By W. Tempeck. Bowdoin College. 2018.

Although health in healthy individuals 89 countries (46%) reported active Citation: Mintzes B (2006) Disease mongering in • Inflated disease prevalence rates regulation of drug promotion cheap antabuse 500 mg on line, drug promotion: Do governments have a regulatory • Promotion of aggressive drug role? However antabuse 500mg mastercard, in many other reproduction in any medium, provided the original countries, unbranded disease-oriented distinguish from normal life author and source are credited. However, the Medicines Health- is a key example of disease mongering Care Products Regulatory Agency linked to drug sales. Disease-Awareness Campaign by millions of women worldwide is the product nor the manufacturer was Sponsored by Pfizer, the Manufacturer of likely to have been considerable. They studied the changes in cardiovascular risks and could lead but have taken no broader action to rates of prescriptions of oral terbinafine to harm from medically unjustified review marketing of drugs for disease (Lamisil) and itraconazole (Sporanox, drug use [14]. Web site promoting an estrogen patch, and prescriptions for terbinafine Complaints in Canada, which included and linking postmenopausal estrogen (Lamisil) grew, whereas prescriptions the Lancet letter, resulted in no deficiency to reduced performance, for the competitor drug declined [12]. A subsequent fine motor skills, memory, and a Thus, an unbranded campaign had advert shows a man walking down a reduction in “planned, targeted, a brand-specific effect on sales, most city street, unaware that he is about flexible and adaptable thought” [19]. The only risk factor discussed is and Gynaecologists of Canada), fails to cholesterol. Hot adverts that used images of a tagged toe had financial links to manufacturers flushes, mood and memory, appearance of a corpse (the Canadian campaign (Cleeman was the only member of the (wrinkles), sleep disturbances, bladder was in association with the Canadian panel with no such ties; see http:⁄⁄www. This was at for further growth of the cholesterol- for wrinkles, given the cardiovascular, odds with existing scientific evidence: lowering market Lower Thresholds for Symptomatic lowering drugs in primary prevention found no difference in mortality Treatment and Public Health between drug and placebo [13]. Paradoxically, although these of patent protection for Prozac (also exists to support this hypothesis [31]. An additional antidepressant prescriptions just which prescribing increased 10-fold. In 2004, researchers found a link on recall rather than daily symptom depression or adjustment disorder. Letters of violation Box 1 summarizes the types of disease- be burning the lining of her esophagus. Accessed 7 March link between morbidity and prescribing in the exaggerates prevalence rates. National Prescribing Service (2004) Sertraline for a treatment and (2) to insist on “Help-seeking” and other disease awareness (Zoloft), fluoxetine (Lovan, Prozac) for prescreening of adverts by a government communications by or on behalf of drug premenstrual dysphoric disorder. Accessed 7 Better definitions are needed of the prescriptions of terbinafine in primary care. Therapeutics Initiative (2003) Do statins have (2002) Prevalence, incidence and stability to ensure consistency with assessed a role in primary prevention? Moynihan R, Cassels A (2005) Selling sickness: of benefit should be based on clinical 14. Letter (2005) Warning letters and untitled is sufficient political will among to Anne Rochon Ford, June 16, 2004. European Commission (2003) Community References in healthy postmenopausal women: Principal code relating to medicinal products for human 1. Moynihan R, Heath I, Henry D (2002) Selling results from the Women’s Health Initiative use. Brown B, Standing Committee on Health Gynaecologists of Canada (2006) The criteria for medicinal drug promotion. Available: report on health aspects of prescription (Ontario): The Society of Obstetricians http:⁄⁄mednet2. Assessing current awareness could provide a basis for further research, leading to the Disease Mongering among Medical development of effective measures that will raise awareness levels and motivate students to participate in future and Pharmaceutical Students campaigns that seek to combat disease mongering. Jairaj Kumar, Abhizith Deoker, Ashwini Kumar, Most medical and pharmaceutical students in India are Arunachalam Kumar, B. Articles have been published warning the profession about disease mongering [5–7], but for the most part these warnings have not been heeded. One is reminded of Aristotle, who so rightly observed that “truth could influence only half a score of men in a century, while falsehood and mystery would drag millions by the nose. The questionnaires were distributed greater problem because the restrictions on drug dispensing among a random sample of 250 final-year medical and 250 are very limited—drugs often being dispensed without a final-year pharmaceutical students. Of the medical students, 30 out are poor and illiterate, and lack information on health care, of 199 (15%) were able to explain disease mongering with they often visit local pharmacists or quacks for medical relevant examples. Pharmacists routinely dispense drugs illegally over of 207 (55%) were able to do so, suggesting that awareness the counter. We visited 40 local pharmacy stores for medical of the problem was much greater among these students. Pharmaceutical promotional campaigns in India, unlike All the students, both medical and pharmaceutical, those in developed countries (where pharmacists have little said they had frequently seen drugs dispensed without influence on drug sales), are not only aimed at changing prescription. They had also often seen patients visit local the prescribing habits of physicians but also at pharmacists pharmacists for medical advice. However, both the medical and various schemes and incentives (including television sets, the pharmaceutical students were unaware of the incentives motorcycles, and the opportunity for higher profit margins) offered by drug companies to pharmacists for buying their to lure pharmacists into buying more drugs than they would drugs, which lead to unethical dispensing.

As we have seen buy cheap antabuse 500 mg, women had no higher social position here and they may well have been less literate than women in neighboring areas buy discount antabuse 500 mg on-line. Few specialized texts on women’s medicine existed in Arabic, and nonewere translated by Constantine. The larger intellectual currents of Salernitan medicine—the concern to system- atically analyze and explain, the eagerness to incorporate new pharmaceutical products, and, most important, the desire to capture all this new knowledge in writing—provided the spark that would make Salernitan women’s medicine different from anything that had gone before it. Women’s Medicine P-S G Had it been possible to draw up an inventory of European medical writings on women in the third quarter of the eleventh century, that list would have included at least two dozen different texts. But such an inventory would be insufficient to assess the varying im- Introduction  portance of these texts, for even though copies might be found in this library or that, an individual text’s usefulness may have been minimal, either because its Latin (often interlarded with Greek terminology) had been corrupted over the course of several centuries of copying or because its theoretical precepts were no longer adhered to or even understood. The gynecological literature in western Europe prior to the late eleventh century represented two ancient medical traditions. First was the Hippocratic tradition, embodied in a corpus of anonymous Greek writings composed be- tween the fifth and fourth centuries . The gynecologi- cal materials of the Hippocratic Corpus constituted as much as one-fifth of that vast collection of writings. The abbreviated translation of Diseases of Women  laid out the basic physiology of women (especially as it related to pregnancy), then moved on to alterations of the womb, impedi- ments to conception, disorders of gestation, causes of miscarriage, difficulties of birth, and subsequent problems. The longer version, called by its modern editor On the Diverse Afflictions of Women, addresses questions of etiology, diagnosis, and prognosis, as well as the more routine matters of basic pathology and ther- apy in its ninety-one subheadings. Three other texts (Book on the Afflictions of Women, Book on the Female Affliction, and Book on Womanly Matters) also derive from Diseases of Women ; these are fairly brief and often redundant recipe col- lections rather than organized medical treatises. Just as influential in dissemi- nating Hippocratic views of the female body were the Aphorisms, a collection of pithy verities about the nature of the physician’s craft, the symptoms of dis- ease, prognostic signs, and so forth. The fifth (or in some versions the sixth) of the seven sections of the Aphorisms was devoted primarily to women and their diseases; it was on occasion accompanied by an extensive commentary. Here, a reader would find such statements as ‘‘If the menses are deficient, it is a good thing when blood flows from the nostrils,’’ or ‘‘If in a woman who is pregnant the breast suddenly dries up, she will abort. Soranus of Ephesus, a Greek physician from Asia Minor who practiced in Rome in the late first and early second century . All the physician needed to know was that therewere three basic states of the human body: the lax, the con- stricted, and a combination of the two. Upon diagnosing which of the three states was manifest in any given case, the physician’s therapeutic response was to treat by opposites: to relax the constricted, constrict the lax, and do both in mixed cases, treating the more severe symptoms first. Soranus’s views of female physiology and pathology in particular seem to have been novel. He argued, for example, that menstruation, sexual activity, and pregnancy were harmful to women, in contrast to the Hippocratic tradition, which asserted (as we shall see in more detail later) that these three processes were not only salubrious but actually vital to women’s health. Soranus’s Greek Gynecology was adapted into Latin several times in the late antique period, in every instance (though to varying degrees) being stripped of its more theoretical elements. The most influential of these Latin Soranian texts was the Gynecology of Muscio, who had deliberately abbreviated and sim- plified his translation of Soranus (using, he says, ‘‘women’s words’’) so that he would not overburden the allegedly weaker minds of midwives, to whom the work was addressed. In its first book, Muscio’s Gynecology set out in question- and-answer form basic information on female anatomy (originally with an accompanying diagram of the uterus), physiology, and embryology and de- scribed in detail how normal birth and neonatal care should be handled. The second book covered both gynecological and obstetrical pathological condi- tions and included a series of fetus-in-utero figures to show the midwife the various ways in which the fetus might malpresent. Forall its simplifications and heuristic aids, however, there was much in the text that proved incomprehen- sible to later European readers; by the eleventh century, perhaps even earlier, the Gynecology was abbreviated into two shorter texts, both of which eliminated much of Muscio’s technical vocabulary and his concepts of Methodism. Gynecological texts were regu- larly grouped together, with the result that even a single manuscript could contain a substantial collection of material on women. The author of Conditions of Women made use of one of the Hippocratic texts, the Book on Womanly Matters71 and may have made a passing allusion to a section of Mus- cio’s Gynecology,72 but he was either ignorant of all the other texts or actively chose to ignore them. Treatments for Women exhibits no direct textual parallels at all with the pre-Salernitan works, while cosmetics, the topic of both large parts of Treatments for Women and Women’s Cosmetics, was almost never com- bined with gynecological matters in early medieval medical writings. For all the wealth of the early medieval gynecological corpus, then, the new Salerni- tan writings on women are largely independent of the Latin works preceding them. Still, it seems likely that the author of Conditions of Women took the existence of some of these texts—and, perhaps, the rhetoric of at least one of them—as a spur to writing his own specialized text about an area of medicine that some were reluctant to speak about openly. The former and, to a far lesser degree, the latter, have their origin in theories and practices developed in Greco-Roman antiquity. From the disease categories they envisioned to the therapeutic practices they deployed, the uniqueness of each Trotula text can best be seen by analyzing the content of the texts in relationship to the theories and practices from which they derived. Entitled, in its sole complete copy, Treatise on the Diseases of Women (Trac- tatus de egritudinibus mulierum), this first attempt to synthesize the new Ara-  Introduction bic medicine employs a simplified, colloquial vocabulary to render technical concepts accessible. Conditions of Women proper reflects a greater confidence with the Arabic material and is a thoroughly revised version; for all intents and purposes, it can be considered a new text. A slightly later version (Conditions of Women ) was to add aids for normal birth. Although we cannot be entirely certain that it was composed at Salerno, its strong philosophical and stylistic similarities to other Salernitan writings make a southern Italian origin likely.

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It would seem purchase antabuse 500mg with mastercard, however generic antabuse 250mg visa, whether by preference, mutual decision or default, that women physicians continue to take Physicians who enjoy successful intimate partnerships learn more responsibility on the home front than their male counter- early that certain attributes that serve them well at work are parts. For example, while physicians of female physicians being the primary or sole income earner are accustomed to their role as experts and expect to be in in their households. In contrast to Protecting and nurturing our intimate relationships may require most physicians’ experience of medical education, marriage is a re-examination of our professional responsibilities and work non-competitive. As you develop your resident group or consider Relationships, however, do require work in realtime, a sense of your eventual practice setting, keep these questions in mind: humour, and a degree of luck. John Gottman, a respected re- • Does your group discuss shock-absorber systems for searcher in marriage and relationships, stresses the importance parental leaves and urgent family issues? She had speculated that a child would keep geographical triangle: home, school and workplace. Keeping her relationship together, given her partner’s attraction to logistics as simple as possible will beneft your marriage and “more medicine” and achievement. He expresses fear of giving in Raising children together to his feelings lest they derail his career focus. With the For many women physicians, the question of when to plan counsellor’s help, they review their priorities with regard childbearing is especially challenging when training demands to career plans and the timing of child-bearing. Supportive sessions lead to a better understanding of their mutual colleagues and training programs are nearly as important as a objectives, and of the supports available to them to help supportive partner. Furthermore, resi- dency training directors never accompany graduated residents impact on your family, whose sleep is being disturbed by the to the infertility clinic. The concept that it takes a village to raise a child applies to medical families, too. Women physicians are particularly aware Vacations are one of the non-urgent but important elements that the more they work, and the greater number of children of time management. Vacations in which play and fun—and they choose to have, the greater the chance that they will need not perfection—are modelled, where being rather than doing to rely on child care arrangements beyond the family. Many are valued and pleasure for its own sake is enjoyed, are healthy women physicians and dual-career couples fnd live-in help with for the whole family (Maier 2005) regard to child care invaluable. External assistance with regard to other household duties can also be a time-management tool Summary that benefts everyone. Managing the expectations of our partners and others can be problematic in medical relationships. Some of these expecta- Two points to remember when your medical relationship is tions may be fnancial, arising from assumptions about what blessed with children are these: the lifestyles of physicians will be. You do not have to be perfect, but you can be good pectation of concierge service within the health care system. All deserve Although little has been written about the children of physi- refection, good communication and attention to maintaining cians, we do know that children want and deserve their parents’ appropriate and ubiquitous boundaries. Depending on their stage of development, this may mean breastfeeding for the recommended time, taking Relationships go through cycles. Should your medical marriage the maximum possible parental leave, delaying a career move, run into challenges, remember you are not alone. Even if you cannot Myers, through his book Doctors’ Marriages, shares his wisdom always be there, it is important to work with your partner and that face-to-face couples’ therapy works best. Seek professional to communicate with your child so that you are emotionally help through your community resources or your physician involved and up-to-date with what is going on in your child’s health program. In addition, more men than ever before are taking This chapter will advantage of parental leave policies. Thus, traditional gender • describe some of the challenges commonly faced by phy- roles in Canadian culture are clearly undergoing a healthy evo- sician parents, lution. However, these shifts have created new challenges for • summarize supports that programs can use to facilitate training programs as they strive to balance principles of sound sustainability of residents who are parents, and education and training, human rights and responsibilities, and • identify strategies for resident physicians to promote their health care human resource issues. Medical students are watching this transition and may choose not to Case engage in specialty medicine if it is perceived to be adverse to A second-year resident has recently adopted an infant their family-related values and expectations. However, several residents in the year are In the meantime, academic medicine has not been particularly off on parental leave, and the frequency of call is higher kind to physician parents who have typically enjoyed less insti- than usual. Several colleagues mention that they hope the tutional support (research funding, mentorship, administrative resident is not planning on taking parental leave, as that support) than non-parents, tend to have fewer publications, would increase call frequency to 1:4. In fact, the resident is perceive a slower progression of career goals, and have lower planning on taking leave, but is now dreading approaching levels of career satisfaction. Children add a dimen- sion to life that is unique and delightful, and the parental role Unique challenges of parenting provides opportunities to know ourselves better. That being Physician parents are in an unique position as they promote said, parenting can add to the complexity of managing busy and monitor their children’s health and development. Where some may argue that knowledge about health is valuable and helpful, but—as is the physician parents lack full professional commitment, others case with any parent—their objectivity is limited.

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