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The crude biological determinism apparent in such attempts to establish a direct link of causality that extends from embryonic DNA cheap estrace 1mg with amex, through the structure and function of the brain to the individual personality and social behaviour reflects the profoundly fatalistic outlook that underlies the concept of addiction generic 2 mg estrace with visa. If human behaviour is ‘hard wired’ into our genes and hormones order estrace 1mg without prescription, then the scope for individual autonomy and self-control is drastically curtailed cheap estrace 2mg amex. The culture of addiction is assiduously promoted by the therapeutic entrepreneurs of the worlds of counselling and therapy and by the cults of self-help order 1mg estrace visa, personal growth and victim support. Bookshop shelves are heaving with manuals of pop psychology and numerous websites provide similar wisdom in an easily accessible form for the internet generation. Both often provide handy checklists against which readers can assess whether they qualify for the diagnosis of co-dependency (the answer, of course, is yes). Two young men have come into the surgery, having completed one such checklist confirming the diagnosis of the adult form of attention deficit hyperactivity disorder. Indeed both had poor records at school, difficulties in maintaining jobs and relationships, problems with the law: how about some Ritalin (the amphetamine- type drug recommended for ADHD)? The propaganda of addiction finds a ready resonance in a society in which people are all too ready to accept a medical label for their difficulties. It encourages people to regard themselves as passive victims of external forces, of demonised ‘substances’ or ‘toxic’ relationships, even of their own biology. The widespread acceptance of this outlook is all the more remarkable if you consider the extent to which it contradicts most people’s experience. As Peele writes, ‘people regularly quit smoking, cut back drinking, lose weight, improve their health, create healthy love relationships, raise strong and happy children and contribute to communities and combat wrong—all without expert intervention’ (Peele 1995:29). I wonder whether expert intervention is in fact often counterproductive. This is most clearly apparent in relation to methadone maintenance where the goal of abstinence is replaced with that of indefinite dependence. But there is also a marked tendency for vulnerable people to develop 113 THE EXPANSION OF HEALTH an ongoing dependence on therapy, which is as likely to confirm their inadequacy as it is to enable them to overcome it. Counselling and Prozac Doctors of all sorts, notably psychiatrists and GPs, have helped to encourage the inflation of addiction and other psychological disorders and the demand for medical or psychological treatment that follows from it. Experts are continually advising us of the need to identify problem drinkers and others with ‘substance abuse’ problems so that they can be offered appropriate treatment. In 1992 the Health of the Nation white paper identified mental health as a key area and, for the first time, set targets on reducing the suicide rate. The neglect of any means of achieving this (or indeed its other targets) meant that this policy had little consequence, but this defect was remedied when the New Labour government after 1997 also established a target. It also sponsored a ‘Defeat Depression’ campaign, which sought to encourage GPs to increase their diagnosis of depression, in the hope that this would facilitate treatment and thus reduce the suicide rate. Treatments on offer in the surgery fall into two broad categories: counselling and medication. A BMJ editorial in 1993 noted that, even though ‘many attempts to evaluate its effectiveness have shown little or no benefit’, counselling had rapidly become established in general practice in Britain (Pringle, Laverty 1993). The authors noted that ‘as well as its general indications in anxiety and depression, and problems with relationships’, counselling had been advocated for ‘smoking cessation, modification of diet, alcohol misuse, postnatal depression, addiction to tranquillisers, and high risk sexual behaviour’. The government-imposed GP contract in 1990 had encouraged the provision of counselling in general practice by agreeing to reimburse up to 70 per cent of the cost. The later growth of fundholding practices gave a further boost to the employment of counsellors in the surgery. The theme of Pringle and Laverty’s editorial was ‘reasons for caution’ about the explosion of counselling in general practice, given the lack of evidence of effectiveness and uncertainties about confidentiality, qualifications and accreditation. There was a generally negative response to their editorial, and particularly to their suggestion that ‘the main reason for GPs’ enthusiasm for 114 THE EXPANSION OF HEALTH counselling may well be a desire to reduce contact with and responsibility for a very demanding group of patients’. One critic insisted that GPs ‘were not just avoiding “heartsink” patients, as the editorial suggests, but recognised the mutual benefit of bringing new skills and knowledge into the practice and extending the range of options within the primary care team’ (Jewell 1993). Counselling was one of those initiatives whose value was considered self-evident. Attempts to investigate its effectiveness were all very well, but should not be allowed to delay its implementa-tion. The provision of counselling in GPs’ surgeries was a radical departure with a number of significant features, not the least of which was the fact that it generally passed without much comment.

A similar process must be followed when solving a medical mystery through our Eight Step method purchase estrace 2mg otc. It too includes probing generic 1mg estrace overnight delivery, collecting estrace 1mg visa, record- ing order estrace 2mg, researching discount estrace 1mg amex, and analyzing steps. It means formulating a hypothesis, testing it against additional data, and constantly reviewing the data and the- ories using deductive reasoning until the correct diagnosis finally emerges. Although not every crime is solved and not every mystery malady will be diagnosed, one thing is certain: unless the perpetrator of the crime comes forward or unless your malady simply resolves itself, the only opportunity to solve the mystery comes from the principles of good detection. Our Eight Steps to Self-Diagnosis are your road map to good medical detection. Working through our program will uncover the clues necessary to correctly diagnose your condition. You gather the puzzle pieces and then assemble and reassemble them until an accurate picture appears. Each clue builds on the previous one, just as All About Mystery Maladies: A New Mind-Set 33 each puzzle piece locks into the next. However, it will be necessary for you to try several different combinations until you find the pieces that interlock. In working through the process, you may have to go back several times and repeat certain steps until you find the necessary clue. In this case, the crime scene is your body in its past and present settings. Although the idea of a crime scene may seem like a negative way of looking at your body, it is absolutely not intended that way. In fact, if there is any negative connota- tion in your mind, we want to reframe this immediately. We believe that part of striving for and maintaining good health is to nurture and appre- ciate our bodies for the complicated and miraculous instruments they are (even though they may be giving us a rough time at the moment). Viewing the body in its setting as a crime scene is to recognize that it is very fertile ground. Our bodies and the circumstances in which they are placed can pro- vide a wealth of information if we know how to access it, listen to it, and try to understand it. As a medical detective using our Eight Step method, you will begin by collecting and documenting the presence or absence of the primary evidence of your mystery malady. So perform each step and then do it again, as needed, part- nering with your physician as you proceed. At the conclusion of that chapter, you’ll have completed a diagnostic notebook that can help your doctor help you to solve your mystery malady. And in Chap- ter 5, we’ll show you how to do medical detective work on the Internet as you continue the search for clues to solve your mystery malady. If you’re willing to spend the time and make the effort, the Eight Steps to Self-Diagnosis and the other tools and techniques we’ll share in this book can help you not only find the solution to your mystery malady but live well while you’re doing it. John Ball, UNDERSTANDING DISEASE In this chapter we reveal the revolutionary self-diagnosis model you’ve been waiting for. We’ve already discussed what mystery maladies are, how these conditions may develop, and the open mind-set that is necessary to begin to unravel them. In this chap- ter, we will outline the Eight Step method designed to help you become your own medical detective. If you carefully work through the Eight Steps to Self-Diagnosis, you will uncover at least one or more important clues to solving your mystery malady. Each step builds on the one before it, and all the steps taken together will create a much clearer picture of your mystery malady. It requires a serious level of commitment on your part to work through the Eight Steps. Keep in mind that actually doing them is different from simply reading about them. The solutions you have been searching for can be discovered 35 Copyright © 2005 by Lynn Dannheisser and Jerry Rosenbaum. It won’t necessarily be a quick or easy process, but we promise the ben- efits you’ll receive will be directly proportional to the effort you are willing to make.

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Although the United the United States Department of State have identified a list of States formally stopped biological weapons research in 1969 potential enemy states developing biological weapons generic estrace 1mg fast delivery. Nixon) 1mg estrace amex, the potentially hostile nations include Iran generic estrace 2 mg with mastercard, Iraq discount estrace 1 mg free shipping, Libya generic estrace 2mg mastercard, Syria, Soviet Union carried on biological weapons research until its North Korea, and China. Despite the international prohibitions, the existence of The BWC prohibits the offensive weaponization of bio- biological weapons remains dangerous reality. The BWC also prohibits the transformation of biological agents with established legit- See also Anthrax, terrorist use of as a biological weapon; imate and sanctioned purposes into agents of a nature and Bacteria and bacterial infection; Bioterrorism, protective quality that could be used to effectively induce illness or measures; Bioterrorism; Infection and resistance; Viruses and death. In addition to offensive weaponization of microorgan- response to viral infection isms or toxins, prohibited research procedures include con- centrating a strain of bacterium or virus, altering the size of aggregations of potentially harmful biologic agents (e. Although there have been several international meet- BBioluminescenceIOLUMINESCENCE ings designed to strengthen the implementation and monitor- Bioluminescence is the production of light by living organ- ing of BWC provisions, BWC verification procedures are isms. Some single-celled organisms (bacteria and protista) as currently the responsibility of an ad hoc commission of scien- well as many multicellular animals and fungi demonstrate bio- tists. Light is produced by most bioluminescent organisms when a chemical called luciferin reacts with oxygen to pro- See also Anthrax, terrorist use of as a biological weapon; duce light and oxyluciferin. The reaction between luciferin Bacteria and bacterial infection; Biological warfare; and oxygen is catalyzed by the enzyme luciferase. Epidemics and pandemics; Vaccine Luciferases, like luciferins, usually have different chemical structures in different organisms. In addition to luciferin, oxy- gen, and luciferase, other molecules (called cofactors) must be BIOLOGY, CENTRAL DOGMA OF • see present for the bioluminescent reaction to proceed. Cofactors MOLECULAR BIOLOGY AND MOLECULAR GENETICS are molecules required by an enzyme (in this case luciferase) 72 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bioremediation to perform its catalytic function. Common cofactors required is the firefly, which can often be seen glowing during the warm for bioluminescent reactions are calcium and ATP, a molecule summer months. In some instances organisms use biolumines- used to store and release energy that is found in all organisms. The German scientist Emil du Bois-Reymond port a number of bioluminescent organisms including species obtained two different extracts from bioluminescent clams and of bacteria, dinoflagellates, jellyfish, coral, shrimp, and fish. When Dubois mixed these extracts they produced On any given night one can see the luminescent sparkle pro- light. He also found that if one of these extracts was first duced by the single-celled dinoflagellates when water is dis- heated, no light would be produced upon mixing. See also Antibiotic resistance, tests for; Biotechnology; Food Dubois hypothesized that the heat-resistant chemical under- safety; Immunoflorescence; Microbial genetics goes a chemical change during the reaction, and called this compound luciferin. The heat sensitive chemical, Dubois con- cluded, was an enzyme which he called luciferase. BBioremediationIOREMEDIATION The two basic components needed to produce a biolu- minescent reaction, luciferin and luciferase, can be isolated Bioremediation is the use of living organisms or ecological from the organisms that produce them. When they are mixed processes to deal with a given environmental problem. The in the presence of oxygen and the appropriate cofactors, these most common use of bioremediation is the metabolic break- components will produce light with an intensity dependent on down or removal of toxic chemicals before or after they have the quantity of luciferin and luciferase added, as well as the been discharged into the environment. Luciferases isolated from advantage of the fact that certain microorganisms can utilize fireflies and other beetles are commonly used in research. Bioremediation is a relatively new and determine the concentrations of important biological molecules actively developing technology. After adding a known amount of and plants are being genetically engineered to aide in their luciferin and luciferase to a blood or tissue sample, the cofac- ability to remove deleterious substances. The first approach, bioaugmentation, for the bioluminescent reaction such as using it to quantify spe- aims to increase the abundance of certain species or groups cific molecules that do not directly participate in the biolumi- of microorganisms that can metabolize toxic chemicals. To do this, scientists attach luciferase to Bioaugmentation involves the deliberate addition of strains antibodies—molecules produced by the immune system that or species of microorganisms that are effective at treating bind to specific molecules called antigens. The antibody- particular toxic chemicals, but are not indigenous to or abun- luciferase complex is added to a sample where it binds to the dant in the treatment area. Following washing to remove ditions may be altered in order to enhance the actions of such unbound antibodies, the molecule of interest can be quantified organisms that are already present in the environment.

Step Four: Do a Family Medical History and Determine If You Have or Had Any Blood Relatives with a Similar Problem Your genes often predispose you to certain conditions purchase 2 mg estrace free shipping. For example buy generic estrace 2 mg on-line, it is less likely that the chest pain you are experiencing is a heart attack if you don’t have a family member with this condition (although this generality is not true for all people) order 2 mg estrace with amex. On the other hand estrace 1 mg cheap, those bumps appearing on your knuckles are probably a form of familial osteoarthritis if your mother had The Eight Steps to Self-Diagnosis 43 them too discount 2 mg estrace. If you are wondering whether you or someone you love may be suffering from depression, check out whether another family member is or was depressed, since it tends to run in families. The Importance of Degrees of Consanguinity First-degree relatives (parents, siblings, and offspring) with similar symp- toms are more relevant and revealing than second-degree relatives (grand- parents, aunts/uncles, and grandchildren). However, the medical history of all your blood relatives should be examined, including their age at diagno- sis of illness, significant lifestyle and environmental factors (if known), and their age at death. Similar Backgrounds and Similar Conditions We authors are not related, but we do come from very similar ethnic, reli- gious, and cultural backgrounds. Our families emigrated from the same countries, and it is a documented fact that in past centuries there was much inbreeding within our religious and cultural groups. Consequently, we do not believe it is a coincidence that we have suffered from several of the same mystery maladies. Step Five: Search for Other Past or Present Mental or Physical Problems By now you’ve created your notebook, recorded your symptoms with some specificity and objectivity, and explored the history and circumstances of your ailment. If you’ve analyzed all this data and still haven’t arrived at the solution to your mystery malady, then the time has come to pause and ask yourself, What am I missing here? Let’s look at whether there is any relationship between your past and present physical and/or mental symptoms. It is fairly common for laypeo- ple (and even some doctors) to see their conditions in a linear way, but the notion that you have only one condition at a time is a fallacy. You may have several active medical problems, any one of which may be contributing to 44 Becoming Your Own Medical Detective your current malady even if it’s not immediately obvious. The goal here is to uncover any other past or active problems that may be causing symptoms and to identify whether there is a relationship to what you perceive as your mystery malady. At the very least, consider the following questions: • Has anything else been bothering you? For example, if apart from your mysterious chest pain, you are having respiratory problems that you believe are related to your allergy to grass and have nothing to do with your chest pain, list them anyway. If your neck hurts, but you feel certain that this resulted from lifting weights and you don’t think there is a relationship between the neck pain and your inexpli- cably feeling hot and cold flashes, log both in your notebook. Obtaining All of Your Past and Present Medical Records You have a legal right to obtain copies of your medical records. A compre- hensive review of all your medical records may help you see a pattern or sim- ilarity to your current ailment. Record in chronological order the dates of all office vis- its, hospitalizations or immunizations, and any laboratory and diagnostic tests performed (with their findings). List all medications or treatments you’ve had, including the dates they started and stopped. When you review all your test results, bear in mind that testing and the instruments used in testing always have some degree of fallibility and The Eight Steps to Self-Diagnosis 45 limitations—just like the humans who perform them. It is better to rely on a statement of your symptoms at the time you sought medical attention and let your current doctor draw her own conclusions about whether your previous diagnosis was accurate. Step Six: Categorize Your Current (and Prior) Significant Medical Problems by Etiology Etiology is the study of the causes of disease. This is a lengthy step, but it can be extraordinarily fruitful for your medical detective work. Most medical texts categorize disease and disorders by organ systems (which you reviewed as part of Step Five. However, with recurrent headaches, there can be any number of causes from bacterial (sinusitis to meningitis) to biomechanical (cervical arthritis or muscle tension) to traumatic (chronic subdural hematoma) to psychological (stress). Understanding the origin or cause of these headaches is most often key to treatment and resolution, and the same can be true with other mystery maladies. Rosenbaum over the years with a diagnosis of SLE based solely on a positive ANA result. That same ANA test performed by a second laboratory or possibly even the same laboratory on a different day could well have a different result. Certain medications can create a false-positive result (a positive test result in the absence of disease). Other condi- tions (such as thyroid disease and its antibodies) can also cause a false positive.

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