among the poorer
sections of the community living in primitive conditions, plague and cholera, smallpox
and leprosy, typhus and amoebic dysentery, malaria, tuberculosis and not least, that
Egyptian eye disease, caused by a virus trachoma, which so often led to blindness.
Particularly widespread, and especially prevalent among farm workers was the parasitic
disease, schistomiasis haemoatobium, which produces a tormenting type of nettle rash,
pelvic pains, haematuria, stones, anaemia and general physical decline. The kidneys of
some mummies have been found to contain the calcified eggs of the parasite that causes
this disease.
2. Herodotus, the Greek historian, made the following report based on personal
observation of the habits and way of life of the Egyptians. ―The practice of medicine is
so divided among them, that each physician is a healer of one disease and no more. All
the country is full of physicians, some of the eye, some of the teeth, some of what
pertains to the belly and some of the hidden diseases‖. One of the most instructive
papyrus scrolls, one of the oldest known handbooks of Egyptian medicine is the Edwin
Smith papyrus. This scroll, which was found in a grave near Luxor in 1862, is a copy
which was probably made during the middle of the sixteenth century BC, Egyptologists
assumed however that the original dates back to the time of the pyramids, between 3000
and 2500 BC. This papyrus discusses all the measures that were taken in the care of
injuries thousands of years ago, the treatment of wounds by sutures and plasters, the
placing of broken bones into splints made from hollowed-out ox bones, supporting straps
made of bandages soaked in quick-setting resin, the laying of flesh on wounds
cauterization and many other methods of treatment. On the other hand, the knife, is not
mentioned, therapy was conservative. Their knowledge of the skeleton was good but that
of the internal organs, despite the practice of embalming, was deficient.
3.. Ancient Egyptican medicine came to light when the Kahun Papyrus was discovered
by Flinders Petrie in April of 1889 at the Fayum site of Lahun. The town itself flourished
during the Middle Kingdom, principally under the reign of Amenenhat II and his
immediate successor. The papyrus is dated to this period by a note on the recto which
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states the date as being the 29th year of the reign of Amenenhat III (c. 1825 B.C.E.). The
text was published in facsimile, with hieroglyphic transcription and translation into
English, by Griffith in 1898, and is now housed in the University College London. The
Ebers papyrus, bought by George Ebers, in 1873 from an Arab in Luxor and which, in the
opinion of Egyptologists was written, at the latest around 1555 BC, once again, a copy of
various older texts. Surgery, the science of the internal organs and the science of
medicines, are dealt with and it is just as amazing to observe that almost nine hundred
medical prescriptions existed as it is to find that many of the medical substances are still
in everyday use. Fennel, senna leaves, castor oil, gentian, mandragora, mandrake,
henbane, hemlock, squill, thorn-apple, poppy juice (for soothing crying children) and
countless other drugs. Among animal substances still in the modern pharmacopocia,
were Spanish fly (Cantharides) and both goat and goose fat. Among the minerals used in
making up the many prescriptions were magnesium, lead and copper salts, sulphur,
crushed alabaster and antimony, compounds of which were considered until quite
recently to be the best remedies for worms. 39 Here again we have evidence of
surprisingly advanced and rational methods of treatment overlapping a confused mass of
demonology, magic and invocations to produce a strange amalgam in Ancient Egyptian
medicine. Three-and-a-half thousand years ago, the compiler of the Edwin Smith
papyrus described the relationship between the two in the following surprisingly sensible
words, Magic spells complement the effect of medicines and medicines on the other
hand, support the effect of incantations. That is a tenet which mutatis mutandis is still
completely valid in medical practice today.
4. Of the three main species of the platyhelminth worm Schistosoma, the most important
for Egypt are S. mansoni and S. haematobium. There is a complex life cycle alternating
between two hosts, humans and the fresh water snail of the genus Bulinus. The infection
is caught by humans who come into contact with the free swimming worm which the
snail releases in the water. The worm penetrates the intact skin and enters the veins of the
human host. The main symptom of the presence of the parasite is haematuria which
results in serious anemia, loss of appetite, urinary infection, and loss of resistance to other
diseases. There may also be interference with liver functions. One of the finest
archaeological examples for the existence of schistosomiasis in ancient Egypt was the
discovery of calcified ova in the unembalmed 21st Dynasty mummy of Nakht. Upon
medical examination, the mummy not only exhibited a preserved tapeworm, but also ova
of the Schistosoma haematobium and displayed changes in the liver resulting from a
schistosomal infection.
F. The hygienic conditions in the capital of the Aztec, Tenochtitlan, later to be known as
Mexico City, were found to be far superior to those in contemporary towns of the Old
World. Steam and sweating baths served for the treatment rheumatism, a great number of
medicines were stored ready for use in the pharmacies, the list of drugs used by the
Aztecs was immense, they knew no less than 1,200 medical plants of which several, such
as the sarsaparilla root and Chenopodium-wormseed oil, have maintained their medicinal
use to his day. The Ancient Aztecs used the powdered leaves of the tobacco plant as a
specific against various kinds of disease as well as for enjoyment. There is no collection
of medicines in any other ancient civilization which contains quite so many narcotic and
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intoxicating drugs as that of the Ancient Mexicans. Of these magic drugs, which were
used by the ancient inhabitants of the Aztec lands to induce states of trance, three have
become most widely known, the peyotl cactus, the nanakatk fungus and the seed from a
species of bindweed called oluiliuqui. A less dangerous endowment made by the Aztecs
to the Old World was the cocoa bean.
1.Aztec doctors used enema syringes made of rubber, and prepared cantharides plasters
from the juice of the rubber tree. The specialization of doctors appears to have been as
extensive as that of the Ancient Egyptians. There were specialists for eyes, dentists,
specialists in phlebotomy, intestinal and bladder complaints, as well as surgeons who
treated wounds by sewing them up with human hair, set broken bones, plated fractures
and carried out caesarian sections. Dietary prescriptions and physical therapy were
widespread and hospitals were available for clinical treatment. The Aztecs had penetrated
from the north only about four centuries before the Spanish invasion and barbarians
themselves, had taken over the civilization they found there, a civilization
which,stretched back in part to the middle of the second millennium BC, and whose
origins are to be found among the Olmeks on the coast of the gulf of Mexico.
2. The Mayan chronology begins with 3113 BC by our own method of reckoning.
According to the ancvient pirctograms, especially those of the Tizmin chronicle, which
have now been completely deciphered, an epidemic of yellow fever raged among the
Maya people two centuries and it was so virulent that the greater part of the population,
especially the upper stratum died of the plague. The fluctuating waves of yellow fever
had already been weakening the ancient high civilization for almost a century and as they
marched into the interior, the Spaniards could not but marvel at the many towns full of
monumental ruins which ahd already been largely reclaimed by the jungle. Houses hae
been found which once served as steam baths, containing hot and cold rooms, and one
has every right to assume that apeople who had such excellent hygienic arrangements at
their disposal would also possess a high standard of medical knowledge. However, here
we can only rely on guesswork for, by order of the third bishop of Yucatan, Diego de
Landa, in the year 1562, all the historical books of the Maya were publicly burnt as works
of the devil and as a result, the sole, irreplaceable source material about he early period of
Maya civilization was destroyed for ever. Only a few scanty fragments, which can
scarcely be said to deal with the Maya medical science, miraculously escaped the general
conflagration and later turned up in Spain. They are now in Dresden, Paris, and Madrid.
3.The doctors of Ancient Peru also had a considerable knowledge of drugs. Balsam of
Peru or copaiba, which is obtained form the balsam tree (myroxylon) is still in use today
as is cocaine, the alkaloid derived from the leaves of the coca bush. The medical
knowledge of Ancient Peru was unquestionably superior to that of the Aztecs in the
realms of surery. Amputations were performed and artificial limbs made ending in a
hollow wooden cylinder to accommodate the stump. The incas were also active in
obstetrics, they removed tumours surgically and carried out trepanations in large numbers
in accordance with the most diverse, far-reaching methods, at first with knives made of
obsidian and later with copper and bronze instruments. Skulls that have been found
clearly show that a considerable percentage of the trepanations healed successfully. The
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extent to which the Incas carried out a system of public health welfare is really
astonishing and seems modern in the best sense of the world. Once a year, a big festical
of health took place, in the course of which a thorough cleaning of all houses and
dwellings was undertaken. Care for old people, no longer capable of work, was highly
developed. Attempts were made to offer thema suitable occupation and the State was
responsible for their keep. The State also looked after the lame, crippled and deformed
citizens, and the fact that they were forbidden to marry seems a form of guided natural
selection. Their extraordinary perspicacity is borne out by the fact that they undertook
forceful measures to prevent the misuse of medicines and also knew how to discourage
drug addiction. But in spite of all progress in rational healing processes and outstanding
hygienic conditions, the doctors of Ancient Peru did not abandon the god and demon
worship, the magic diseases and invocation of spirits which were also so much a part of
their medical practice. The inhabitants of the Inca kingdom, as their predecessors had
done before them, kept alive the belief that the cause of an illness could be found in the
sins of the patient.
G. what none of the ancient civilizations had succeeded in doing, neither the Egyptian,
the Mesopotamian, the Chinese and Indian nor the pre-Columbian American, was the
separation of medicine from god and demon-worship, invocations, sorcery, magic or
expiatory sacrifice, the Greeks, a comparatively small nation in the Eastern
Mediterranean managed to achieve. This decisive break was made more than two-and-a-
half thousand years ago. The new attitude had its roots in the Trojan was which ended in
the destruction of Troy, in the year 1184 BC, made no use at all of magic spells and
incantations. Instead, the Homeric doctors were practical men, they were appointed as
military surgeons, soldiers and doctors in one. Their chief function was the care of war
wounds. During the following centuries, philosophical thought was centered among the
Greeks who had settled on the coast of Asia Minor and its off-shore islands. Schools of
pupils and disciples grew up round an outstanding philosopher. The founders and leaders
of these intellectual communities were generally also doctors. Philosophy and medicine
influenced each other more than ever before and resulted in a synthesis which ahs not
changed to this day. These men ruled out all though to magic in their search for truth,
they sought to establish the fundamental principles of natural science such as space,
matter, time motion, life etc. by exploring these subjects with a critical mind. A gigantic
revolution in human though divides them from the rest, a thirst for knowledge an innate
struggle for reason, were the peculiarities of this new human mentality. It was in Ancient
Greece that the search for knowledge freed itself from magic or priestly ties for the first
time. It was here that people first began to reflect on the harmony of the world and the
purpose of existence, here that they began to observe nature and themselves, trying to
understand man in all his aspects, who, after all, is himself no more than a part of nature.
1.The oldest schools of philosophy and medicine was situated on the periphery of the
Magna Graecia of those days. It was built about 700 BC in Cnidus on the far, outjutting
point of Cnidian Chersonese on the south-west coast of Asia Minor, north of Rhodes.
According to tradition it seems that diagnosis played a leading part. Treatment was
concentrated more on the area where the patient‘s pain was felt rather than on the whole
of his body. During the sixth century BC the Greeks founded a medical school at Cos,
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one of the Dodecanese Islands off the south-west coast of Asia Minor. This school
acquired immortal fame because of the idealized image of the doctor who taught there,
Hippocrates. Another medical school grew up in Croton on the Gulf of Tarentum. The
names of two of the Greek doctors who taught at this school have remained with us, they
are Democedes and Alcmaeon. Democedes, who travelled all over the then known Greek
world, practised his profession during his travels, from Alcmaeon, who was convinced
that without a knowledge of the human body an efficient medical science would be
impossible, stems the first Greek textbook on anatomy. Alcmaeon expressed the
thoroughly advanced view that illness is brought about as a result of an imbalance
between the different components of the human body. According to the teachings of
Empedocles, a native of Agrigento on the south coast of Sicily, these body components
apparently consisted of the body liquids, blood, mucous, yellow gall and black gall, their
places of origin being, it was thought, the heart, the brain, the liver and the spleen. 69-70
Democritus of Abdera was born about 460 BC in Thrace. From Democritus stems the
theory of atoms, according to which a multitude of tiny, indivisible particles spins about
in space and so brings forth matter. Democratus did not confine himself to philosophy,
ethics, and poetry, he was also a doctor, as is evidenced by a saying his which is so apt
today, ― Men pray to their gods for health, they do not realize that they have control over
it themselves. They jeopardize it by their excesses and so their greed makes them
traitors to their health. The great humanity of Democritus‘ philosophy is confirmed by his
conviction that the best kind of happiness was one which derived from a cheerful
disposition.
2. When Aristophanes was born, Hippocrates was just ten years old. He was destined to
become the idealized image of a doctor of all time, and the sobriquet ‗the great‘ was not
added to his name at some later date, Aristotle had already called him this. Galen
describes his as the godly. The Middle Ages turned him into the father of Medicine, for
what has been discovered today about the medical sciences of the older civilizations was
totally unknown at that time. Even though we ourselves no longer believes that medical
science began with Hippocrates, we cannot help but commend his outstanding new
conception of the truth ethics of medicine which has remained valid to this day.
Hippocrates was born about 460 BC, the son of the doctor Heraclides. His mother,
Phainarete, was a descendant of the family of Aesculapius, one of the noble families of
Cos, whose ancestral line, which went back to the sixth century BC, was said to descend
from the god of healing himself. In ancient times, Hippocrates was already thought the
greatest doctor of all times, the father of doctors, in fact the classical originator of
medical science. He received his initial training from his father, and counted Herodicos,
the Sophist gorgias, and the philosopher Democritus of Abdera, among his later teachers.
He was born in a brilliant era. Socrates was pronouncing his philosophy, Thucydides was
at work on his histories, Sophocles was thrilling audiences with his trageides, Praxiteles
was creating his unique masterpieces of sculpture and Preicles was practicing his brilliant
statesmanship.
3.Hippocrates practiced his profession on countless journeys through Hellas and the cures
which he achieved soon caused him to become the most famous doctor in his own
country, and one who was constantly called in when all other help had failed. He spent
1570
some time Chizikos on the Propontis, also in Meliboia and Abdera in Thrace. He visited
the island of Thasos and according to tradition, perhaps even travelled to southern Russia,
Egypt and Kyrenia. In 429 BC he was in Athens fighting the plague which claimed
Pericles among its victims and he spent the last days of a life rich in fulfillment and
blessings in Thessalian Larissa, where he died in 377 BC. He was concerned not just to
treat a sick organ, but with the whole patient, his attention was always fixedo nthe
general condition, the toality of the sick man. The human body is a circle, of which each
part may be esteemed as both the beginning and the end, of the knowledge of their parts,
their sympathy and communication. By the affection of one part, the whole body may
become affected. The writings of Hippocrates and Galen present a genuinely warm
humanitarian attitude as the fundamental basis on which his healing activities were built.
He maintained that the chief aim of treatment was to draw observation of nature, the
constitution and circumstances of life into the field of examination in support of the
natural healing processes. Hippocrates greatest contribution was his belief in the ethics
governing the practice of medicine, as expressed by the Oath.
4.It is not certain whther Hippocrates himself left any written work to posterity, of the
seventy-two books which were written between 480 and 380 BC and assembled in
Alexandria under the title, Corpus Hippocraticus, during the third century BC. The book
The Sacred Disease (De Morbum Sacrum) confirms most unequivocally the total
separation of Hippocratic medicine from any involvement with magic. It begins by
saying in a downright authoritative way, I am about to discuss the disease called sacred.
It is not, in my opinion, any more divine or more sacred than other diseases, but has a
natural cause, and its supposed divine origin is due to men‘s inexperience, and to their
wonder at its peculiar character. 76 The Corups Hippocraticus deals with different
branches of medicine. One book entitled About Air, Water and Places was on medical
climatology. The About the Nature of Man describes the theory of body liquids in utmost
detail. The theory was based on the existence of four cardinal fluids: blood, mucous,
yellow gall and black gall. Moreover blood represented the warm-damp principle,
mucous the cold-damp, yellow gall the arm-dry and black gall the cold-dry principle.
Other fluids were the intestinal juices, lymph and semen.. Illness was the result of a
wrong mixture of the liquids of dykrasy; health on the other hand, depended on the
correct blending of the liquids, or eukrasy, as a result of which the harmony of an
organism wasw guaranteed. The book Prognosticon evidently comes from Hippocrates
himself. It demonstrates a very sharp talent for observation and by means of accurately
described symptoms, explains the prognoses which palyed an important role in
Hippocratic medicine. A feature common to all books, in spite of some contradictions, is
that they are al imbued with the Hippocratic spirit and put professional ethics before all
other medical vitues. This attitude is expressed most forcibly in the Law and the Doctor.
5.It was thought that food alone would not achieve health, many other things had to be
added, gymnastics, strengthening exercises, baths, massage, the use of light, air and
water, breathing exercises, voice exercises and may more things besides. Finally, it was
believed that every case demanded its own special diet. High standards of professional
ethics can be found in the medical sciences of much older civilizations and much higher
levels of treatment by medicines of surgery and hygiene can sometimes be found
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thousands of years before Hippocrates. It is important to help, or at least not to harm, to
undertake nothing useless, but also not to overlook anything. A short time after
Hippcrates death, during the fourth century BC, a doctor became famous who, by his
research and knowledge, demonstrates that interest in anatomy was beginning to become
more and more active. Diocles was a known in Athens as a second Hippocrates. He was
a much-travelled man. He wrote sixteen books, but, though all the titles are known, of
the texts only fragments remain. One of them deals with anatomy, medical plants and
poisons. What he wrote about a healthy way of life has come down to us intact and
deserves full attention even today, two thousand three hundred years later: Rise before
sun-up. Wash the face and head. Tooth-care – whereby gums and teeth should be
carefully rubbed with peppermint powder. Rub oil into the whole body. Then take a
little walk before starting work. At midday visit the gymnasium and perform physical
exercise. Then have a bath and massage. Breakfast is understandably plain: bread, a
light porridge with vegetables, cucumbers or similar vegetables, depending on the season,
everything being prepared simply. Quench the thirst with water before eating. After the
meal, drink white wine mixed with water and a little honey. After breakfast, during the
midday heat, come sth siesta, in a cool shady spot free from draught, as in all southern
countries. Then back to work and later another visit to the gymnasium. In summer, the
main meal takes place during the evening shortly before sunset. It consists of fruit,
vegetables, bread and fish or meat. The day ends with a short walk and bed sought early.
§398 Active Aging
A.People are living longer and, in some parts of the world, healthier lives. This represents
one of the crowning achievements of the last century but also a significant challenge.
The U.S. National Institute on Aging predicts a very large increase in disability caused by
increases in age-related chronic disease in all regions of the world (e.g., cardiovascular
disease, dementia and Alzheimer‘s disease, cancer, arthritis, and diabetes) than from
infectious diseases, childhood diseases, and accidents. In 2006, almost 500 million
people worldwide were 65 and older. By 2030, that total is projected to increase to 1
billion—1 in every 8 of the earth‘s inhabitants. Significantly, the most rapid increases in
the 65-and-older population are occurring in developing countries, which will see a jump
of 140 percent by 2030. This figure is expected to double by 2050 which will lead to
increasing demands on health and social-service systems worldwide. In Stengthening
Active and Healthy Aging WHA58.16 WHO defines active ageing as ―the process of
optimizing opportunities for health, participation and security in order to enhance quality
of life as people age‖.
1. The overall population is aging. For the first time in history, and probably for the rest
of human history, people age 65 and over will outnumber children under age 5. Life
expectancy is increasing. Most countries, including developing countries, show a steady
increase in longevity over time, which raises the question of how much further life
expectancy will increase. The number of oldest old is rising. People age 85 and over are
now the fastest growing portion of many national populations. Family structures are
changing. As people live longer and have fewer children, family structures are
transformed, leaving older people with fewer options for care. Patterns of work and
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retirement are shifting. Shrinking ratios of workers to pensioners and people spending a
larger portion of their lives in retirement increasingly strain existing health and pension
systems. Social insurance systems are evolving. As social insurance expenditures
escalate, an increasing number of countries are evaluating the sustainability of these
systems. New economic challenges are emerging. Population aging will have dramatic
effects on social entitlement programs, labor supply, trade, and savings around the globe
and may demand new fiscal approaches to accommodate a changing world.
2. The overall objective of health is to promote well being and ultimately lengthen life.
In the time of King David, BC 1037-967, when people obeyed strict dietary and hygienic
laws and alms and wisdom flowed freely, regulated by written Psalms, the bible states,
―the days of our lives are 70 yrs, and by reason and strength 80, yet they boast only of
labor and sorrow‖(Psalm 90-10). For most of history humanity was not so wisely ruled
and life expectancy was between 25-50 years. Primarily as the result of improvements in
water purity and sewage treatment, but also because of technological advancements in
medical treatment, pharmaceutical drugs and government regulation between 1900 and
2000, life expectancy at birth in the United States increased from 47 to 77 years. Life
expectancy for people aged 65 increased more than 6 years during the twentieth century,
in 2002 a 65 year old American woman could expect to live almost 20 more years and a
moan additional 16.6 years.
3. In 1900, one third of all deaths in the United States were attributed to three major
categories of infectious disease: pneumonia and influenza, tuberculosis, and diarrheal
diseases and enteritis. Many additional deaths were caused by typhoid, menningococcal
meningitis, scarlet fever, whooping cough, diphtheria, dysentery, and measles.
Altogether, common infectious diseases accounted for 40% of all deaths in 1900 but they
accounted for only 4% of all deaths in 2000. Cardiovascular disease (CVD; heart disease
and stroke) accounted for 14% of all deaths in 1900 and for 37% in 2000. Cancer
accounted for only 4% of all deaths in 1900 but for 23% in 2000. In 1900, infant
mortality was 162 per 1,000 live births and life expectancy at birth was only 47 years. In
1940, infant mortality was 63 per 1,000 live births and life expectancy was 55 years. In
2000, infant mortality was 7 per 1,000 and life expectancy was 77 years. As a result of
these changes in mortality, and of reduced birth rates, the population of the US is aging.
In 1900, only 18% of US residents were age 45 or older. In 1940, 28% were age 45 or
older and in 2000, 34% were age 45 or older.
Fig. 9-46 Infant Mortality and Life Expectancy in the United States, 1900-2000
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Source: Montana Cancer Control Section. Quarterly Surveillance Report. October 2006
4.The United States is by no means the world leader in longevity. For life expectancy at
birth, it is ranked twenty fourth among males and twenty first among females, behind
Japan and most Western European countries. The oldest person in the world is however
often an American. In terms of life expectancy at age sixty-five the United States ranks
thirteenth for males and fourteenth for females, once again trailing Japan and Western
Europe. Counting smaller countries, the United States continues to lag behind at least 40
other nations. Andorra, a tiny country in the Pyrenees mountains between France and
Spain, has the longest life expectancy, at 83.5 years, according to the U.S. Census
Bureau. Most of recent progress in life expectancy is attributed to the public becoming
increasingly aware of the impact of smoking, excessive drinking, uncontrolled
hypertension, lack of exercise and poor diet on the incidence of disease and injury.
5.Never before have so many people lived to a healthy old age. In 1900 there were about
3 million people aged sixty-five and over in the United States, making up 4.1 percent of
the population. By 1963 the number had grown to 17.5 million; and one could
reasonably expect to survive to old age. In 2000 about 35 million citizens were aged
sixty-five or over, constituting 12.5 percent of the population. By 2030, this age group
will account for about 70 million people, or 20 percent of the population. Life
expectancy at age sixty-five is now seventeen years, five years longer than at the turn of
the century. Many sixty-five year olds remain physically and mentally active and capable
of contributing to society on many levels. Those over age eighty-five, known as the
oldest old, are the fastest growing segment of the population. In 1900, they accounted for
only 4 percent of all people over age sixty-five. Now that figure is 12 percent and
growing, it is expected to triple by 2040 to 14.3 million. Now that figure is 12 percent
and growing, it is expected to triple by 2040 to 14.3 million. Even living to one hundred
is no longer a rarity. In 1950 there were roughly 3,000 centenarians in the United States.
In 2000 centenarians on the rolls of the Social Security Administration numbered about
65,000. In 2010, estimates put the number at well over 100,000, perhaps as high as
200,000. In fifty years the figure may approach 1 million. Some authorities talk
seriously of life expectancies of 110 or 120 years (Cassel 2005).
6. The life expectancy for Americans was nearly 78 years in 2005, the longest in U.S.
history. That age, based on the latest data available, was still lower than the life span in
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more than three dozen other countries, however. The annual number of U.S. deaths rose
from 2,397,616 in 2004 to 2,447,910 in 2005, a depressing uptick after the figure had
dropped by 50,000, 2 percent, from 2003 to 2004, the biggest decline in nearly 70 years.
On the other hand, the age-adjusted death rate reached a record low of 798.8 deaths per
100,000 U.S. standard population. This value is 0.2 percent lower than the 2004 rate of
800.8 deaths per 100,000 U.S. standard population. In 2005, the number of deaths
increased by about that same amount. U.S. life expectancy at birth inched up to 77.9 from
the previous record, 77.8, recorded for 2004.
B. The United Nations' International Day of Older Persons is celebrated annually on
October 1 to recognize the contributions of older persons and to examine issues that
affect their lives. The follow up to the Second World Assembly on Ageing of 2 February
2006 endorses the Political Declaration and the Madrid International Plan of Action on
Ageing, 2002 that calls for ―Age-friendly‖ primary health care to be the focus of geriatric
care. Member States are urged:
1.To develop, implement and evaluate policies and programmes that promote healthy and
active ageing and the highest attainable standard of health and well-being for their older
citizens;
2.To consider the situation of older persons as an integral part of their efforts to achieve
the internationally agreed development goals of the United Nations Millennium
Declaration, and to mobilize political will and financial resources for that purpose;
3.To take measures to ensure that gender-sensitive health policies, plans and programmes
recognize and address the rights and comprehensive health, social-service and
development needs of older women and men, with special attention to the socially
excluded, older persons with disabilities, and those unable to meet their basic needs;
4.To take steps and encourage measures to ensure that resources are made available for
persons or legal entities who take care of older persons;
5.To pay special attention to the key role that older persons, especially older women, play
as caregivers in their families and the community, and particularly the burdens placed on
them by the HIV/AIDS pandemic;
6.To consider establishing an appropriate legal framework, to enforce legislation and to
strengthen legal efforts and community initiatives designed to eliminate economic,
physical and mental elder abuse;
7.To develop, use and maintain systems to provide data, throughout the life-course,
disaggregated by age and sex, on intersectoral determinants of health and health status in
order to underpin the planning, implementation, monitoring and evaluation of evidence-
based healthpolicy interventions relevant to older persons; and
8.To undertake education and recruitment measures and incentives, in order to ensure
sufficient health personnel and volunteers to meet the needs of older persons.
1575
C. The cost of elder care in the US is estimated at $11.4 billion to $29 billion annually.
Between 2010 and 2030 the size of the 65+ population will grow by more than 75%
while the population paying payroll taxes will rise less than 5%. During the 20th Century,
the number of American whoa re 65+ has increase eleven fold, from 3 million to 33
million. According to the US Census Bureau by 2035 some 70 million people will be age
65 or over.
1. The American Association of Retired People (AARP) is headquartered in Washington
DC and describes its mission as the improvement of every aspect of living for older
people. The AARP has 32 million members, a staff of 1,700, a 32 scholar think tank, 19
staff lobbyists, and annual budget of approximately $550 million and tens of thousands of
enthusiastic volunteers in communities across the country. AARP is the worlds second
largest nonprofit organization after the Catholic Church
2. According the Ken Dychwald the highly respected author of Age Wave reviewed HA-
14-4-05. The elderly in the US are a very influential group who, (a) control more than $7
trillion wealth-70% of total, (b) own 77% of all financial assets, (c) comprise 66% of all
stockholders, (d) own 40% of all mutual funds ($1 trillion), (e) own almost 60% of all
annuities, (f) represent 50% of IRA and Keogh account holders, (g) 79% own their own
homes the highest ration of any age group, (h) own 46% of home equity loans, (i) transact
more than 5 million auto loans each year, (j) purchase 42% of all homeowner‘s insurance
(50 million policyholders), (k) own 38% of all life insurance a $90 billion industry, (l)
purchase more than 90% of long term care insurance representing $800 million annual
premiums (a figure that grow at 23% every year), (m) comprise 35% of the author
insurance market (50 million consumers), (n) represent 40 million credit card users,
owning almost half of the credit cards in the US, (o) purchase 41% of all new cars and
48% of all luxury cars totaling more than $60 billion, (p) represent more than $610
billion per year in direct health spending, (q) Account for 51% of all over the counter
drug purchases, (r) consume 74% of all prescription drugs, a $103 billion market, (s)
represent 65% of all hospital bed days, 42% of all physician office visits, 1.5 million
residents in nursing homes and 1.5 million residents in continuing care retirement and
assisted living residences, (t) Nearly 70% of of American 65 and over voted in 1996
compared with only 33% between the ages of 18 and 24, (q) The elderly voted 60%
democratic and 40% republican in 1996 and tend to vote as bloc.
D. Living to 100 is easier than one might think. Surprising new research suggests that
even people who develop heart disease or diabetes late in life have a decent shot at
reaching the century mark. In Hall‘s study, Boston University researchers did phone
interviews and health assessments of more than 500 women and 200 men who had
reached 100. They found that roughly two-thirds of them had avoided significant age-
related ailments. But the rest, dubbed "survivors," had developed an age-related disease
before reaching 85, including high blood pressure, heart disease or diabetes. Yet many
functioned remarkably well - nearly as well as their disease-free peers. Overall, the men
were functioning better than the women. Nearly three-fourths of the male survivors could
bathe and dress themselves, while only about one-third of the women could. The
researchers think that may be because the men had to be in exceptional condition to reach
1576
100. Women, on the other hand, may be better physically and socially adept at living with
chronic and often disabling conditions.
1.One centenarian recommended, ―Life beautifully, don't take any medicines, don't
smoke and don't drink. Never do anything like that."
§399 Diet, Exercise and Hygiene
A.The Global Strategy on Diet, Physical Activity and Health 2003 reports that chronic
diseases are now the major cause of death and disability worldwide. Noncommunicable
conditions, including cardiovascular diseases (CVD), diabetes, obesity, cancer and
respiratory diseases, now account for 59% of the 56.5 million deaths annually and 45.9%
of the global burden of disease. Half of the 17 million deaths resulting from chronic
disease were from (CVD). Relatively few risk factors – high cholesterol, high blood
pressure, obesity, smoking and alcohol – cause the majority of the chronic disease
burden. Conversely, relatively few factors benefit a person‘s health and longevity – a
balanced diet, exercise, and freedom from stress and exposure to toxins such as cigarette
smoke or malevolently distributed laboratory supplies.
1.More than one billion adults worldwide are overweight, and at least 300 million of
these are clinically obese. According the National Center for Health Statistics, who have
been tracking obesity problems for over four decades, between 1962 and 2000 the
number of obese Americans, with a Body Masse Index (BMI) in excess of 30%, grew
from 13% to an alarming 31% of the population. 63% of Americans are overweight with
a BMI in excess of 25.0 in all 50 states. Childhood obesity in the United States has more
than tripled in the past two decades. The U.S. Surgeon General estimates obesity is
responsible for 300,000 death every year.
2. In 2006 scientists at the Harvard School of Public Health reported that the prevalence
of obesity in infants under 6 months had risen 73 percent since 1980. This epidemic of
obese 6-month-olds, poses a problem for conventional explanations of the fattening of
America. Since they're eating only formula or breast milk, and never exactly got a lot of
exercise, the obvious explanations for obesity don't work for babies. You have to look
beyond the obvious. Bruce Blumberg of the University of California, Irvine conducted
genetic tests to reveal how that had happened. The tributyltin activated a receptor called
PPAR gamma, which acts like a switch for cells' fate: in one position it allows cells to
remain fibroblasts, in another it guides them to become fat cells. It would seem that the
American diet of hamburgers, french fries and television are not the only cause of the
obesity epidemic, but there are toxins in the food and the environment making people fat.
3. In 1960, 52% of men and 34% of women smoked cigarettes, by 2007 the smoking rate
had dropped to 28% of men and 20% of women. Despite the decline in smoking the U.S.
Surgeon General estimates more than 400,000 Americans die from smoking-related
causes each year. A new study, indicates that cigarettes — even the supposedly safer ones
— pose a much higher risk of lung cancer than before the surgeon general first declared
them a health hazard in 1964. The current curing process, has doubled the lung cancer
1577
risk in American cigarettes since the 1950s. The risk of a smoker‘s developing lung
cancer may be twice as high as it was then, even though tar and nicotine have been
reduced. In the past in this country, and in places like Australia, tobacco was cured in the
open air. But many American growers now speed it up with nitrogen fertilizers and
propane heaters, leading to the formation of nitrosamines, one of the 47 known animal or
human carcinogens in cigarette smoke. While quitting smoking is undeniably a good
idea, smokers must be extra careful to select imported cigarettes and avoid the bio-
terrorists enforcing the U.S. Surgeon General‘s war against cigarettes. Smoking bans in
public places such as restaurants and bars, are reported to dramatically reduce incidences
of heart attack in many communities, but these reports are subject to other variables, that
deserve attention in their right, such as if the cardiac research laboratory was secured or
did the bio-terrorists cease attacking people at random, to focus upon smokers at home.
In another community where the smoking ban was coupled with a new cardiac animal
lab, the heart attack rate went up following a smoking ban.
B. There is no magic bullet. The best way to lose weight is to take in fewer calories than
you burn and to aim for a weight loss of about 1 or 2 pounds a week. Exercise most days
of the week for at least 30 minutes. This is the most effective way to lose weight.
1.Diet is extremely important. Nutrition is all about the study of food and how our bodies
use food as fuel for growth and daily activities. The macro-nutrients, or "big" nutrients
include proteins, carbohydrates, and fats. The micro-nutrients, or "little" nutrients are the
vitamins and minerals needed to be healthy. Calories are the basic unit of food energy.
A healthy diet consists exclusively of fruit, vegetables and whole grains. Meat, bread and
dairy products are luxury foods that are excessively fattening and should be avoided most
of the time, although the fats, proteins, vitamins and minerals are important in
moderation. Sweets, junk food, fast food, fried food, processed foods such as
hydrogenated fats and oils (trans-fats), white flour, white rice and bread, and high
fructose corn syrup, should be avoided all of the time.
a. In 1942, Louis Dublin, a statistician at Metropolitan Life Insurance Company, grouped
some four million people who were insured with Metropolitan Life into categories based
on their height, body frame (small, medium or large) and weight. He discovered that the
ones who lived the longest were the ones who maintained their body weight at the level
for average 25-year-olds. To determine proper caloric intake to achieve a desired weight.
First, determine a desired weight according to the following tables: Multiply this weight
by 15 calories per pound if sedentary and 20 calories if moderately active to determine
proper caloric intake to maintain stasis. Finally, from this amount, subtract 500 calories
per day to lose an estimated pound per week. Children and young adults need slightly
more calories and elderly people slightly less.
Fig. 9-47: Caloric Intake Chart for Ideal Weight
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Source: Metorpolitan Life Insurance
b. Unlike protein, carbohydrates and fats, vitamins do not yield usable energy when
broken down. They assist the enzymes that release energy from carbohydrates, proteins
and fats, but they do not provide energy themselves. Vitamins and minerals are widely
available from natural foods. They are important for maintain health and treating many
diseases. One should ideally get all the vitamins and minerals needed from natural food
sources to consume what could be construed as a balanced diet. There are also daily
multi-vitamins and special vitamins for people recovering from a deficiency or with
special needs, but there is no substitute for a healthy, balanced diet.
Fig. 9-48 Vitamins and Minerals, What they do, Food Source
What the Significant food sources
Vitamin
vitamin does
Supports spinach, green peas, tomato juice,
B1 (thiamin) energy metabolism watermelon, sunflower seeds, lean ham, lean pork
and nerve function chops, soy milk
Supports spinach, broccoli, mushrooms, eggs, milk,
energy metabolism, liver, oysters, clams
B2 (riboflavin)
normal vision and
skin health
B3 (niacin) Supports spinach, potatoes, tomato juice, lean ground
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energy metabolism, beef, chicken breast, tuna (canned in water), liver,
skin health, shrimp
nervous system and
digestive system
Energy widespread in foods
metabolism, fat
Biotin synthesis, amino
acid metabolism,
glycogen synthesis
Pantothenic Supports widespread in foods
Acid energy metabolism
Amino acid bananas, watermelon, tomato juice, broccoli,
and fatty acid spinach, acorn squash, potatoes, white rice,
B6
metabolism, red chicken breast
(pyridoxine)
blood cell
production
Supports tomato juice, green beans, broccoli, spinach,
Folate DNA synthesis and asparagus, okra, black-eyed peas, lentils, navy,
new cell formation pinto and garbanzo beans
Used in new meats, poultry, fish, shellfish, milk, eggs
cell synthesis, helps
break down fatty
B12 acids and amino
acids, supports
nerve cell
maintenance
Collagen spinach, broccoli, red bell peppers, snow
synthesis, amino peas, tomato juice, kiwi, mango, orange,
acid metabolism, grapefruit juice, strawberries
C (ascorbic
helps iron
acid)
absorption,
immunity,
antioxidant
Supports mango, broccoli, butternut squash, carrots,
vision, skin, bone tomato juice, sweet potatoes, pumpkin, beef liver
A (retinol) and tooth growth,
immunity and
reproduction
Promotes self-synthesis via sunlight, fortified milk, egg
D
bone mineralization yolk, liver, fatty fish
E Antioxidant, polyunsaturated plant oils (soybean, corn and
1580
regulation of canola oils), wheat germ, sunflower seeds, tofu,
oxidation reactions, avocado, sweet potatoes, shrimp, cod
supports cell
membrane
stabilization
Synthesis of Brussels sprouts, leafy green vegetables,
blood-clotting spinach, broccoli, cabbage, liver
K
proteins, regulates
blood calcium
What the Significant food sources
Mineral
mineral does
Maintains salt, soy sauce, bread, milk, meats
fluid and
electrolyte balance,
Sodium supports muscle
contraction and
nerve impulse
transmissions
Maintains salt, soy sauce, milk, eggs, meats
fluid and
Chloride
electrolyte balance,
aids in digestion
Maintains potatoes, acorn squash, artichoke, spinach,
fluid and broccoli, carrots, green beans, tomato juice,
electrolyte balance, avocado, grapefruit juice, watermelon, banana,
Potassium cell integrity, strawberries, cod, milk
muscle contractions
and nerve impulse
transmission
Formation of milk, yogurt, cheddar cheese, Swiss cheese,
bones and teeth, tofu, sardines, green beans, spinach, broccoli
Calcium
supports blood
clotting
Formation of all animal foods (meats, fish, poultry, eggs,
cells, bones and milk)
Phosphorus
teeth, maintains
acid-base balance
Supports bone spinach, broccoli, artichokes, green beans,
mineralization, tomato juice, navy beans, pinto beans, black-eyed
Magnesium
protein building, peas, sunflower seeds, tofu, cashews, halibut
muscular
1581
contraction, nerve
impulse
transmission,
immunity
Part of the artichoke, parsley, spinach, broccoli, green
protein hemoglobin beans, tomato juice, tofu, clams, shrimp, beef liver
Iron (carries oxygen
throughout body's
cells)
A part of spinach, broccoli, green peas, green beans,
many enzymes, tomato juice,lentils, oysters, shrimp, crab, turkey
involved in (dark meat), lean ham, lean ground beef, lean
production of sirloin steak, plain yogurt, Swiss cheese, tofu,
genetic material ricotta cheese
and proteins,
Zinc transports vitamin
A, taste perception,
wound healing,
sperm production
and the normal
development of the
fetus
Antioxidant. seafood, meats and grains
Works with vitamin
Selenium
E to protect body
from oxidation
Component of salt, seafood, bread, milk, cheese
thyroid hormones
that help regulate
Iodine
growth,
development and
metabolic rate
Necessary for meats, water
the absorption and
utilization of iron,
Copper
supports formation
of hemoglobin and
several enzymes
Facilitates widespread in foods
Manganese
many cell processes
Involved in fluoridated drinking water, tea, seafood
Fluoride
the formation of
1582
bones and teeth,
helps to make teeth
resistant to decay
Associated vegetable oils, liver, brewer's yeast, whole
with insulin and is grains, cheese, nuts
Chromium required for the
release of energy
from glucose
Facilitates legumes, organ meats
Molybdenum
many cell processes
Source: Health Check Systems
2. Exercise is necessary to burn off excess calories and to keep the body fit. Most
exercise routines involve strength exercises such as push up and sit ups as well as
cardiovascular exercise. Cardiovascular exercise is by far the most important part of an
exercise routine. Being physically active is one of the most important steps that
Americans of all ages can take to improve their health. The 2008 Physical Activity
Guidelines for Americans provides science-based guidance to help Americans aged 6 and
older improve their health through appropriate physical activity.
a. Children and adolescents should do 60 minutes (1 hour) or more of physical activity
daily. All adults should avoid inactivity. Some physical activity is better than none, and
adults who participate in any amount of physical activity gain some health benefits. For
substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes)
a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-
intensity aerobic physical activity, or an equivalent combination of moderate- and
vigorous intensity aerobic activity. Aerobic activity should be performed in episodes of at
least 10 minutes, long enough to break a sweat and increase heart beat and respiration,
and, it should be spread throughout the week. For additional and more extensive health
benefits, adults should increase their aerobic physical activity to 300 minutes (5 hours) a
week of moderate intensity, or 150 minutes a week of vigorous intensity aerobic physical
activity, or an equivalent combination of moderate- and vigorous-intensity activity.
Additional health benefits are gained by engaging in physical activity beyond this
amount. Ideally a person would exercise for at least an hour five days a week. That
exercise routine, should include 100 push ups, 200 sit ups, and at 1-3 miles of jogging.
The goal is a flat stomach. Don‘t do to much when starting out, stop if you are injured, in
time, with perseverance all goals can be achieved.
Fig. 9-49 Exercise Calorie Expenditure Chart, by Weight and Activity
90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Activity
lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs. lbs.
Aerobic dancing 104 115 127 138 149 161 172 184 195 207 218 230 253 276 299 322 345
1583
Aerobics, 4" step 131 145 160 174 189 203 218 232 247 261 276 290 319 348 377 406 435
Aerobics, slide 135 150 165 180 195 210 225 240 255 270 285 300 330 360 390 420 450
Badminton 135 150 165 180 195 210 225 240 255 270 285 300 330 360 390 420 450
Basketball (game) 198 220 242 264 286 308 330 352 374 396 418 440 484 528 572 616 660
Basketball (leisurely) 117 130 143 156 169 182 195 208 221 234 247 260 286 312 338 364 390
Bicycling, 10 mph 112 125 138 150 162 175 188 200 213 225 237 250 275 300 325 350 375
Bicycling, 13 mph 180 200 220 240 260 280 300 320 340 360 380 400 440 480 520 560 600
Billiards 41 45 49 54 58 63 68 72 76 81 85 90 99 108 117 126 135
Bowling 50 55 60 66 72 77 82 88 94 99 105 110 121 132 143 154 165
Canoeing, 2.5 mph 63 70 77 84 91 98 105 112 119 126 133 140 154 168 182 196 210
Canoeing, 4.0 mph 122 135 149 162 175 189 202 216 230 243 257 270 297 324 351 378 405
Croquet 54 60 66 72 78 84 90 96 102 108 114 120 132 144 156 168 180
Cross country ski,
297 330 363 396 429 462 495 528 561 594 627 660 726 792 858 924 990
hard
Cross country ski,
140 155 171 186 202 217 232 248 263 279 294 310 341 372 403 434 465
easy
Cross country ski, med 198 220 242 264 286 308 330 352 374 396 418 440 484 528 572 616 660
Dancing (noncontact) 90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Dancing (slow) 50 55 60 66 72 77 82 88 94 99 105 110 121 132 143 154 165
Gardening, moderate 81 90 99 108 117 126 135 144 153 162 171 180 198 216 234 252 270
Golfing (walking) 90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Golfing (with a cart) 63 70 77 84 91 98 105 112 119 126 133 140 154 168 182 196 210
Handball 207 230 253 276 299 322 345 368 391 414 437 460 506 552 598 644 690
Hiking 10 lb. load 162 180 198 216 234 252 270 288 306 324 342 360 396 432 468 504 540
Hiking 20 lb. load 180 200 220 240 260 280 300 320 340 360 380 400 440 480 520 560 600
Hiking 30 lb. load 211 235 259 282 306 329 352 376 399 423 446 470 517 564 611 658 705
Hiking, no load 140 155 171 186 202 217 232 248 263 279 294 310 341 372 403 434 465
Housework 81 90 99 108 117 126 135 144 153 162 171 180 198 216 234 252 270
Ironing 45 50 55 60 65 70 75 80 85 90 95 100 110 120 130 140 150
Jogging, 5 mph 167 185 203 222 240 259 278 296 315 333 352 370 407 444 481 518 555
Jogging, 6 mph 207 230 253 276 299 322 345 368 391 414 437 460 506 552 598 644 690
Mopping 77 85 94 102 111 119 128 136 144 153 162 170 187 204 221 238 255
Mowing 122 135 149 162 175 189 202 216 230 243 257 270 297 324 351 378 405
Ping Pong 81 90 99 108 117 126 135 144 153 162 171 180 198 216 234 252 270
Raking 68 75 82 90 98 105 112 120 128 135 142 150 165 180 195 210 225
1584
Raquetball 185 205 225 246 266 287 308 328 349 369 389 410 451 492 533 574 615
Rowing (leisurely) 68 75 82 90 98 105 112 120 128 135 142 150 165 180 195 210 225
Rowing machine 162 180 198 216 234 252 270 288 306 324 342 360 396 432 468 504 540
Running, 08 mph 274 305 336 366 396 427 458 488 518 549 579 610 671 732 793 854 915
Running, 09 mph 297 330 363 396 429 462 495 528 561 594 627 660 726 792 858 924 990
Running, 10 mph 315 350 385 420 455 490 525 560 595 630 665 700 770 840 910 980 1050
Scrubbing the floor 126 140 154 168 182 196 210 224 238 252 266 280 308 336 364 392 420
Scuba diving 171 190 209 228 247 266 285 304 323 342 361 380 418 456 494 532 570
Shopping for groceries 54 60 66 72 78 84 90 96 102 108 114 120 132 144 156 168 180
Skipping rope 257 285 313 342 370 399 428 456 484 513 541 570 627 684 741 798 855
Snow shoveling 176 195 215 234 253 273 292 312 332 351 371 390 429 468 507 546 585
Snow skiing, downhill 117 130 143 156 169 182 195 208 221 234 247 260 286 312 338 364 390
Soccer 176 195 215 234 253 273 292 312 332 351 371 390 429 468 507 546 585
Squash 185 205 225 246 266 287 308 328 349 369 389 410 451 492 533 574 615
Stair climber machine 144 160 176 192 208 224 240 256 272 288 304 320 352 384 416 448 480
Stair climbing 126 140 154 168 182 196 210 224 238 252 266 280 308 336 364 392 420
Swimming (25
108 120 132 144 156 168 180 192 204 216 228 240 264 288 312 336 360
yrd/min)
Swimming (50
202 225 248 270 292 315 338 360 382 405 428 450 495 540 585 630 675
yrd/min)
Table Tennis 81 90 99 108 117 126 135 144 153 162 171 180 198 216 234 252 270
Tennis 144 160 176 192 208 224 240 256 272 288 304 320 352 384 416 448 480
Tennis (doubles) 99 110 121 132 143 154 165 176 187 198 209 220 242 264 286 308 330
Trimming hedges 94 105 115 126 136 147 158 168 178 189 199 210 231 252 273 294 315
Vacuuming 68 75 82 90 98 105 112 120 128 135 142 150 165 180 195 210 225
Volleyball (game) 108 120 132 144 156 168 180 192 204 216 228 240 264 288 312 336 360
Volleyball (leisurely) 63 70 77 84 91 98 105 112 119 126 133 140 154 168 182 196 210
Walking, 2 mph 54 60 66 72 78 84 90 96 102 108 114 120 132 144 156 168 180
Walking, 3 mph 72 80 88 96 104 112 120 128 136 144 152 160 176 192 208 224 240
Walking, 4 mph 90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Washing the car 68 75 82 90 98 105 112 120 128 135 142 150 165 180 195 210 225
Waterskiing 144 160 176 192 208 224 240 256 272 288 304 320 352 384 416 448 480
Waxing the car 90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Weeding 90 100 110 120 130 140 150 160 170 180 190 200 220 240 260 280 300
Weights (40 sec.
230 255 280 306 332 357 382 408 433 459 484 510 561 612 663 714 765
down)
1585
Weights (60 sec.
171 190 209 228 247 266 285 304 323 342 361 380 418 456 494 532 570
down)
Weights (90 sec.
112 125 138 150 162 175 188 200 213 225 237 250 275 300 325 350 375
down)
Window cleaning 68 75 82 90 98 105 112 120 128 135 142 150 165 180 195 210 225
Source: Nutribase Professional Nutrition and Fitness Software.
C. Hygiene is important. One must make sure the food one eats is clean and fresh and
not spoiled or contaminated. One must wash their hands before eating, or after handling
toxic material, or before doing surgery or seeing a new patient. One must look and smell
good to avoid offending people who might choose to torture. One must throw away war-
drobes and death beds that have been contaminated with laboratory toxins, they do not
wash out. One must be careful when choosing one‘s friends and relations, a friend or
family member who poisons must be excommunicated. When a home is not defensible
against bio-terrorism or environmental defects prove detrimental to the health, one must
move. When under social stress like losing a job health problems, including high blood
pressure, diabetes, heart disease, heart attack and stroke, may be unavoidable. Not only
is one thrown into the loving arms of the government but one‘s family is particularly
vulnerable to be induced to join in on the persecution.
1.Kate Strully, a Robert Wood Johnson Foundation scholar at the Harvard School of
Public Health, published an article in the May 8 issue of Demography, that analyzed U.S.
data on a wide range of occupations: managerial and professional positions; sales, clerical
and craft jobs; machine operator jobs; and service positions. Among both white or blue
collar workers who lost a job through workplace closure, the likelihood of reporting fair
or poor health increased by 54%. And the odds of developing a new health condition rose
by 83% among those who had no preexisting health problems. Even when these workers
found new jobs, they still had an increased risk of new stress-related health problems.
2. One must be extremely cautious when submitting one‘s personally identification to
government agencies, such as unemployment insurance, the courts or Medicaid. One
must be prepared, with a legal excuse, to exercise one‘s right to remain silent when
questions become too personal or make one feel vulnerable. Provided important criteria
are met, most agencies do accept legal excuses for protecting privacy, particularly
pertaining to one‘s family, mailing address, etc.
3. While there is certainly a place for government in health care, it is not at the individual
or family level. Governments are extremely dangerous to public health when they abuse
personally identifying health information, when they butcher the law to condone or
ignore serious violations of human rights such as torture, when they are politically active
without sufficient justification and give rise to chaos, when they are infiltrated and
controlled by special interests, or are when they are otherwise damaging to the liberty of
the patient to pursue their best interest, to be cured, free of disease, in most cases. And
there is no guarantee that a government, or a random insider, is not going to abuse their
1586
power, so the government must create a real separation between public and private
health.
4. On the other hand, governments are extremely useful to regulate, control and recall
toxic substances that pose an imminent risk of harm to the population. The government
is also needed to prevent and punish medical and legal malpractice. Without a good
government the goal of universal health insurance is not practical. A good government
would give the power of making informed medical decisions and whether or not to pay
for the treatment, entirely to the person affected, the patient. A good government
requires all health institutions to employ an independent Ethics Committee under E 9.11
of the AMA Code of Medical Ethics. A good government has a precise, up-to-date,
geographic and political system of statistical epidemiological surveillance that is does not
violate the privacy of medical records, but is open to public cross-examination, criticism
and commission by concerned citizens. A good government would separate Mandatory
Benefit Programs from the public health service, putting them under the management of
the Social Security Administration (SSA). A good government would ban trans-fats,
prohibit the de-liver-y of toxic laboratory supplies, jail the Nazi scientists, free the
alleged mentally ill, compensate victims of medical malpractice, torture and disability,
and outlaw disease and death.
Fig. 9-50 Global Vital Statistics, 2005
WHO Population Growth Life Births per Deaths Infant AIDS
Country Expec 1,000 per 1,000 Mortal ity rate
tancy per 1,000
World 6,607,356,246 1.02% 67.73 22.03 9.364 36.08 2.03%
Africa 861,974,185 1.57% 49.4 34.35 17.01 80.99 7.27%
America 885,909,568 0.59% 73.29 18.66 6.58 19.01 1.96%
Asia 3,416,455,647 1.33% 70.18 20.9 6.7 28.8 0.5%
Europe 729,916,846 0.19% 76.2 10.73 10.2 8.8 0.29%
Middle East 713,100,000 1.4% 69.59 25.48 6.33 42.79 0.1%
Albania 3,563,112 0.52% 77.24 15.08 5.12 21.52
Algeria 32,129,324 1.28% 72.74 17.76 4.61 32.16 0.1%
Andorra 70,549 0.95% 83.51 9 6.07 4.05
Angola 10,978,552 1.93% 36.79 45.14 25.86 192.5 3.9%
Anguilla 13,254 1.77% 77.11 14.26 5.43 21.03
Antigua & 68,722 0.57% 71.9 17.26 5.44 19.46
Barbuda
Argentina 39,537,943 0.98% 75.91 16.9 7.56 15.18 0.7%
Aruba 71,566 0.47% 79.14 11.26 6.57 5.89
Australia 20,090,437 0.87% 80.39 12.26 7.44 4.69 0.1%
Austria 8,184,691 0.11% 78.92 8.81 9.7 4.66 0.3%
Bahamas 301,790 0.67% 65.54 17.87 8.97 25.21 3%
Bangladesh 144,319,628 2.09% 62.08 30.01 8.4 62.6 <0.1%
Barbados 279,254 0.33% 71.41 12.83 9.17 12.5 1.5%
1587
Belarus 10,300,483 -0.09% 68.72 10.83 14.15 13.37 0.3%
Belgium 10,364,388 0.15% 78.62 10.48 10.22 4.68 0.2%
Belize 279,457 2.33% 67.49 29.34 6.04 25.69 2.4%
Benin 7,250,033 2.89% 50.81 42.57 13.69 85.88 1.9%
Bermuda 65,365 0.64% 77.79 11.6 7.63 8.53
Bhutan 2,232,291 2.11% 54.39 34.03 12.94 100.4 <0.1%
Bolivia 8,857,870 1.49% 65.5 23.76 7.64 53.11 0.1%
Bosnia& 4,025,476 0.44% 72.85 12.49 8.44 21.05 0.1%
Herzegovina
Botswana 1,640,115 33.87 23.33 29.36 54.58 113 37.3%
Brazil 186,112,794 1.06% 71.69 16.83 6.15 29.61 0.7%
British Virgin 22,643 2.06% 76.27 14.96 4.42 18.05
Islands
Brunei 372,361 1.9% 74.8 19.01 3.42 12.61 <0.1%
Bulgaria 7,450,349 -0.89% 72.03 9.66 14.26 20.55 0.1%
Burkina Faso 13,574,820 2.57% 44.2 44.46 18.79 98.67 4.2%
Burma 42,909,464 0.42% 60.7 18.11 12.15 67.24 1.2%
Burundi 6,231,221 2.2% 43.36 39.68 17.61 70.4 6%
Cambodia 13,607,069 1.81% 58.92 27.08 8.97 71.48 2.6%
Cameroon 16,063,678 1.97% 47.95 35.08 15.34 69.18 6.9%
Canada 32,805,041 0.9% 80.1 10.85 7.73 4.75 0.3%
Cape Verde 415,294 0.73% 70.14 26.13 6.72 49.14 0.04%
Cayman Islands 44,270 2.64% 79.95 12.93 4.81 8.19
CentralAfrican 3,742,482 1.56% 41.36 35.55 19.99 92.15 13.5%
Republic
Chad 9,538,544 3% 48.24 46.5 16.38 94.78 4.8%
Chile 15,980,912 0.97% 76.58 15.44 5.76 8.8 0.3%
China 1,306,313,812 0.58% 72.27 13.14 6.94 24.18 0.1%
Columbia 42,954,279 1.49% 71.72 20.82 5.59 20.97 0.7%
Comoros 651,901 2.94% 61.57 38 8.63 77.22 0.12%
Congo, Republic 2,998,040 1.42% 49.51 28.66 14.49 93.86 4.9%
of
Congo,Democratic 58,317,930 2.99% 49.14 44.73 14.64 94.69 4.2%
Republic of the
Cook Islands 21,388
Costa Rica 4,016,173 1.48% 76.84 18.6 4.33 9.95 0.6%
Cote d‘Ivoire 17,327,724 2.11% 42.48 39.64 18.48 97.1 7%
Croatia 4,495,904 -0.02% 74.45 9.57 11.38 6.84 0.1%
Cuba 11,346,670 0.33% 77.23 12.03 7.19 6.33 <0.1%
Cyprus 780,133 0.54% 77.65 12.57 7.64 7.18 0.1%
Czech Republic 10,241,138 -0.05% 76.02 9.07 10.54 3.93 0.1%
Denmark 5,432,335 0.34% 77.62 11.36 10.43 4.56 0.2%
Djibouti 466,900 2.1% 43.12 40.39 19.42 105.54 2.9%
Dominica 69,029 -0.27 74.65 15.73 6.81 14.15
1588
Dominican 8,950,034 1.29% 67.27 23.28 7.35 32.38 1.7%
Republic
East Timor 1,040,880 2.09% 65.9 27.19 6.3 47.41
Ecuador 13,363,593 1.24% 76.21 22.67 4.24 23.66 0.3%
Egypt 76,117,421 1.83% 70.71 23.84 5.3 33.9 0.1%
El Salvador 6,704,932 1.75% 71.22 27.04 5.85 25.1
Equatorial Guinea 523,051 2.43% 55.15 36.56 12.27 87.08 3.4%
Eritria 4,447,307 2.57% 52.7 39.03 13.36 75.59 2.7%
Estonia 1,332,893 -0.65% 71.77 9.91 13.21 7.87 1.1%
Ethiopia 67,851,281 1.89% 40.88 39.23 20.36 102.12 4.4%
Falkland Islands 2,967 2.44%
Fiji 893,354 1.4% 69.53 22.73 5.65 12.62 0.1%
Finland 5,223,442 0.16% 78.35 10.5 9.79 3.57 0.1%
France 60,656,178 0.37% 79.6 12.15 9.08 4.26 0.4%
French Guiana 195,506 2.1% 77.09 20.7 4.85 12.07
Gabon 1,355,246 2.5% 56.46 36.4 11.43 54.35 8.1%
Gambia, The 1,546,848 2.98% 54.79 40.3 12.08 73.48 1.2%
Germany 82,431,390 0% 78.65 8.33 10.55 4.16 0.1%
Ghana 20,757,032 1.36% 56.27 24.9 10.67 52.22 3.1%
Greece 10,668,354 0.19% 79.09 9.72 10.15 5.53 0.2%
Grenada 89,502 0.19% 64.53 22.3 7.17 14.62
Guadalupe 448,713 0.92% 77.9 15.42 6.06 8.6
Guam 168,564 1.46% 78.4 19.03 4.41 6.94
Guatemala 14,655,189 2.57% 65.14 34.11 6.81 35.93 1.1%
Guinea 2.37% 49.87 42.03 15.38 90.37 160 3.2%
Guinea-Bissau 1,388,363 1.99% 46.98 38.03 16.57 108.72 10%
Guyana 765,283 0.26% 65.5 18.45 8.32 33.26 2.5%
Haiti 8,121,622 2.26% 52.92 36.59 12.34 73.45 5.6%
Holy See 921 0.01%
Honduras 6,975,204 2.16% 65.6 30.38 6.87 29.32 1.8%
Hong Kong 6,898,686 0.65% 81.5 7.23 5.98 2.97 0.1%
Hungary 10,006,835 -0.26% 72.4 9.76 13.19 8.57 0.1%
Iceland 296,737 0.91% 80.19 13.73 6.68 3.31 0.2%
India 1,080,264,388 1.4% 64.35 22.32 8.28 56.29 0.9%
Indonesia 241,973,879 1.45% 69.57 20.71 6.25 35.6 0.1%
Ireland 4,015,676 1.16% 77.56 14.47 7.85 5.39 0.1%
Italy 58,103,033 0.07% 79.68 8.89 10.3 5.94 0.5%
Jamaica 2,731,832 0.71% 76.29 16.56 5.37 12.36 1.2%
Japan 127,417,244 0.05% 81.15 9.47 8.95 3.26 <0.1%
Kenya 32,021,856 1.14% 44.92 27.82 16.31 62.62 6.7%
Kiribati 103,092 2.25% 61.71 30.86 8.37 48.52
Korea, North 22,912,177 0.9% 71.37 16.09 7.05 24.04
Korea, South 48,422,644 0.38% 76.85 10.08 6.26 7.05 <0.1%
Laos 6,217,141 2.42% 55.08 35.99 11.83 85.22 0.1%
1589
Latvia 2,290,237 -0.69% 71.05 9.04 13.7 9.55 0.6%
Lesotho 1,865,040 0.14% 36.81 26.91 24.79 85.22 28.9%
Liberia 3,390,635 2.7% 47.93 44.81 17.86 130.51 5.9%
Libya 5,631,585 2.37% 76.28 27.17 3.48 25.7 0.2%
Liechtenstein 33,717 0.82% 79.55 10.41 7.06 4.7
Lithuania 3,596,617 -0.3% 73.97 8.62 10.92 6.89 0.1%
Luxembourg 468,571 1.25% 78.74 12.06 8.41 4.81 0.2%
Macau 449,198 0.87% 82.12 8.04 4.23 4.39
Macedonia 2,045,262 0.26% 73.73 12 8.73 10.09 0.1%
Madagascar 17,501,871 3.03% 56.54 41.91 11.62 78.52 1.7%
Malawi 11,906,855 2.14% 37.48 44.35 23.01 104.23 14.2%
Malaysia 23,953,136 1.8% 72.24 23.07 5.06 17.7 0.4%
Mali 11,956,788 2.78% 45.28 47.29 19.12 117.99 1.9%
Malta 398,534 0.42% 78.86 10.17 8 3.89 0.2%
Marshall Islands 59,071 2.27% 70.01 33.52 4.88 29.45
Martinique 432,900 0.76% 79.04 14.14 6.44 7.09
Mauritania 2,998,563 2.91% 52.32 41.79 12.74 72.35 0.6%
Mauritius 1,220,481 0.81% 72 15.85 6.82 15.57 0.1%
Mexico 106,202,903 1.17% 75.19 21.01 4.73 20.91 0.3%
Micronesia 108,105 -0.08% 69.75 25.11 4.87 30.21
Moldova 4,455,421 0.22% 65.18 15.27 12.79 40.42 0.2%
Monaco 32,409 0.43% 79.57 9.26 12.71 5.43
Mongolia 2,791,272 1.45% 64.52 21.52 7.03 53.79 <0.1%
Montserrat 9,341 1.04% 78.71 17.56 7.17 7.35
Morocco 32,209,101 1.61% 70.35 22.79 5.71 43.25 0.1%
Mozambique 18,811,731 1.22% 37.1 36.06 23.86 137.08 12.2%
Namibia 1,954,033 1.25% 40.53 33.51 21.02 69.58 21.3%
Nauru 13,048 1.83% 62.73 25.14 6.82 9.95
Nepal 27,676,547 2.2% 59.8 31.45 9.47 66.98 0.5%
Netherlands 16,407,491 0.53% 78.81 11.14 8.68 5.04 0.2%
Netherlands 219,958 0.82% 75.83 15 6.41 10.03
Antilles
New Caledonia 216,494 1.28% 74.04 18.49 5.65 7.72
New Zealand 4,035,461 1.02% 78.66 13.9 7.53 5.85 0.1%
Nicaragua 5,465,100 1.92% 70.33 24.88 4.49 29.11 0.2%
Niger 11,360,538 2.67% 42.18 48.91 21.51 122.66 1.2%
Nigeria 137,253,133 2.45% 50.49 38.24 13.99 70.49 5.4%
Niue 2,166
Northern Mariana 80,362 2.61% 75.88 19.51 2.3 7.11
Islands
Norway 4,593,041 0.4% 79.4 11.67 9.45 3.7 0.1%
Palau 20,303 1.39% 70.14 18.37 6.85 14.84
Panama 3,039,150 1.26% 71.94 19.96 6.54 20.47 0.9%
Papua New 5,545,268 2.26% 64.93 29.95 7.37 51.45 0.6%
1590
Guinea
Paraguay 6,347,884 2.48% 74.89 29.43 4.53 25.63 0.5%
Peru 27,925,628 1.36% 69.53 20.87 6.26 31.94 0.5%
Philippines 87,857,473 1.84% 69.91 25.31 5.47 23.51 <0.1%
Poland 38,635,144 0.03% 74.41 10.78 10.01 8.51 0.1%
Portugal 10,566,212 -0.39% 77.53 10.82 10.43 5.05 0.4%
Puerto Rico 3,916,632 0.47% 77.62 13.93 7.86 8.24
Romania 22,329,977 -0.12% 71.35 10.7 11.74 26.43 0.1%
Russia 143,420,309 -0.37% 67.1 9.8 14.52 15.39 1.1%
Rwanda 7,954,013 1.82% 39.14 40.01 21.86 101.68 5.1%
Saint Helena 7,460 0.59% 77.76 12.33 6.43 19
Saint Kitts & 38,958 0.38% 72.15 18.12 8.47 14.49
Nevis
Saint Lucia 166,312 1.28% 73.61 20.05 5.12 13.53
Saint Pierre 7,012 0.21% 78.46 13.83 6.7 7.54
Saint Vincent 117,534 0.27% 73.62 16.34 6 14.78
Samoa 177,287 -0.23% 70.72 15.95 6.54 27.71
Samoa, American 57,881 -0.11% 75.84 23.13 3.33 9.27
San Marino 28,880 1.3% 81.62 10.18 8.07 5.73
SaoTomeand 181,565 3.18% 66.63 41.36 6.89 44.58 N/a
Principe
Senegal 10,852,147 2.52% 56.56 35.72 10.74 56.53 0.8%
Serbia & 10,829,175 0.03% 74.73 12.12 10.49 12.89 0.2%
Montenegro
Seychelles 80,832 0.45% 71.53 16.55 6.41 15.97 N/A
Sierra Leone 5,883,889 2.27% 42.69 43.34 20.62 145.02 7%
Singapore 4,425,720 1.56% 81.62 9.49 4.16 2.29 0.2%
Slovakia 5,431,363 0.15% 74.5 10.62 9.43 7.41 0.1%
Slovenia 2,011,070 -0.03% 76.14 8.95 10.22 4.45 0.1%
Solomon Islands 538,032 2.68% 72.66 30.74 3.98 21.29
Somalia 8,304,601 3.41% 47.71 46.04 17.3 118.52 1%
South Africa 42,718,530 -0.25% 44.19 18.38 20.54 62.18 21.5%
Spain 40,341,462 0.15% 79.52 10.1 9.63 4.42 0.7%
Sri Lanka 20,064,776 0.79% 73.17 15.63 6.49 14.35 <0.1%
Sudan 39,148,162 2.64% 58.13 35.79 9.37 64.05 2.6%
Suriname 438,144 0.25% 68.96 18.39 7.16 23.57 1.7%
Swaziland 1,169,241 0.55% 37.54 28.55 23.06 68.35 38.8%
Sweden 9,001,774 0.17% 80.4 10.36 10.36 2.77 0.1%
Switzerland 7,489,370 0.49% 80.39 9.77 8.48 4.39 0.4%
Taiwan 22,894,384 0.63% 77.26 12.64 6.38 6.4
Tanzania 36,588,225 1.95% 44.39 39 17.45 102.13 8.8%
Thailand 65,444,371 0.87% 71.95 15.7 7.02 20.48 1.5%
Togo 5,556,812 2.27% 53.05 34.36 11.64 67.66 4.1%
Tokelau 1,405 -0.01%
1591
Tonga 112,422 1.98% 69.53 25.18 5.35 12.62
Trinidad & 1,088,644 -0.74% 68.91 12.81 9.37 24.31 3.2%
Tobago
Tunisia 9,974,722 1.01% 74.66 15.74 5.05 25.76 0.1%
Turks & Caicos 20,556 2.9% 74.51 22.23 4.28 15.67
Tuvalu 11,636 1.47% 68.01 21.91 7.22 20.03
Uganda 26,404,543 2.97% 45.28 46.31 16.61 86.15 4.1%
Ukraine 47,425,336 -0.63% 66.85 10.49 16.42 20.34 1.4%
United Kingdom 60,441,457 0.28% 78.38 10.78 10.18 5.16 0.2%
United States 295,734,134 0.92% 77.71 14.14 8.25 6.5 0.6%
Uruguay 3,415,920 0.47% 76.13 14.09 9.06 11.95 0.3%
Vanuatu 205,754 1.52% 62.49 23.06 7.9 55.16
Venezuela 25,375,281 1.4% 74.31 18.91 4.9 22.2 0.7%
Vietnam 83,535,576 1.04% 70.61 17.07 6.2 25.95 0.4%
Virgin Islands 108,708 0.07% 78.91 14.2 6.26 8.03
Western Sahara 267,405
Zambia 10,462,436 1.47% 35.18 38.99 24.35 98.4 16.5%
Zimbabwe 12,671,860 0.68% 37.82 30.05 23.3 67.08 33.7%
Source: WHO Country Atlas
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