Medical Intern Quotes

We all build internal sea walls to keep at bay the sadnesses of life and the often overwhelming forces within our minds. In whatever way we do this--through love, work, family, faith, friends, denial, alcohol, drugs, or medication, we build these walls, stone by stone, over a lifetime.

But money spent while manic doesn't fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you're given excellent reason to be even more so.

Those who fail to exhibit positive attitudes, no matter the external reality, are seen as maladjusted and in need of assistance. Their attitudes need correction. Once we adopt an upbeat vision of reality, positive things will happen. This belief encourages us to flee from reality when reality does not elicit positive feelings. These specialists in "happiness" have formulated something they call the "Law of Attraction." It argues that we attract those things in life, whether it is money, relationships or employment, which we focus on. Suddenly, abused and battered wives or children, the unemployed, the depressed and mentally ill, the illiterate, the lonely, those grieving for lost loved ones, those crushed by poverty, the terminally ill, those fighting with addictions, those suffering from trauma, those trapped in menial and poorly paid jobs, those whose homes are in foreclosure or who are filing for bankruptcy because they cannot pay their medical bills, are to blame for their negativity. The ideology justifies the cruelty of unfettered capitalism, shifting the blame from the power elite to those they oppress. And many of us have internalized this pernicious message, which in times of difficulty leads to personal despair, passivity and disillusionment.

We all build internal sea walls to keep at bay the sadnesses of life and the often overwhelming forces within our minds. In whatever way we do this—through love, work, family, faith, friends, denial, alcohol, drugs, or medication—we build these walls, stone by stone, over a lifetime. One of the most difficult problems is to construct these barriers of such a height and strength that one has a true harbor, a sanctuary away from crippling turmoil and pain, but yet low enough, and permeable enough, to let in fresh seawater that will fend off the inevitable inclination toward brackishness.

How We Gain and Lose Weight To understand how we gain and lose weight, we need to start with insulin. Medical researchers and internal medicine doctors almost universally agree that the amount of insulin a person produces determines weight gain and weight loss. For example, Gary Taubes, a medical researcher and recipient of multiple awards from the National Association of Science Writers, refers to insulin as “the stop-and-go light of weight gain and loss.”    Produce more insulin—you will gain weight. Produce less insulin— you will lose weight.

When I am high I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere; I am entitled; God will provide. Credit cards are disastrous, personal checks worse. Unfortunately, for manics anyway, mania is a natural extension of the economy. What with credit cards and bank accounts there is little beyond reach. So I bought twelve snakebite kits, with a sense of urgency and importance. I bought precious stones, elegant and unnecessary furniture, three watches within an hour of one another (in the Rolex rather than Timex class: champagne tastes bubble to the surface, are the surface, in mania), and totally inappropriate sirenlike clothes. During one spree in London I spent several hundred pounds on books having titles or covers that somehow caught my fancy: books on the natural history of the mole, twenty sundry Penguin books because I thought it could be nice if the penguins could form a colony. Once I think I shoplifted a blouse because I could not wait a minute longer for the woman-with-molasses feet in front of me in line. Or maybe I just thought about shoplifting, I don’t remember, I was totally confused. I imagine I must have spent far more than thirty thousand dollars during my two major manic episodes, and God only knows how much more during my frequent milder manias. But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford. It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn’t fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you’re given excellent reason to be even more so.

No one 'just adopts'.

Today we are less likely to speak of humanitarianism, with its overtones of paternalistic generosity, and more likely to speak of human rights. The basic freedoms in life are not seen as gifts to be doled out by benevolent well-wishers, but as Casement said at his trial, as those rights to which all human beings are entitled from birth. It is this spirit which underlies organizations like Amnesty International, with its belief that putting someone in prison solely for his or her opinion is a crime, whether it happens in China or Turkey or Argentina and Medecins Sans Frontieres, with its belief that a sick child is entitled to medical care, whether in Rwanda or Honduras or the South Bronx.

This was the way of it with Parker. One kiss, and she was lost.

A lot of the appeal of internal medicine is Sherlockian—solving the case from the clues. We are detectives; we revel in the process of figuring it all out. It’s what doctors most love to do.

My abortion was a normal medical procedure that got tangled up in my bad relationship, my internalized fatphobia, my fear of adulthood, my discomfort with talking about sex; and one that, because of our culture’s obsession with punishing female sexuality and shackling women to the nursery and the kitchen, I was socialized to approach with shame and describe only in whispers. But the procedure itself was the easiest part. Not being able to have one would have been the real trauma.

contradiction with this the majority of medical writers hardly admit that the dream is a psychical phenomenon at all. According to them dreams are provoked and initiated exclusively by stimuli proceeding from the senses or the body, which either reach the sleeper from without or are accidental disturbances of his internal organs.

Claiming that the past was socially better than the present is also a hallmark of white supremacy. Consider any period in the past from the perspective of people of color: 246 years of brutal enslavement; the rape of black women for the pleasure of white men and to produce more enslaved workers; the selling off of black children; the attempted genocide of Indigenous people, Indian removal acts, and reservations; indentured servitude, lynching, and mob violence; sharecropping; Chinese exclusion laws; Japanese American internment; Jim Crow laws of mandatory segregation; black codes; bans on black jury service; bans on voting; imprisoning people for unpaid work; medical sterilization and experimentation; employment discrimination; educational discrimination; inferior schools; biased laws and policing practices; redlining and subprime mortgages; mass incarceration; racist media representations; cultural erasures, attacks, and mockery; and untold and perverted historical accounts, and you can see how a romanticized past is strictly a white construct. But it is a powerful construct because it calls out to a deeply internalized sense of superiority and entitlement and the sense that any advancement for people of color is an encroachment on this entitlement.

In the sitcom Scruns, medicals interns used the supply closet as a hideout when they needed to have a panic attack or a good cry. If you seek private space, you are much more likely to find it.

In my view, the recognition that a person has distorted thinking that comes from or produces suffering is important, but it has no inherent implication for action. It doesn’t imply medication, incarceration, or any particular brand of treatment. It just means stating openly that an internal conflict is not being resolved, is instead being expressed externally, and that those who did not cause the pain will be the ones to be blamed and to pay for it.

[I]nternalized experiences of selfhood are linked to autobiographical narratives, which are linked to biographies, legal testimonies, and medical case histories, which are linked to forms of therapy and theories of the subject. . .

They demanded legal clarity. So, beginning with California, states passed laws exempting doctors from prosecution if they prescribed opiates for pain within the practice of responsible health care. Numerous states approved so-called intractable pain regulations: Ohio, Oregon, Washington, and others. Soon what can only be described as a revolution in medical thought and practice was under way. Doctors were urged to begin attending to the country’s pain epidemic by prescribing these drugs. Interns and residents were taught that these drugs were now not addictive, that doctors thus had a mission, a duty, to use them. In some hospitals, doctors were told they could be sued if they did not treat pain aggressively, which meant with opiates. Russell

But the worst of the expense lies with the medications, and there is no reason for their high and fluctuating prices: the drugs have been off patent for decades, and we know that the same companies sell the same drugs at wildly different prices in different countries. Drug prices should not constitute the chief barrier to effective therapy for all patients... With less complaining, and more coordination, international public health authorities could have brought these prices down rapidly, as we have learned by our efforts to do so.

Many of the Chinese medical texts dating back from 2,000 years ago lament the ills of 'modern times' and allude to the traditional 'good old days' another 3,000 years before that. A common theme in these texts is the decline in human health due to careless lifestyles and the deterioration in human relations due to lack of love: degenerative conditions that Taoist alchemy as well as psychoneuroimmunology would link as symptoms of the same syndrome. In his essay entitled 'Loving People' Chang San-feng, the thirteenth-century master, summed it up by saying: 'Therefore to those who want to know the way to deal with the world, I suggest, Love People.' This is a potent description for health and longevity that generates positive healing energy throughout the human system by stimulating the internal alchemy of psychoneuroimmunology.

So much of what is broadly called wellness now involves an expensive kind of burrowing into our selves, wobbling on the plank between self-care and self-obsession. Many get lost in the labyrinth of internal observation, an endless cycle of maintenance of muscle, mood and self-medication.

Century after century, the belief that an individual’s physical health was independent of his or her emotional health has so dominated medical thought that there has even been open contempt for anyone who would dare to claim that a person’s physical well-being is the sum of its internal and external influences.

If overtly depressed men are paralyzed, men who are covertly depressed, as I was, cannot stand still. They run, desperately trying to outdistance shame by medicating their pain, pumping up their tenuous self-esteem, or, if all else fails, inflicting their torture on others. Overt depression is violence endured. Covert depression is violence deflected. In either case, understanding depression in men means coming to grips with men's violence. How has the door of the psyche been opened to such a dark visitation? By what mechanisms does violence in the boy's environment become internalized as a stable force inside his own mind?

Forces of digestion and metabolism are at work within me that are utterly beyond my perception or control. Most of my internal organs may as well not exist for all I know of them directly, and yet I can be reasonably certain that I have them, arranged much as any medical textbook would suggest. The taste of the coffee, my satisfaction at its flavor, the feeling of the warm cup in my hand—while these are immediate facts with which I am acquainted, they reach back into a dark wilderness of facts that I will never come to know... Where am I, that I have such a poor view of things? And what sort of thing am I that both my outside and my inside are so obscure?

Nostalgia was diagnosed [as a medical illness] at a time when art and science had not yet entirely severed their umbilical ties and when the mind and body internal and external well-being were treated together...Our progeny well might poeticize depression and see it as a global atmospheric condition, immune to treatment with Prozac.

Interestingly, it’s possible that practices related to the observance of Passover helped to protect Jewish neighborhoods from the plague. Passover is a week-long holiday commemorating Jews’ escape from slavery in Egypt. As part of its observance, Jews do not eat leavened bread and remove all traces of it from their homes. In many parts of the world, especially Europe, wheat, grain, and even legumes are also forbidden during Passover. Dr. Martin J. Blaser, a professor of internal medicine at New York University Medical Center, thinks this “spring cleaning” of grain stores may have helped to protect Jews from the plague, by decreasing their exposure to rats hunting for food—rats that carried the plague.

At the end of World War II, we had wage and price controls. Under wartime inflationary conditions, many employers found it difficult to recruit employees. To get around the limitations of wage control, many began to offer health care as a fringe benefit to attract workers. As a new benefit, it took some years for the Internal Revenue Service to get around to requiring the cost of the medical care to be included in the reported taxable income of the employees. By the time it did, workers had come to regard nontaxable medical care provided by the employer as a right—or should I say entitlement? They raised such a big political fuss that Congress legislated nontaxable status for employer-provided medical care.

Despite the intervening six decades of scientific inquiry since Selye’s groundbreaking work, the physiological impact of the emotions is still far from fully appreciated. The medical approach to health and illness continues to suppose that body and mind are separable from each other and from the milieu in which they exist. Compounding that mistake is a definition of stress that is narrow and simplistic. Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary. For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaninglessness. People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such persons stress feels desirable, while the absence of it feels like something to be avoided. When people describe themselves as being stressed, they usually mean the nervous agitation they experience under excessive demands — most commonly in the areas of work, family, relationships, finances or health. But sensations of nervous tension do not define stress — nor, strictly speaking, are they always perceived when people are stressed. Stress, as we will define it, is not a matter of subjective feeling. It is a measurable set of objective physiological events in the body, involving the brain, the hormonal apparatus, the immune system and many other organs. Both animals and people can experience stress with no awareness of its presence. “Stress is not simply nervous tension,” Selye pointed out. “Stress reactions do occur in lower animals, and even in plants, that have no nervous systems…. Indeed, stress can be produced under deep anaesthesia in patients who are unconscious, and even in cell cultures grown outside the body.” Similarly, stress effects can be highly active in persons who are fully awake, but who are in the grip of unconscious emotions or cut off from their body responses. The physiology of stress may be triggered without observable effects on behaviour and without subjective awareness, as has been shown in animal experiments and in human studies.

It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn’t fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you’re given excellent reason to be even more so.

Dr. Deanna Adkins of Duke University School of Medicine claims that gender identity is “the only medically supported determinant of sex,” adding, “It is counter to medical science to use chromosomes, hormones, internal reproductive organs, external genitalia, or secondary sex characteristics to override gender identity for purposes of classifying someone as male or female.

A few weeks ago, he had invited a young physician friend, Sigmund Freud, to accompany him for an entire day. A mistake perhaps! The young man had been attempting to decide on his choice of medical specialty, and that day may have frightened him away from the practice of general internal medicine. For, according to Freud’s calculations, Breuer had spent six hours in his fiacre!

Because now mental health disorders have gone “mainstream”. And for all the good it’s brought people like me who have been given therapy and stuff, there’s a lot of bad it’s brought too. Because now people use the phrase OCD to describe minor personality quirks. “Oooh, I like my pens in a line, I’m so OCD.” NO YOU’RE FUCKING NOT. “Oh my God, I was so nervous about that presentation, I literally had a panic attack.” NO YOU FUCKING DIDN’T. “I’m so hormonal today. I just feel totally bipolar.” SHUT UP, YOU IGNORANT BUMFACE. Told you I got angry. These words – words like OCD and bipolar – are not words to use lightly. And yet now they’re everywhere. There are TV programmes that actually pun on them. People smile and use them, proud of themselves for learning them, like they should get a sticker or something. Not realizing that if those words are said to you by a medical health professional, as a diagnosis of something you’ll probably have for ever, they’re words you don’t appreciate being misused every single day by someone who likes to keep their house quite clean. People actually die of bipolar, you know? They jump in front of trains and tip down bottles of paracetamol and leave letters behind to their devastated families because their bullying brains just won’t let them be for five minutes and they can’t bear to live with that any more. People also die of cancer. You don’t hear people going around saying: “Oh my God, my headache is so, like, tumoury today.” Yet it’s apparently okay to make light of the language of people’s internal hell

The Mongols made culture portable. It was not enough to merely exchange goods, because whole systems of knowledge had to also be transported in order to use many of the new products. Drugs, for example, were not profitable items of trade unless there was adequate knowledge of how to use them. Toward this objective, the Mongol court imported Persian and Arab doctors into China, and they exported Chinese doctors to the Middle East. Every form of knowledge carried new possibilities for merchandising. It became apparent that the Chinese operated with a superior knowledge of pharmacology and of unusual forms of treatment such as acupuncture, the insertion of needles at key points in the body, and moxibustion, the application of fire or heat to similar areas. Muslims doctors, however, possessed a much more sophisticated knowledge of surgery, but, based on their dissection of executed criminals, the Chinese had a detailed knowledge of internal organs and the circulatory system. To encourage a fuller exchange of medical knowledge, the Mongols created hospitals and training centers in China using doctors from India and the Middle East as well as Chinese healers.

The young doctor was disappointed: he had never had th eopportunity to study the effects of gold cyanide on a cadaver. Dr. Juvenal Urbino had been surprised that he had not seen him at the Medical School, but he understood in an instant from the young man's blush and Andean accent that he was probably a recent arrival to the city. He said: "There is bound to be someone driven mad by love who will give you the chance one of these days." And only after he said it did he realize that among the countless suicides he could remeber, this was the first with cyanide that had not been caused by the sufferings of love. Then something changed in the tone of his voice. "And when you do find one, observe with care," he said to the intern: "they almost always have crystals in their heart.

A black intern at the County Hospital now watched Mary Young die of pneumonia. The intern did not know her. He had been in Midland City for only a week. He wasn't even a fellow-American, although he had taken his medical degree at Harvard. He was an Indaro. He was a Nigerian. His name was Cyprian Ukwende. He felt no kinship with Mary or with any American blacks. He felt kinship only with Indaros. As she died, Mary was as alone on the planet as were Dwayne Hoover or Kilgore Trout. She had never reproduced. There were no friends or relatives to watch her die. So she spoke her very last words on the planet to Cyprian Ukwende. She did not have enough breath left to make her vocal chords buzz. She could only move her lips noiselessly. Here is all she had to say about death: "Oh my, oh my.

according to a recent paper published in the Annals of Internal Medicine, patients failing to properly take their medication cost society somewhere between $100 billion and $289 billion every year.36 (It’s estimated that nearly 50 percent of prescriptions for chronic diseases are not used as prescribed.)37 Obesity, meanwhile, adds another $190 billion in direct health care costs. Drunk driving? $114 billion.38 Smoking? Nearly $290 billion.

[ Dr. Lois Jolyon West was cleared at Top Secret for his work on MKULTRA. ] Dr. Michael Persinger [235], another FSMF Board Member, is the author of a paper entitled “Elicitation of 'Childhood Memories' in Hypnosis-Like Settings Is Associated With Complex Partial Epileptic-Like Signs For Women But Not for Men: the False Memory Syndrome.” In the paper Perceptual and Motor Skills,In the paper, Dr. Persinger writes: On the day of the experiment each subject (not more than two were tested per day) was asked to sit quietly in an acoustic chamber and was told that the procedure was an experiment in relaxation. The subject wore goggles and a modified motorcycle helmet through which 10-milligauss (1 microTesla) magnetic fields were applied through the temporal plane. Except for a weak red (photographic developing) light, the room was dark. Dr. Persinger's research on the ability of magnetic fields to facilitate the creation of false memories and altered states of consciousness is apparently funded by the Defense Intelligence Agency through the project cryptonym SLEEPING BEAUTY. Freedom of Information Act requests concerning SLEEPING BEAUTY with a number of different intelligence agencies including the CIA and DEA has yielded denial that such a program exists. Certainly, such work would be of direct interest to BLUEBIRD, ARTICHOKE, MKULTRA and other non-lethal weapons programs. Schnabel [280] lists Dr. Persinger as an Interview Source in his book on remote viewing operations conducted under Stargate, Grill Flame and other cryptonyms at Fort Meade and on contract to the Stanford Research Institute. Schnabel states (p. 220) that, “As one of the Pentagon's top scientists, Vorona was privy to some of the strangest, most secret research projects ever conceived. Grill Flame was just one. Another was code-named Sleeping Beauty; it was a Defense Department study of remote microwave mind-influencing techniques ... [...] It appears from Schnabel's well-documented investigations that Sleeping Beauty is a real, but still classified mind control program. Schnabel [280] lists Dr. West as an Interview Source and says that West was a, “Member of medical oversight board for Science Applications International Corp. remote-viewing research in early 1990s.

Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary.

For nearly a hundred years, psychiatry has been striving to apply medical model thinking to psychiatric disorders. In this model, the symptoms besieging patients are sorted into specific disease entities and the causes then identified and removed. For doctors of internal medicine, this works. In the case of diabetes mellitus, for example, the symptoms of urinary frequency, fatigue, and confusion often lead to suspicion of the underlying cause, which is confirmed by blood sugar monitoring and then treated by insulin replacement. But psychiatric symptoms are much harder to sort into diagnoses. People with depression sometimes become paranoid. People with schizophrenia sometimes become depressed. Some people who hear voices have no other symptoms whatsoever, and others who hear voices also fall victim to terrible mood swings. Thus far, the hope that psychiatry would be able to identify homogeneous disease states, uncover the biological underpinnings, and remedy them has been largely a barren one. Kappler's symptoms, however, evolved when the hope for psychiatry's becoming a true medical specialty was bright to the point of being blinding. Over the years he would collect over a dozen diagnoses and cavalierly take a myriad of medicines, but no one would be able to bring him close to confronting the past he had disowned, to stand a chance of making peace with it and, ultimately, overcoming it. (46)

In Women and Madness, Phyllis Chesler writes of what she calls “psychiatric imperialism,” whereby normal responses to trauma are methodically pathologized in science and medicine. At the time of the book’s publication in 1972, few women were coming forward about gender biases in the study and practice of psychology. Chesler felt compelled to bring forward a conversation around gender, race, class, and medical ethics because “modern female psychology reflects a relatively powerless and deprived condition.” Of sensitivity she writes: “Many intrinsically valuable female traits, such as intuitiveness or compassion, have probably been developed through default or patriarchal-imposed necessity, rather than through either biological predisposition or free choice. Female emotional ‘talents’ must be viewed in terms of the overall price exacted by sexism.” Regardless of causation, of note here is that women’s internal lives were barely acknowledged or considered.

But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford. It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn't fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you're given excellent reason to be even more so.

We all build internal sea walls to keep at bay the sadnesses of life and the often overwhelming forces within our minds. In whatever way we do this - through love, work, family, faith, friends, denial, alcohol, drugs, or medication - we build these walls, stone by stone, over a lifetime. One of the most difficult problems is to construct these barriers of such a height and strength that one has a true harbor, a sanctuary away from crippling turmoil and pain, but yet low enough, and permeable enough, to let in fresh seawater that will fend off the inevitable inclination toward brackishness.

When trying to comprehend what is happening to, and through, oneself, why not question the narratives one has been handed to make sense with? This is an approach increasingly utilized within transgender knowledge production, one spearheaded by transgender people themselves. It brings to light questions about previous entries into the trans nonfiction canon, asking: Is it necessary, when writing a trans protagonist, to describe in detail a medical transition, to 'confess' conflicted feelings of body confusion? Has it even been internalized into a communal consciousness, into something resembling a trans storytelling requirement?

Some of the Israelis’ punitive actions reminded one of pre-modern age incarceration and imprisonment methods – long outlawed in the civilized world. They included corporal punishment before and during arrests, a method particularly used with children and youths as part of the penalization operation. As the uprising continued the international community became more aware of the victimization of children that was taking place. The Swedish branch of Save the Children estimated that between 23,600 and 29,900 children required medical treatment for injuries sustained from beatings in the first two years of the Intifada, a third of whom were under the age of ten

Needless to say, elderly people taking steroids may also experience the same side effects as younger persons. So, if you are a senior and need to be on a long course of steroids, what should you do? We would suggest a practical approach—which could apply to anyone on steroids, regardless of age, but may be particularly relevant for seniors because they are particularly vulnerable to side effects: • Understand and verify the need for steroids in your own situation, weighing the anticipated benefit with the possible risks. This means that you should explore the range of other treatments that may be available for your particular condition. You need to learn about the benefits and risks of any other treatment suggested. In other words, get all the information you can prior to going on treatment, be it with steroids or other medications. • Be sure that your health is well-assessed before or at the start of therapy. If you have underlying, separate health conditions, those should be noted and followed while you are on steroids. • Assess bodily systems that might particularly be affected by being on steroids. This means an assessment of your skeletal health, your eyes, your teeth, and your internal organs. • Request guidance about staying active. Physical therapy should be planned, to minimize the chances that your muscles and joints will be overtaxed or that any existing damage might get worse. • Ask to reassess the length and dose of your medication course at various intervals. A reasonable interval is every couple of months, if you are on a long course of steroids.

In 1995, China passed the National Maternal and Infant Health Law, forbidding couples who had “genetic diseases of a serious nature” to procreate. The conditions listed include mental retardation, mental illness, and seizures. These couples were required to undergo a mandatory premarital medical exam. It was hugely controversial, reviving international criticism that China practices eugenics. Actually, the wording of the national law was considered mild. Some provinces had more explicit regulations. In 1988, Gansu Province passed local regulations prohibiting “reproduction of the dull-witted, idiots, or blockheads.” Gansu abolished that law in 2002. Similarly, the National Maternal and Infant Health Law was defanged when requirements for the premarital medical examination were quietly dropped in 2003.

We all build internal sea walls to keep at bay the sadness of life and the often overwhelming forces within our minds. In whatever way we do this--through love, work, family, faith, friends, denial, alcohol, drugs, or medication--we guild these walls, stone by stone, over a lifetime. One of the most difficult problems is to construct these barriers of such a height and strength that one has a true harbor, a sanctuary away from crippling turmoil and pain, and yet low enough, and permeable enough, to let in fresh seawater that will fend off the inevitable inclination toward blackishness. For someone with my cast of mind and mood, medication is an integral element of this wall: without it, I would be constantly beholden to the crushing movements of the mental sea; I would, unquestionably, be dead or insane. But love is, to me, the ultimately more extraordinary part of the breakwater wall: it helps to shut out the terror and awfulness, while, at the same time, allowing in life and beauty and vitality.

There were six hundred thousand Indian troops in Kashmir but the pogrom of the pandits was not prevented, why was that. Three and a half lakhs of human beings arrived in Jammu as displaced persons and for many months the government did not provide shelters or relief or even register their names, why was that. When the government finally built camps it only allowed for six thousand families to remain in the state, dispersing the others around the country where they would be invisible and impotent, why was that. The camps at Purkhoo, Muthi, Mishriwallah, Nagrota were built on the banks and beds of nullahas, dry seasonal waterways, and when the water came the camps were flooded, why was that. The ministers of the government made speeches about ethnic cleansing but the civil servants wrote one another memos saying that the pandits were simply internal migrants whose displacement had been self-imposed, why was that. The tents provided for the refugees to live in were often uninspected and leaking and the monsoon rains came through, why was that. When the one-room tenements called ORTs were built to replace the tents they too leaked profusely, why was that. There was one bathroom per three hundred persons in many camps why was that and the medical dispensaries lacked basic first-aid materials why was that and thousands of the displaced died because of inadequate food and shelter why was that maybe five thousand deaths because of intense heat and humidity because of snake bites and gastroenteritis and dengue fever and stress diabetes and kidney ailments and tuberculosis and psychoneurosis and there was not a single health survey conducted by the government why was that and the pandits of Kashmir were left to rot in their slum camps, to rot while the army and the insurgency fought over the bloodied and broken valley, to dream of return, to die while dreaming of return, to die after the dream of return died so that they could not even die dreaming of it, why was that why was that why was that why was that why was that.

I can hardly believe that our nation’s policy is to seek peace by going to war. It seems that President Donald J. Trump has done everything in his power to divert our attention away from the fact that the FBI is investigating his association with Russia during his campaign for office. For several weeks now he has been sabre rattling and taking an extremely controversial stance, first with Syria and Afghanistan and now with North Korea. The rhetoric has been the same, accusing others for our failed policy and threatening to take autonomous military action to attain peace in our time. This gunboat diplomacy is wrong. There is no doubt that Secretaries Kelly, Mattis, and other retired military personnel in the Trump Administration are personally tough. However, most people who have served in the military are not eager to send our young men and women to fight, if it is not necessary. Despite what may have been said to the contrary, our military leaders, active or retired, are most often the ones most respectful of international law. Although the military is the tip of the spear for our country, and the forces of civilization, it should not be the first tool to be used. Bloodshed should only be considered as a last resort and definitely never used as the first option. As the leader of the free world, we should stand our ground but be prepared to seek peace through restraint. This is not the time to exercise false pride! Unfortunately the Trump administration informed four top State Department management officials that their services were no longer needed as part of an effort to "clean house." Patrick Kennedy, served for nine years as the “Undersecretary for Management,” “Assistant Secretaries for Administration and Consular Affairs” Joyce Anne Barr and Michele Bond, as well as “Ambassador” Gentry Smith, director of the Office for Foreign Missions. Most of the United States Ambassadors to foreign countries have also been dismissed, including the ones to South Korea and Japan. This leaves the United States without the means of exercising diplomacy rapidly, when needed. These positions are political appointments, and require the President’s nomination and the Senate’s confirmation. This has not happened! Moreover, diplomatically our country is severely handicapped at a time when tensions are as hot as any time since the Cold War. Without following expert advice or consent and the necessary input from the Unites States Congress, the decisions are all being made by a man who claims to know more than the generals do, yet he has only the military experience of a cadet at “New York Military Academy.” A private school he attended as a high school student, from 1959 to 1964. At that time, he received educational and medical deferments from the Vietnam War draft. Trump said that the school provided him with “more training than a lot of the guys that go into the military.” His counterpart the unhinged Kim Jong-un has played with what he considers his country’s military toys, since April 11th of 2012. To think that these are the two world leaders, protecting the planet from a nuclear holocaust….

What are the health effects of the choice between austerity and stimulus? Today there is a vast natural experiment being conducted on the body economic. It is similar to the policy experiments that occurred in the Great Depression, the post-communist crisis in eastern Europe, and the East Asian Financial Crisis. As in those prior trials, health statistics from the Great Recession reveal the deadly price of austerity—a price that can be calculated not just in the ticks to economic growth rates, but in the number of years of life lost and avoidable deaths. Had the austerity experiments been governed by the same rigorous standards as clinical trials, they would have been discontinued long ago by a board of medical ethics. The side effects of the austerity treatment have been severe and often deadly. The benefits of the treatment have failed to materialize. Instead of austerity, we should enact evidence-based policies to protect health during hard times. Social protection saves lives. If administered correctly, these programs don’t bust the budget, but—as we have shown throughout this book—they boost economic growth and improve public health. Austerity’s advocates have ignored evidence of the health and economic consequences of their recommendations. They ignore it even though—as with the International Monetary Fund—the evidence often comes from their own data. Austerity’s proponents, such as British Prime Minister David Cameron, continue to write prescriptions of austerity for the body economic, in spite of evidence that it has failed. Ultimately austerity has failed because it is unsupported by sound logic or data. It is an economic ideology. It stems from the belief that small government and free markets are always better than state intervention. It is a socially constructed myth—a convenient belief among politicians taken advantage of by those who have a vested interest in shrinking the role of the state, in privatizing social welfare systems for personal gain. It does great harm—punishing the most vulnerable, rather than those who caused this recession.

Flow is an extremely potent response to external events and requires an extraordinary set of signals. The process includes dopamine, which does more than tune signal-to-noise ratios. Emotionally, we feel dopamine as engagement, excitement, creativity, and a desire to investigate and make meaning out of the world. Evolutionarily, it serves a similar function. Human beings are hardwired for exploration, hardwired to push the envelope: dopamine is largely responsible for that wiring. This neurochemical is released whenever we take a risk or encounter something novel. It rewards exploratory behavior. It also helps us survive that behavior. By increasing attention, information flow, and pattern recognition in the brain, and heart rate, blood pressure, and muscle firing timing in the body, dopamine serves as a formidable skill-booster as well. Norepinephrine provides another boost. In the body, it speeds up heart rate, muscle tension, and respiration, and triggers glucose release so we have more energy. In the brain, norepinephrine increases arousal, attention, neural efficiency, and emotional control. In flow, it keeps us locked on target, holding distractions at bay. And as a pleasure-inducer, if dopamine’s drug analog is cocaine, norepinephrine’s is speed, which means this enhancement comes with a hell of a high. Endorphins, our third flow conspirator, also come with a hell of a high. These natural “endogenous” (meaning naturally internal to the body) opiates relieve pain and produce pleasure much like “exogenous” (externally added to the body) opiates like heroin. Potent too. The most commonly produced endorphin is 100 times more powerful than medical morphine. The next neurotransmitter is anandamide, which takes its name from the Sanskrit word for “bliss”—and for good reason. Anandamide is an endogenous cannabinoid, and similarly feels like the psychoactive effect found in marijuana. Known to show up in exercise-induced flow states (and suspected in other kinds), this chemical elevates mood, relieves pain, dilates blood vessels and bronchial tubes (aiding respiration), and amplifies lateral thinking (our ability to link disparate ideas together). More critically, anandamide also inhibits our ability to feel fear, even, possibly, according to research done at Duke, facilitates the extinction of long-term fear memories. Lastly, at the tail end of a flow state, it also appears (more research needs to be done) that the brain releases serotonin, the neurochemical now associated with SSRIs like Prozac. “It’s a molecule involved in helping people cope with adversity,” Oxford University’s Philip Cowen told the New York Times, “to not lose it, to keep going and try to sort everything out.” In flow, serotonin is partly responsible for the afterglow effect, and thus the cause of some confusion. “A lot of people associate serotonin directly with flow,” says high performance psychologist Michael Gervais, “but that’s backward. By the time the serotonin has arrived the state has already happened. It’s a signal things are coming to an end, not just beginning.” These five chemicals are flow’s mighty cocktail. Alone, each packs a punch, together a wallop.

A lot of girls think they're ready to have sex, but then change their mind, after the fact." It took Daniel a minute to find his voice. "Are you saying that my daughter's lying?" "No. But I want you to understand that even if Trixie is willing to testify, you might not get the outcome you're hoping for." "She's fourteen, for God's sake," Daniel said. "Kids younger than that are having sex. And according to the medical report, there wasn't significant internal trauma." "She wasn't hurt enough?" "I'm just saying that given the details-the alcohol, the strip poker, the former relationship with Jason-rape could be a hard sell to a jury. The boy's going to say it was consensual." Daniel clenched his jaw. "If a murder suspect told you he was innocent, would you just let him walk away?" "It's not quite the same-" "No, it's not. Because the murder victim's dead and can't give you any information about what really happened. As opposed to my daughter, the one who's inside there telling you exactly how she was raped, while you aren't fucking listening to her.

Medicine once consisted of the knowledge of a few simples, to stop the flow of blood, or to heal wounds; then by degrees it reached its present stage of complicated variety. No wonder that in early days medicine had less to do! Men's bodies were still sound and strong; their food was light and not spoiled by art and luxury, whereas when they began to seek dishes not for the sake of removing, but of rousing, the appetite, and devised countless sauces to whet their gluttony, – then what before was nourishment to a hungry man became a burden to the full stomach. 16. Thence come paleness, and a trembling of wine-sodden muscles, and a repulsive thinness, due rather to indigestion than to hunger. Thence weak tottering steps, and a reeling gait just like that of drunkenness. Thence dropsy, spreading under the entire skin, and the belly growing to a paunch through an ill habit of taking more than it can hold. Thence yellow jaundice, discoloured countenances, and bodies that rot inwardly, and fingers that grow knotty when the joints stiffen, and muscles that are numbed and without power of feeling, and palpitation of the heart with its ceaseless pounding. 17. Why need I mention dizziness? Or speak of pain in the eye and in the ear, itching and aching[11] in the fevered brain, and internal ulcers throughout the digestive system? Besides these, there are countless kinds of fever, some acute in their malignity, others creeping upon us with subtle damage, and still others which approach us with chills and severe ague. 18. Why should I mention the other innumerable diseases, the tortures that result from high living?   Men used to be free from such ills, because they had not yet slackened their strength by indulgence, because they had control over themselves, and supplied their own needs.[12] They toughened their bodies by work and real toil, tiring themselves out by running or hunting or tilling the earth. They were refreshed by food in which only a hungry man could take pleasure. Hence, there was no need for all our mighty medical paraphernalia, for so many instruments and pill-boxes. For plain reasons they enjoyed plain health;

When I was a child, no one ever said the words "institutionalized racism." We hardly even said the word "racism." I don't think I took a single class in college that talked about the physiological effects of years of personally medicated racism and internalized racism. This was before studies came out that showed that black women were four times more likely to die from childbirth, before people were talking about epigenetics and whether or not trauma was heritable. If those studies were out there, I never read them. If those classes were offered, I never took them. There was little interest in these ideas back then because there was, there *is,* little interest in the lives of black people. What I'm saying is I didn't grow up with a language for, a way to explain, to parse out, my self-loathing. I grew up only with my part, my little throbbing stone of self-hate that I carried around with me to church, to school, to all those places in my life that worked, it seemed to me then, to affirm the idea that I was irreparably, fatally, wrong. I was a child who liked to be right.

Christianity has been the means of reducing more languages to writing than have all other factors combined. It has created more schools, more theories of education, and more systems than has any other one force. More than any other power in history it has impelled men to fight suffering, whether that suffering has come from disease, war or natural disasters. It has built thousands of hospitals, inspired the emergence of the nursing and medical professions, and furthered movement for public health and the relief and prevention of famine. Although explorations and conquests which were in part its outgrowth led to the enslavement of Africans for the plantations of the Americas, men and women whose consciences were awakened by Christianity and whose wills it nerved brought about the abolition of slavery (in England and America). Men and women similarly moved and sustained wrote into the laws of Spain and Portugal provisions to alleviate the ruthless exploitation of the Indians of the New World. Wars have often been waged in the name of Christianity. They have attained their most colossal dimensions through weapons and large–scale organization initiated in (nominal) Christendom. Yet from no other source have there come as many and as strong movements to eliminate or regulate war and to ease the suffering brought by war. From its first centuries, the Christian faith has caused many of its adherents to be uneasy about war. It has led minorities to refuse to have any part in it. It has impelled others to seek to limit war by defining what, in their judgment, from the Christian standpoint is a "just war." In the turbulent Middle Ages of Europe it gave rise to the Truce of God and the Peace of God. In a later era it was the main impulse in the formulation of international law. But for it, the League of Nations and the United Nations would not have been. By its name and symbol, the most extensive organization ever created for the relief of the suffering caused by war, the Red Cross, bears witness to its Christian origin. The list might go on indefinitely. It includes many another humanitarian projects and movements, ideals in government, the reform of prisons and the emergence of criminology, great art and architecture, and outstanding literature.

Yet skill in the most sophisticated applications of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination; order the appropriate laboratory, imaging, and diagnostic tests; and extract the key results from densely populated computer screens to determine whether to treat or to “watch.” As the number of tests increases, so does the likelihood that some incidental finding, completely unrelated to the clinical problem at hand, will be uncovered. Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed test, preventive measure, or treatment entails a greater risk than the disease itself are essential judgments that a skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.

When I am high I couldn’t worry about money if I tried. So I don’t. The money will come from somewhere; I am entitled; God will provide. Credit cards are disastrous, personal checks worse. Unfortunately, for manics anyway, mania is a natural extension of the economy. What with credit cards and bank accounts there is little beyond reach....During one spree in London I spent several hundred pounds on books having titles or covers that somehow caught my fancy: books on the natural history of the mole, twenty sundry Penguin books because I thought it could be nice if the penguins could form a colony..... But then back on lithium and rotating on the planet at the same pace as everyone else, you find your credit is decimated, your mortification complete: mania is not a luxury one can easily afford. It is devastating to have the illness and aggravating to have to pay for medications, blood tests, and psychotherapy. They, at least, are partially deductible. But money spent while manic doesn’t fit into the Internal Revenue Service concept of medical expense or business loss. So after mania, when most depressed, you’re given excellent reason to be even more so.

Army studies indicate that if a wounded soldier arrives alive at a combat support hospital where surgeons and nurses can treat him, the chances of his surviving are extremely high—greater than 90 percent. “Surviving,” of course, doesn’t necessarily entail keeping arms or legs or retaining the ability to function independently back home. The leading cause of preventable death on the battlefield is bleeding. Having a leg blown off by an IED, for instance, can be fatal if quick steps are not taken to control the blood loss. Even deadlier is internal bleeding, a problem for which medics generally don’t have a good answer. A soldier who is bleeding internally needs to be evacuated and delivered to a surgeon immediately if he is to have any hope of survival. The second-leading cause of preventable death is something called tension pneumothorax. If a bullet punctures a soldier’s lung, air can leak from that hole into the “pleural space,” or cavity outside the lungs. That air can build up and eventually interfere with the functioning of the heart. This can be a relatively simple problem to correct: a medic can simply stick a big needle in the soldier’s chest to relieve the pressure in the pleural space.

The ability to draw a connection between two things that had previously appeared to be unrelated is an important part of creativity, and it appears that it can be enhanced by electrical stimulation. Compared to participants who were given fake tDCS, those who got electricity created more unusual analogies—that is, analogies between things that seemed very unlike one another. Nevertheless, these highly creative analogies were just as accurate as the more obvious ones created by the participants whose devices were secretly turned off. Dopaminergic drugs can do the same thing. Although some patients who take dopaminergic drugs for Parkinson’s disease develop devastating compulsions, others experience enhanced creativity. One patient who came from a family of poets had never done any creative writing. After starting dopamine-boosting drugs for his Parkinson’s disease, he wrote a poem that won the annual contest of the International Association of Poets. Painters treated with Parkinson’s medication often increase their use of vivid color. One patient who developed a new style after being treated said, “The new style is less precise but more vibrant. I have a need to express myself more. I just let myself go.” Just like Winnie-the-Pooh: “It is the best way to write poetry, letting things come.

Yet the homogeneity of contemporary humanity is most apparent when it comes to our view of the natural world and of the human body. If you fell sick a thousand years ago, it mattered a great deal where you lived. In Europe, the resident priest would probably tell you that you had made God angry and that in order to regain your health you should donate something to the church, make a pilgrimage to a sacred site, and pray fervently for God’s forgiveness. Alternatively, the village witch might explain that a demon had possessed you and that she could cast it out using song, dance, and the blood of a black cockerel. In the Middle East, doctors brought up on classical traditions might explain that your four bodily humors were out of balance and that you should harmonize them with a proper diet and foul-smelling potions. In India, Ayurvedic experts would offer their own theories concerning the balance between the three bodily elements known as doshas and recommend a treatment of herbs, massages, and yoga postures. Chinese physicians, Siberian shamans, African witch doctors, Amerindian medicine men—every empire, kingdom, and tribe had its own traditions and experts, each espousing different views about the human body and the nature of sickness, and each offering their own cornucopia of rituals, concoctions, and cures. Some of them worked surprisingly well, whereas others were little short of a death sentence. The only thing that united European, Chinese, African, and American medical practices was that everywhere at least a third of all children died before reaching adulthood, and average life expectancy was far below fifty.14 Today, if you happen to be sick, it makes much less difference where you live. In Toronto, Tokyo, Tehran, or Tel Aviv, you will be taken to similar-looking hospitals, where you will meet doctors in white coats who learned the same scientific theories in the same medical colleges. They will follow identical protocols and use identical tests to reach very similar diagnoses. They will then dispense the same medicines produced by the same international drug companies. There are still some minor cultural differences, but Canadian, Japanese, Iranian, and Israeli physicians hold much the same views about the human body and human diseases. After the Islamic State captured Raqqa and Mosul, it did not tear down the local hospitals. Rather, it launched an appeal to Muslim doctors and nurses throughout the world to volunteer their services there.15 Presumably even Islamist doctors and nurses believe that the body is made of cells, that diseases are caused by pathogens, and that antibiotics kill bacteria.

Yet, it was precisely our failure to differentiate between work and politics, between reality and illusion; it was precisely our mistake of conceiving of politics as a rational human activity comparable to the sowing of seeds or the construction of buildings that was responsible for the fact that a painter who failed to make the grade was able to plunge the whole world into misery. And I have stressed again and again that the main purpose of this book—which, after all, was not written merely for the fun of it—was to demonstrate these catastrophic errors in human thinking and to eliminate irrationalism from politics. It is an essential part of our social tragedy that the farmer, the industrial worker, the physician, etc., do not influence social existence solely through their social activities, but also and even predominantly through their political ideologies. For political activity hinders objective and professional activity; it splits every profession into inimical ideologic groups; creates a dichotomy in the body of industrial workers; limits the activity of the medical profession and harms the patients. In short, it is precisely political activity that prevents the realization of that which it pretends to fight for: peace, work, security, international cooperation, free objective speech, freedom of religion, etc.

She looked thoughtful. “Who knows? Perhaps now is the time to see through the habit. Accidents, illness, healing, they’re all more mysterious than any of us ever imagined. I believe that we have an undiscovered ability to influence what happens to us in the future, including whether we are healthy—although, again, the power has to remain with the individual patient. “There was a reason that I didn’t offer an opinion concerning how badly you were hurt. We in the medical establishment have learned that medical opinions have to be offered very carefully. Over the years the public has developed almost a worship of doctors, and when a physician says something, patients have tended to take these opinions totally to heart. The country doctors of a hundred years ago knew this, and would use this principle to actually paint an overly optimistic picture of any health situation. If the doctor said that the patient would get better, very often the patient would internalize this idea in his or her mind and actually defy all odds to recover. In later years, however, ethical considerations have prevented such distortions, and the establishment has felt that the patient is entitled to a cold scientific assessment of his or her situation. “Unfortunately when this was given, sometimes patients dropped dead right before our eyes, just because they were told their condition was terminal. We know now that we have to be very careful with these assessments, because of the power of our minds. We want to focus this power in a positive direction. The body is capable of miraculous regeneration. Body parts thought of in the past as solid forms are actually energy systems that can transform overnight. Have you read the latest research on prayer? The simple fact that this kind of spiritual visualization is being scientifically proven to work totally undermines our old physical model of healing. We’re having to work out a new model.” She paused and poured more water on the towel around my ankle, then continued, “I believe the first step in the process is to identify the fear with which the medical problem seems to be connected; this opens up the energy block in your body to conscious healing. The next step is to pull in as much energy as possible and focus it at the exact location of the block.” I was about to ask how this was done, but she stopped me. “Go ahead and raise your energy level as much as you can.” Accepting her guidance, I began to observe the beauty around me and to concentrate on a spiritual connection within, evoking a heightened sensation of love. Gradually the colors became more vivid and everything in my awareness increased in presence. I could tell that she was raising her own energy at the same time. When I felt as though my vibration had increased as much as possible, I looked at her. She smiled back at me. “Okay, now you can focus the energy on the block.” “How do I do that?” I asked. “You use the pain. That’s why it’s there, to help you focus.

The appropriation of terms from psychology to discredit political opponents is part of the modern therapeutic culture that the sociologist Christopher Lasch criticized. Along with the concept of the authoritarian personality, the term “-phobe” for political opponents has been added to the arsenal of obloquy deployed by technocratic neoliberals against those who disagree with them. The coinage of the term “homophobia” by the psychologist George Weinberg in the 1970s has been followed by a proliferation of pseudoclinical terms in which those who hold viewpoints at variance with the left-libertarian social consensus of the transatlantic ruling class are understood to suffer from “phobias” of various kinds similar to the psychological disorders of agoraphobia (fear of open spaces), ornithophobia (fear of birds), and pentheraphobia (fear of one’s mother-in-law). The most famous use of this rhetorical strategy can be found in then-candidate Hillary Clinton’s leaked confidential remarks to an audience of donors at a fund-raiser in New York in 2016: “You know, to just be grossly generalistic, you could put half of Trump’s supporters into what I call the basket of deplorables. Right? They’re racist, sexist, homophobic, xenophobic, Islamophobic—you name it.” A disturbed young man who is driven by internal compulsions to harass and assault gay men is obviously different from a learned Orthodox Jewish rabbi who is kind to lesbians and gay men as individuals but opposes homosexuality, along with adultery, premarital sex, and masturbation, on theological grounds—but both are "homophobes.” A racist who opposes large-scale immigration because of its threat to the supposed ethnic purity of the national majority is obviously different from a non-racist trade unionist who thinks that immigrant numbers should be reduced to create tighter labor markets to the benefit of workers—but both are “xenophobes.” A Christian fundamentalist who believes that Muslims are infidels who will go to hell is obviously different from an atheist who believes that all religion is false—but both are “Islamophobes.” This blurring of important distinctions is not an accident. The purpose of describing political adversaries as “-phobes” is to medicalize politics and treat differing viewpoints as evidence of mental and emotional disorders. In the latter years of the Soviet Union, political dissidents were often diagnosed with “sluggish schizophrenia” and then confined to psychiatric hospitals and drugged. According to the regime, anyone who criticized communism literally had to be insane. If those in today’s West who oppose the dominant consensus of technocratic neoliberalism are in fact emotionally and mentally disturbed, to the point that their maladjustment makes it unsafe to allow them to vote, then to be consistent, neoliberals should support the involuntary confinement, hospitalization, and medication of Trump voters and Brexit voters and other populist voters for their own good, as well as the good of society.

The hot case at a kombini features tonkatsu, fried chicken, menchikatsu (a breaded hamburger patty), Chinese pork buns, potato croquettes, and seafood items such as breaded squid legs or oysters. In a bit of international solidarity, you'll see corn dogs, often labeled "Amerikandoggu." One day for lunch I stopped at 7-Eleven and brought home a pouch of "Gold Label" beef curry, steamed rice, inarizushi (sushi rice in a pouch of sweetened fried tofu), cold noodle salad, and a banana. Putting together lunch for the whole family from an American 7-Eleven would be as appetizing as scavenging among seaside medical waste, but this fun to shop for and fun to eat. Instant ramen is as popular in Japan as it is in college dorms worldwide, and while the selection of flavors is wider than at an American grocery, it serves a predictable ecological niche as the food of last resort for those with no money or no time. (Frozen ramen, on the other hand, can be very good; if you have access to a Japanese supermarket, look for Myojo Chukazanmai brand.) That's how I saw it, at least, until stumbling on the ramen topping section in the 7-Eleven refrigerator case, where you can buy shrink-wrapped packets of popular fresh ramen toppings such as braised pork belly and fermented bamboo shoots. With a quick stop at a convenience store, you can turn instant ramen into a serious meal. The pork belly is rolled and tied, braised, chilled, and then sliced into thick circular slices like Italian pancetta. This is one of the best things you can do with pork, and I don't say that lightly.

Hardy reinforces his narrative with stories of heroes who didn’t have the right education, the right connections, and who could have been counted out early as not having the DNA for success: “Richard Branson has dyslexia and had poor academic performance as a student. Steve Jobs was born to two college students who didn’t want to raise him and gave him up for adoption. Mark Cuban was born to an automobile upholsterer. He started as a bartender, then got a job in software sales from which he was fired.”8 The list goes on. Hardy reminds his readers that “Suze Orman’s dad was a chicken farmer. Retired General Colin Powell was a solid C student. Howard Schultz, the CEO of Starbucks, was born in a housing authority in the Bronx … Barbara Corcoran started as a waitress and admits to being fired from more jobs than most people hold in a lifetime. Pete Cashmore, the CEO of Mashable, was sickly as a child and finished high school two years late due to medical complications. He never went to college.” What do each of these inspiring leaders and storytellers have in common? They rewrote their own internal narratives and found great success. “The biographies of all heroes contain common elements. Becoming one is the most important,”9 writes Chris Matthews in Jack Kennedy, Elusive Hero. Matthews reminds his readers that young John F. Kennedy was a sickly child and bedridden for much of his youth. And what did he do while setting school records for being in the infirmary? He read voraciously. He read the stories of heroes in the pages of books by Sir Walter Scott and the tales of King Arthur. He read, and dreamed of playing the hero in the story of his life. When the time came to take the stage, Jack was ready.

Thanks again, sir.” Jules shook his hand again. “You’re welcome again,” the captain said, his smile warm. “I’ll be back aboard the ship myself at around nineteen hundred. If it’s okay with you, I’ll, uh, stop in, see how you’re doing.” Son of a bitch. Was Jules getting hit on? Max looked at Webster again. He looked like a Marine. Muscles, meticulous uniform, well-groomed hair. That didn’t make him gay. And he’d smiled warmly at Max, too. The man was friendly, personable. And yet . . . Jules was flustered. “Thanks,” he said. “That would be . . . That’d be nice. Would you excuse me, though, for a sec? I’ve got to speak to Max, before I, uh . . . But I’ll head over to the ship right away.” Webster shook Max’s hand. “It was an honor meeting you, sir.” He smiled again at Jules. Okay, he hadn’t smiled at Max like that. Max waited until the captain and the medic both were out of earshot. “Is he—” “Don’t ask, don’t tell.” Jules said. “But, oh my God.” “He seems nice,” Max said. “Yes,” Jules said. “Yes, he does.” “So. The White House?” “Yeah. About that . . .” Jules took a deep breath. “I need to let you know that you might be getting a call from President Bryant.” “Might be,” Max repeated. “Yes,” Jules said. “In a very definite way.” He spoke quickly, trying to run his words together: “I had a very interesting conversation with him in which I kind of let slip that you’d resigned again and he was unhappy about that so I told him I might be able to persuade you to come back to work if he’d order three choppers filled with Marines to Meda Island as soon as possible.” “You called the President of the United States,” Max said. “During a time of international crisis, and basically blackmailed him into sending Marines.” Jules thought about that. “Yeah. Yup. Although it was a pretty weird phone call, because I was talking via radio to some grunt in the CIA office. I had him put the call to the President for me, and we did this kind of relay thing.” “You called the President,” Max repeated. “And you got through . . .?” “Yeah, see, I had your cell phone. I’d accidently switched them, and . . . The President’s direct line was in your address book, so . . .” Max nodded. “Okay,” he said. “That’s it?” Jules said. “Just, okay, you’ll come back? Can I call Alan to tell him? We’re on a first-name basis now, me and the Pres.” “No,” Max said. “There’s more. When you call your pal Alan, tell him I’m interested, but I’m looking to make a deal for a former Special Forces NCO.” “Grady Morant,” Jules said. “He’s got info on Heru Nusantra that the president will find interesting. In return, we want a full pardon and a new identity.” Jules nodded. “I think I could set that up.” He started for the helicopter, but then turned back. “What’s Webster’s first name? Do you know?” “Ben,” Max told him. “Have a nice vacation.” “Recovering from a gunshot wound is not a vacation. You need to write that, like, on your hand or something. Jeez.” Max laughed. “Hey, Jules?” He turned back again. “Yes, sir?” “Thanks for being such a good friend.” Jules’s smile was beautiful. “You’re welcome, Max.” But that smile faded far too quickly. “Uh-oh, heads up—crying girlfriend on your six.” Ah, God, no . . . Max turned to see Gina, running toward him. Please God, let those be tears of joy. “What’s the verdict?” he asked her. Gina said the word he’d been praying for. “Benign.” Max took her in his arms, this woman who was the love of his life, and kissed her. Right in front of the Marines.

Mueller kicked off the meeting by pulling out a piece of paper with some notes. The attorney general and his aides believed they noticed something worrisome. Mueller’s hands shook as he held the paper. His voice was shaky, too. This was not the Bob Mueller everyone knew. As he made some perfunctory introductory remarks, Barr, Rosenstein, O’Callaghan, and Rabbitt couldn’t help but worry about Mueller’s health. They were taken aback. As Barr would later ask his colleagues, “Did he seem off to you?” Later, close friends would say they noticed Mueller had changed dramatically, but a member of Mueller’s team would insist he had no medical problems. Mueller quickly turned the meeting over to his deputies, a notable handoff. Zebley went first, summing up the Russian interference portion of the investigation. He explained that the team had already shared most of its findings in two major indictments in February and July 2018. Though they had virtually no chance of bringing the accused to trial in the United States, Mueller’s team had indicted thirteen Russian nationals who led a troll farm to flood U.S. social media with phony stories to sow division and help Trump. They also indicted twelve Russian military intelligence officers who hacked internal Democratic Party emails and leaked them to hurt Hillary Clinton’s campaign. The Trump campaign had no known role in either operation. Zebley explained they had found insufficient evidence to suggest a conspiracy, “no campaign finance [violations], no issues found. . . . We have questions about [Paul] Manafort, but we’re very comfortable saying there was no collusion, no conspiracy.” Then Quarles talked about the obstruction of justice portion. “We’re going to follow the OLC opinion and conclude it wasn’t appropriate for us to make a final determination as to whether or not there was a crime,” he said. “We’re going to report the facts, the analysis, and leave it there. We are not going to say we would indict but for the OLC opinion.

More to the point, one cannot understand The Holocaust without understanding the intentions, ideology, and mechanisms that were put in place in 1933. The eugenics movement may have come to a catastrophic crescendo with the Hitler regime, but the political movement, the world-view, the ideology, and the science that aspired to breed humans like prized horses began almost 100 years earlier. More poignantly, the ideology and those legal and governmental mechanisms of a eugenic world-view inevitably lead back to the British and American counterparts that Hitler’s scientists collaborated with. Posterity must gain understanding of the players that made eugenics a respectable scientific and political movement, as Hitler’s regime was able to evade wholesale condemnation in those critical years between 1933 and 1943 precisely because eugenics had gained international acceptance. As this book will evidence, Hitler’s infamous 1933 laws mimicked those already in place in the United States, Britain, Norway, Sweden, Finland, and Canada. So what is this scientific and political movement that for 100 years aspired to breed humans like dogs or horses? Eugenics is quite literally, as defined by its principal proponents, an attempt at “directing evolution” by controlling any aspect of human existence that affects human heredity. From its onset, Francis Galton, the cousin of Charles Darwin and the man credited with the creation of the science of eugenics, knew that the cause of eugenics had to be observed with religious fervor and dedication. As the quote on the opening pages of this book illustrates, a eugenicist must “intrude, intrude, intrude.” A vigilant control over anything and everything that affects the gene pool is essential to eugenics. The policies could not allow for the individual to enjoy self-government or self-determination any more than a horse breeder can allow the animals to determine whom to breed with. One simply cannot breed humans like horses without imbuing the state with the level of control a farmer has over its livestock, not only controlling procreation, but also the diet, access to medical services, and living conditions.

But perhaps the best and most memorable way to explain the conflict that arose between honoring traditional honor, and honoring one’s individual psyche, can be conveyed in a story from World War II. In 1943, coming off his dazzling victories in the Sicily campaign, George S. Patton stopped by a medical tent to visit with the wounded. He enjoyed these visits, and so did the soldiers and staff. He would hand out Purple Hearts, pump the men full of encouragement, and offer rousing speeches to the nurses, interns, and their patients that were so touching in nature they sometimes brought tears to many of the eyes in the room. On this particular occasion, as Patton entered the tent all the men jumped to attention except for one, Private Charles H. Kuhl, who sat slouched on a stool. Kuhl, who showed no outward injuries, was asked by Patton how he was wounded, to which the private replied, “I guess I just can’t take it.” Patton did not believe “battle fatigue” or “shell-shock” was a real condition nor an excuse to be given medical treatment, and had recently been told by one of the commanders of Kuhl’s division that, “The front lines seem to be thinning out. There seems to be a very large number of ‘malingerers’ at the hospitals, feigning illness in order to avoid combat duty.” He became livid. Patton slapped Kuhl across the face with his gloves, grabbed him by his collar, and led him outside the tent. Kicking him in the backside, Patton demanded that this “gutless bastard” not be admitted and instead be sent back to the front to fight. A week later, Patton slapped another soldier at a hospital, who, in tears, told the general he was there because of “his nerves,” and that he simply couldn’t “stand the shelling anymore.” Enraged, Patton brandished his white-handled, single-action Colt revolver and bellowed: Your nerves, Hell, you are just a goddamned coward, you yellow son of a bitch. Shut up that goddamned crying. I won’t have these brave men here who have been shot seeing a yellow bastard sitting here crying…You’re a disgrace to the Army and you’re going back to the front lines and you may get shot and killed, but you’re going to fight. If you don’t I’ll stand you up against a wall and have a firing squad kill you on purpose. In fact I ought to shoot you myself, you God-damned whimpering coward.

Tim Tigner began his career in Soviet Counterintelligence with the US Army Special Forces, the Green Berets. That was back in the Cold War days when, “We learned Russian so you didn't have to,” something he did at the Presidio of Monterey alongside Recon Marines and Navy SEALs. With the fall of the Berlin Wall, Tim switched from espionage to arbitrage. Armed with a Wharton MBA rather than a Colt M16, he moved to Moscow in the midst of Perestroika. There, he led prominent multinational medical companies, worked with cosmonauts on the MIR Space Station (from Earth, alas), chaired the Association of International Pharmaceutical Manufacturers, and helped write Russia’s first law on healthcare. Moving to Brussels during the formation of the EU, Tim ran Europe, Middle East, and Africa for a Johnson & Johnson company and traveled like a character in a Robert Ludlum novel. He eventually landed in Silicon Valley, where he launched new medical technologies as a startup CEO. In his free time, Tim has climbed the peaks of Mount Olympus, hang glided from the cliffs of Rio de Janeiro, and ballooned over Belgium. He earned scuba certification in Turkey, learned to ski in Slovenia, and ran the Serengeti with a Maasai warrior. He acted on stage in Portugal, taught negotiations in Germany, and chaired a healthcare conference in Holland. Tim studied psychology in France, radiology in England, and philosophy in Greece. He has enjoyed ballet at the Bolshoi, the opera on Lake Como, and the symphony in Vienna. He’s been a marathoner, paratrooper, triathlete, and yogi.  Intent on combining his creativity with his experience, Tim began writing thrillers in 1996 from an apartment overlooking Moscow’s Gorky Park. Decades later, his passion for creative writing continues to grow every day. His home office now overlooks a vineyard in Northern California, where he lives with his wife Elena and their two daughters. Tim grew up in the Midwest, and graduated from Hanover College with a BA in Philosophy and Mathematics. After military service and work as a financial analyst and foreign-exchange trader, he earned an MBA in Finance and an MA in International Studies from the University of Pennsylvania’s Wharton and Lauder Schools.  Thank you for taking the time to read about the author. Tim is most grateful for his loyal fans, and loves to correspond with readers like you. You are welcome to reach him directly at tim@timtigner.com.

I lost my first patient on a Tuesday. She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight P.M. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest. Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45 A.M., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive. When I finally left the hospital, at five P.M. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven P.M., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case. At eight P.M., my phone rang: Mrs. Harvey had died. I went home to sleep.

In the future that globalists and feminists have imagined, for most of us there will only be more clerkdom and masturbation. There will only be more apologizing, more submission, more asking for permission to be men. There will only be more examinations, more certifications, mandatory prerequisites, screening processes, background checks, personality tests, and politicized diagnoses. There will only be more medication. There will be more presenting the secretary with a cup of your own warm urine. There will be mandatory morning stretches and video safety presentations and sign-off sheets for your file. There will be more helmets and goggles and harnesses and bright orange vests with reflective tape. There can only be more counseling and sensitivity training. There will be more administrative hoops to jump through to start your own business and keep it running. There will be more mandatory insurance policies. There will definitely be more taxes. There will probably be more Byzantine sexual harassment laws and corporate policies and more ways for women and protected identity groups to accuse you of misconduct. There will be more micro-managed living, pettier regulations, heavier fines, and harsher penalties. There will be more ways to run afoul of the law and more ways for society to maintain its pleasant illusions by sweeping you under the rug. In 2009 there were almost five times more men either on parole or serving prison terms in the United States than were actively serving in all of the armed forces.[64] If you’re a good boy and you follow the rules, if you learn how to speak passively and inoffensively, if you can convince some other poor sleepwalking sap that you are possessed with an almost unhealthy desire to provide outstanding customer service or increase operational efficiency through the improvement of internal processes and effective organizational communication, if you can say stupid shit like that without laughing, if your record checks out and your pee smells right—you can get yourself a J-O-B. Maybe you can be the guy who administers the test or authorizes the insurance policy. Maybe you can be the guy who helps make some soulless global corporation a little more money. Maybe you can get a pat on the head for coming up with the bright idea to put a bunch of other guys out of work and outsource their boring jobs to guys in some other place who are willing to work longer hours for less money. Whatever you do, no matter what people say, no matter how many team-building activities you attend or how many birthday cards you get from someone’s secretary, you will know that you are a completely replaceable unit of labor in the big scheme of things.

As she explained to her students, patients often awoke from very bad illnesses or cardiac arrests, talking about how they had been floating over their bodies. “Mm-hmmm,” Norma would reply, sometimes thinking, Yeah, yeah, I know, you were on the ceiling. Such stories were recounted so frequently that they hardly jolted medical personnel. Norma at the time had mostly chalked it up to some kind of drug reaction or brain malfunction, something like that. “No, really,” said a woman who’d recently come out of a coma. “I can prove it.” The woman had been in a car accident and been pronounced dead on arrival when she was brought into the emergency room. Medical students and interns had begun working on her and managed to get her heartbeat going, but then she had coded again. They’d kept on trying, jump-starting her heart again, this time stabilizing it. She’d remained in a coma for months, unresponsive. Then one day she awoke, talking about the brilliant light and how she remembered floating over her body. Norma thought she could have been dreaming about all kinds of things in those months when she was unconscious. But the woman told them she had obsessive-compulsive disorder and had a habit of memorizing numbers. While she was floating above her body, she had read the serial number on top of the respirator machine. And she remembered it. Norma looked at the machine. It was big and clunky, and this one stood about seven feet high. There was no way to see on top of the machine without a stepladder. “Okay, what’s the number?” Another nurse took out a piece of paper to jot it down. The woman rattled off twelve digits. A few days later, the nurses called maintenance to take the ventilator machine out of the room. The woman had recovered so well, she no longer needed it. When the worker arrived, the nurses asked if he wouldn’t mind climbing to the top to see if there was a serial number up there. He gave them a puzzled look and grabbed his ladder. When he made it up there, he told them that indeed there was a serial number. The nurses looked at each other. Could he read it to them? Norma watched him brush off a layer of dust to get a better look. He read the number. It was twelve digits long: the exact number that the woman had recited. The professor would later come to find out that her patient’s story was not unique. One of Norma’s colleagues at the University of Virginia Medical Center at the time, Dr. Raymond Moody, had published a book in 1975 called Life After Life, for which he had conducted the first large-scale study of people who had been declared clinically dead and been revived, interviewing 150 people from across the country. Some had been gone for as long as twenty minutes with no brain waves or pulse. In her lectures, Norma sometimes shared pieces of his research with her own students. Since Moody had begun looking into the near-death experiences, researchers from around the world had collected data on thousands and thousands of people who had gone through them—children, the blind, and people of all belief systems and cultures—publishing the findings in medical and research journals and books. Still, no one has been able to definitively account for the common experience all of Moody’s interviewees described. The inevitable question always followed: Is there life after death? Everyone had to answer that question based on his or her own beliefs, the professor said. For some of her students, that absence of scientific evidence of an afterlife did little to change their feelings about their faith. For others,

The Western medical model — and I don't mean the science of it, I mean the practice of it, because the science is completely at odds with the practice — makes two devastating separations. First of all we separate the mind from the body, we separate the emotions from the physiology. So we don't see how the physiology of people reflects their lifelong emotional experience. So we separate the mind from the body, which is not something that traditional medicine has done, I mean, Ayuverdic or Chinese medicine or shamanic tribal cultures and medicinal practices throughout the world have always recognized that mind and body are inseparable. They intuitively knew it. Many Western practitioners have known this and even taught it, but in practice we ignore it. And then we separate the individual from the environment. The studies are clear, for example, that when people are emotionally isolated they tend to get sick more quickly and they succumb more rapidly to their disease. Why? Because people's physiology is completely related to their psychological, social environment and when people are isolated and alone their stress levels are much higher because there's nothing there to help them moderate their stress. And physiologically it is straightforward, you know, it takes a five-year-old kid to understand it. However because in practice we separate them... when somebody shows up with an inflamed joint, all we do is we give them an anti-inflammatory or because the immune system is hyperactive and is attacking them we give them a medication to suppress their immune system or we give them a stress hormone like cortisol or one of its analogues, to suppress the inflammation. But we never ask: "What does this manifest about your life?", "What does this say about your relationships?", "How stressful is your job?", "To what extent do you lack control in your life?", "Where are you not authentic?", "How are you trying to work so hard to meet your attachment needs by suppressing yourself?" (because that is what you learn to do as a kid). Then we do all this research that has to do with cell biology, so we keep looking for the cause of cancer in the cell. Now there's a wonderful quote in the New York Times a couple of years ago they did a series on cancer and somebody said: "Looking for the cause of cancer inside the individual cell is like trying to understand a traffic jam by studying the internal combustion engine." We will never understand it, but we spend hundreds of billions of dollars a year looking for the cause of cancer inside the cell, not recognizing that the cell exists in interaction with the environment and that the genes are modulated by the environment, they are turned on and off by the environment. So the impact of not understanding the unity of emotions and physiology on one hand and in the other hand the relationship between the individual and the environment.. in other words.. having a strictly biological model as opposed to what has been called a bio-psycho-social, that recognizes that the biology is important, but it also reflects our psychological and social relationships. And therefore trying to understand the biology in isolation from the psychological and social environment is futile. The result is that we are treating people purely through pharmaceuticals or physical interventions, greatly to the profit of companies that manufacture pharmaceuticals and which fund the research, but it leaves us very much in the dark about a) the causes and b) the treatment, the holistic treatment of most conditions. So that for all our amazing interventions and technological marvels, we are still far short of doing what we could do, were we more mindful of that unity. So the consequences are devastating economically, they are devastating emotionally, they are devastating medically.

Balance life's stressors with life's pleasures.

Try to find a medical center that has a finger on the pulse of the latest treatments both nationally and internationally.

Where Western medicine fails, medical intuition picks up by finding the mental and emotional causes for your physical ailments.

All medications, including those in epidurals, reach your baby through the placenta, affecting his ability to find the breast, latch, and suck effectively after he’s born. Depending on how long the epidural was in place and the drugs used in it, these effects can last from a few days to a few weeks. Pain-relieving drugs reduce your own endorphins, which may increase your baby’s discomfort, both before the birth and after the birth, when more endorphins are passed on through your milk. Your baby may cry more. Or, without your natural endorphins, you and baby may feel “flatter” emotionally, making it harder for you to respond to each other. Epidurals can cause your temperature to rise, which raises your baby’s temperature. He may be sent to the nursery for observation and antibiotics in case he has an infection. And if an epidural or induction included hours of IV fluids, your normal breast and nipple shape may be distorted, making latching difficult even with skilled help. This can be hard information to read, but it’s what the research very clearly shows. As childbirth educator Linda Smith, IBCLC, comments, “If your friend tells you how she ‘loved her epidural,’ ask her how her first month of motherhood went.

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The key question for scientists to unravel now is why these transposons get the urge to jump. McClintock believed that the jumps are a genomic response to internal or environmental stress that cells can’t handle under their existing setup. Essentially, a challenge to survival triggers the organism to throw the mutation dice, hoping it will land on a change that will help. That’s what she thought was going on with the corn plants she was studying—too much heat or too little water triggered the corn to gamble its survival on finding a mutation that could help it survive. When that happens, the proofreading mechanism is suppressed and mutations are allowed to blossom. Then natural selection kicks in to select the adaptive mutations over the maladaptive mutations in future generations and presto, evolution!

One assumption that is already being shattered is the idea that only routine, semi-skilled jobs like taxi driving, food delivery, or household chores are susceptible. Even traditional professions like medicine and law are proving to be susceptible to platform models. We’ve already mentioned Medicast, which applies an Uber-like model to finding a doctor. Several platform companies are providing online venues where legal services are available with comparable ease, speed, and convenience. Axiom Law has built a $200 million platform business by using a combination of data-mining software and freelance law talent to provide legal guidance and services to business clients; InCloudCounsel claims it can process basic legal documents such as licensing forms and nondisclosure agreements at a savings of up to 80 percent compared with a traditional law firm.11 In the decades to come, it seems likely that the platform model will be applied—or at least tested—in virtually every market for labor and professional services. How will this trend impact the service industries—not to mention the working lives of hundreds of millions of people? One likely result will be an even greater stratification of wealth, power, and prestige among service providers. Routine and standardized tasks will move to online platforms, where an army of relatively low-paid, self-employed professionals will be available to handle them. Meanwhile, the world’s great law firms, medical centers, consulting partnerships, and accounting practices will not vanish, but their relative size and importance will shrink as much of the work they used to do migrates to platforms that can provide comparable services at a fraction of the cost and with far greater convenience. A surviving handful of world-class experts will increasingly focus on a tiny subset of the most highly specialized and challenging assignments, which they can tackle from anywhere in the world using online tools. Thus, at the very highest level of professional expertise, winner-take-all markets are likely to emerge, with (say) two dozen internationally renowned attorneys competing for the splashiest and most lucrative cases anywhere on the globe.

[Sanctification] is a process that includes on the one hand medication and diet (in the form of biblical instruction and admonition coming in various ways to the heart), and on the other hand tests and exercises (in the form of internal and external pressures, providentially ordered, to which we have to make active response). The process goes on as long as we are in the world, which is something that God decides in each case.

In the cloudy swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction — in other words, that the cause of addiction resides in the power of the drug over the human brain. It is one of the bedrock fables sustaining the so-called “War on Drugs.” It also obscures the existence of a basic addiction process of which drugs are only one possible object, among many. Compulsive gambling, for example, is widely considered to be a form of addiction without anyone arguing that it’s caused by a deck of cards. The notion that addiction is drug-induced is often reinforced. Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people. During my years working on a palliative care ward I sometimes treated terminally ill cancer patients with extraordinarily high doses of narcotics — doses that my hardcore addict clients could only dream of. If the pain was alleviated by other means — for example, when patient was successfully given a nerve block for bone pain due to malignant deposits in the spine — the morphine could be rapidly discontinued. Yet if anyone had reason to seek oblivion through narcotic addiction, it would have been these terminally ill human beings. An article in the Canadian Journal of Medicine in 2006 reviewed international research covering over six thousand people who had received narcotics for chronic pain that was not cancerous in origin. There was no significant risk of addiction, a finding common to all studies that examine the relationship between addiction and the use of narcotics for pain relief. “Doubts or concerns about opioid efficacy, toxicity, tolerance, and abuse or addiction should no longer be used to justify withholding opioids,” concluded a large study of patients with chronic pain due to rheumatic disease. We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are.

The term “myalgic encephalomyelitis” (muscle pain, “myalgic”, with “encephalomyelitis” inflammation of the brain and spinal cord) was first included by the World Health Organization (WHO) in their International Classification of Diseases in 1969. It is ironic that Donald Acheson, who subsequently became the Chief Medical Officer first coined the name in 1956.8 In 1978 the Royal Society of Medicine accepted ME as a nosological organic entity.9 The current version of the International Classification of Diseases—ICD‐10, lists myalgic encephalomyelitis under G.93.3—neurological conditions. It cannot be emphasised too strongly that this recognition emerged from meticulous clinical observation and examination.

As we gain an understanding of what's going on internally, we need to apply that same kind of awareness and understanding to others and to the environment around us. I've done ongoing research on the experiences of North Americans who volunteer overseas for one or two weeks. Most of these volunteers travel to developing countries where they help with disaster relief, build medical clinics, teach English, or engage in religious mission work. Of all the comments made by these North American travelers, the most common statement made upon their return is something like, “Even though those people have so little, they're so happy!” There's something endearing about hearing a group of relatively wealthy North Americans talk about their amazement that people with so little could be so happy. My question is, are the people they observed really happy? I've asked several hundred of these volunteers, “What makes you think they're happy?” They most often respond, “Because they were always smiling and laughing. And they were so generous to us. They fed us better than they eat themselves.” Part of becoming more aware of others requires we slow down to ask what familiar behaviors might mean in a different culture. The observation made by these American travelers is usually accurate—the locals they're meeting are in fact smiling and generous. But the question is whether the North Americans are accurately interpreting what those behaviors mean. First, if you don't speak the language and you're just meeting someone for the first time, what do you do? After some feeble attempts at saying things like “Hola!” “Gross Got!” or “Nee how!” there's often some nervous laughter that ensues. It's really awkward. So the locals might be expressing happiness or their smiles might just be a nervous response. Then add that in places like Thailand, where there are twenty-three different smiles, each smile communicates something different. And in one small, extremely polite community in New Zealand, smiling reactions are a way of expressing that they feel deeply offended.4 As I've consistently said, the point isn't to learn every nuanced meaning. But with heightened awareness of others, an individual will realize that while smiles might reflect genuine happiness, they just as well might be a nervous cross-cultural response that indicates little about one's level of contentment.

Back in 2012, the American Board of Internal Medicine Foundation along with Consumer Reports, a highly regarded independent, nonprofit consumer organization, introduced Choosing Wisely,68–77 an initiative to reduce unnecessary medical tests and cut costs. When Choosing Wisely was first announced, nine medical professional organizations published their lists of five tests and procedures that they deemed were unnecessary. Of these forty-five recommendations for unneeded tests, twenty-five (56 percent) were related

Many people fear that decriminalization and the controlled dispensing of drugs will lead to widespread substance use among people who are now deterred from becoming addicts only by existing legal prohibitions. Like other tenets of the War on Drugs, this view entirely lacks supporting evidence. Any data on the subject points to the opposite prediction. For example, for many decades in the United Kingdom, heroin has been dispensed, under legal supervision, to addicts. The same type of program has been offered on a limited basis in other countries as well, and nowhere has it been found that this measure served in any way to entice unaddicted people into addiction. That is not surprising, given that addiction is a response to life experience, not simply to a drug. People who do not suffer the searing emotional pain that drives hardcore drug addiction will rarely fall into dependency on chemicals, even if these were more readily available — and, once more, public access to habit-forming substances is not being proposed. The call for the decriminalization of drugs for personal use does not imply legal acceptance of drug dealing. Criminalization and prevention are not identical — if anything, the first undermines the other. Paradoxical though it may seem, current drug laws against possession make drugs more readily available to potential new users than decriminalization would. Only the War on Drugs creates the raison d’être of the international trafficking industry, most of whose wealth is based on satisfying the cravings of established drug addicts. Without the exorbitant profits yielded by supplying to addicted users desperate for their substances, the illegal market would shrink to a fragment of its present size. Further, much of the street-level front-line sales force of the illicit drug trade consists of users raising money to support their habit. With the decriminalization of possession for personal use and the medically supervised distribution of drugs, the incentive to sell to new “customers,” including young kids, would largely evaporate. Policing resources could then be concentrated on the remaining large-scale traffickers — if any.

My body, my work, my voice, my confidence, my power, my determination to demand a life as potent, vibrant, public and complex as any man's. My abortion wasn’t intrinsically significant, but it was my first big grown-up decision – the first time I asserted, unequivocally: ‘I KNOW THE LIFE I WANT AND THIS IS NOT IT"; the moment I stopped being a passenger in my own body and grabbed the rudder... The truth is I don't give a damn why anyone has an abortion. I believe unconditionally in the right of people with uteruses to decide what grow inside of their body and feeds on their blood and endangers their life and reroutes their future. There are no "good" abortions and "bad" abortions, there are only pregnant people who want them and pregnant people who don't, pregnant people who have access and support and pregnant people who face institutional roadblocks and lies... For that reason, we simply MUST talk about it. The fact that abortion is still a taboo subject means that opponents of abortion get to define it however suits them best. They can cast those of us who have had abortions as callous monstrosities and seed fear in anyone who might need one by insisting that the procedure is always traumatic, always painful, and always an impossible decision. Well we're not and it's not. The truth is that life is unfathomably complex and every abortion story is as unique as the person who lives it. Some are traumatic, some are even regretted, but plenty are like mine... My abortion was a normal medical procedure that got tangled up in my bad relationship, my internalized fatphobia, my fear of adulthood, my discomfort with talking about sex; and one that, because of our culture’s obsession with punishing female sexuality and shackling women to the nursery and the kitchen, I was socialized to approach with shame and describe only in whispers. But the procedure itself was the easiest part. Not being able to have one would have been the real trauma.

It is worth pondering how much of our struggle with avarice is linked to a tendency to value things solely in terms of their usefulness. When the older generation laments that they are only a burden to society, since they are no longer capable of useful work or productive labor, and their medical care is a constant drain on others’ resources, have they internalized a system of value that measures people’s true worth in terms of a cost–benefit analysis? Time spent with children also becomes “unprofitable” in more than one sense, for we have precious little in the way of tangible payoff to show for such investments. The very use of metaphors of financial transactions to describe personal care for other human beings points to a conceptual framework tilted toward the distortions of avarice. The salary charts for the helping professions, especially compared to the salaries of those who work in financial fields managing investments, also point not so subtly to implicit assumptions of what is truly of value and worth. We are measured by our usefulness, and our usefulness is measured by the production of things and the possession of money. Greed now invades human life and its value in this subtler way as well.

After you’ve decided on a place to study MBBS abroad, the following step is to choose the best medical university. MBBS abroad offers its students a plethora of alternatives and chances. Here are some pointers to help you choose the top medical university in the world to study MBBS. Learn about the university’s rating. The university’s experience in teaching MBBS The university’s recognition Fees for tuition and living expenses Whether or if the university provides FMGE coaching Indian cuisine is available at the hostel canteen. Examine the number of Indian students enrolled at the university. Admission Procedures for MBBS Programs Abroad MBBS overseas is increasingly a popular option for thousands of students. It does not necessitate any difficult procedures or fees. Admission to medical schools in other countries is a pretty straightforward procedure. MBBS abroad offers a plethora of chances to its students. The student must send the necessary paperwork to us, and we will begin the admissions process right away. The admission letter is issued once the following papers are submitted: Results of the 12th grade with eligibility matching according to the university. Passport photocopy Following the submission of the required papers, the student will get an invitation from the Ministry of Education of the particular nation. A representative is on hand at the airport to meet the students, and another is on hand at the destination airport to greet them, The University provides lodging for its students. The Cost of a Medical Degree in Abroad MBBS overseas offers a viable option for medical education studies. The cost of MBBS in Russia, Ukraine, Kyrgyzstan, China, Bangladesh, Guyana, and other such nations is substantially lower than that of private medical institutions in India. Furthermore, the cost of living in these nations is quite low for international students. These colleges also provide scholarships to deserving students. Criteria for Eligibility to Study medical Abroad: The following admission requirements are reserved for Indian candidates seeking admission to MBBS programs at any of the Best Medical Universities in the World: Firtly, A non-reserved Indian medical candidate must have obtained a minimum of 50% in their 12th grade in Physics, Chemistry, and Biology. Secondly, Medical aspirants from the restricted categories (SC/ST/OBC) can apply with a minimum of 40% marks in Physics, Chemistry, and Biology, according to NMC/MCI criteria (Medical Council of India). Medical students must take the NEET (National Eligibility and Entrance Test) starting in 2019.

In March 1942, the Office of the Surgeon General noted a growing incidence of jaundice (yellowing of the skin caused by liver disease) among US Army personnel stationed in California, England, Hawaii, Iceland, and Louisiana. All of those jaundiced had recently received a yellow fever vaccine, which, in addition to containing yellow fever vaccine virus, contained human serum as a stabilizing agent. On April 15, 1942, the surgeon general ordered that yellow fever vaccination be discontinued and that all existing lots be recalled and destroyed. Shortly thereafter, manufacturers made a yellow fever vaccine with water instead of serum, but it was too late. The serum used to stabilize the yellow fever vaccine had been obtained from nurses, medical students, and interns at Johns Hopkins Hospital in Baltimore, several of whom had a history of jaundice and one of whom was actively infected at the time of the donation. By June 1942, fifty thousand US servicemen had been hospitalized with severe liver disease, and 150 had died from what would later be known as hepatitis B. Of the 141 lots of yellow fever vaccine provided to the army, seven were definitely contaminated. Among those who received one of those seven lots, 78 percent became infected. When the dust settled, 330,000 servicemen had been infected and one thousand had died. This was then and remains today one of the worst single-source outbreaks of a fatal infection ever recorded.

What I mean is, if you’re feeling overwhelmed by your internal monologue, and the voice delivering it is no longer a friendly one—please—don’t be afraid to ask for help. One of the most insidious lies mental illness tells us is that asking for help, or taking medication to get better, means that we are weak. It means that we are a failure, and we somehow deserve to suffer. This. Is. Bullshit. You don’t deserve to suffer. You are not weak. You are not a failure. Your brain, like mine, needs help to keep its profoundly complicated machinery working. Depression lies, and when it tells you these lies, you can look right back into its stupid face and say, “Shut up. Wil Wheaton told me that it’s okay to get help, and he pretended to live in outer space, so he outranks you.

One of those 48 studies is the Danish analysis published in November 2020 in the world-renowned journal Annals of Internal Medicine, which concluded: „The trial found no statistically significant benefit of wearing a face mask.“1416 Shortly before, U.S. researcher Yinon Weiss updated his charts on cloth face masks mandates in various countries and U.S. states—and they also showed that mask mandates have made no difference or may even have been counterproductive.1417 The aforementioned website „Ärzte klären auf“ showed a graph with data going until December 4, 2020, which also refutes the effectiveness of the mask obligation.

As in the United States, medical professionals in the Global South most often come from higher-income families; even when they do not, they frequently view medicine as a route of upward mobility. As a result, medical professionals tend to ally themselves with the capitalist class, the “national bourgeoisie,” within these countries. They also frequently support cooperative links between the local capitalist class and business interests in economically dominant countries.4 The class position of health professionals has led them to resist social change that would threaten current class structure, either nationally or internationally.

Ultimately, Laura found sufficient resources, both internal and external, to wean herself from the medications, and to see her emotions and moods as fundamentally human, rather than as problems to be solved.

By the end of the year, X-ray burns were front-page news in virtually every prominent electrical, medical, and scientific journal. No one, however, paid a greater price than the men and women on the front lines of this new technology: radiologists and radiology technicians, most of whom saw themselves as noble warriors, “martyrs to science,” in their quest to save lives with X-rays. In November 1896, Walter Dodd, a founding father of radiology in the United States, suffered severe skin burns on both hands. Within five months, the pain was “beyond description” and his face and hands were visibly scalded. When the pain kept him awake at night, Dodd paced the floor of Massachusetts General Hospital with his hands held above his head. In July 1897, he received the first of fifty skin grafts, all of which failed. Bit by bit, his fingers were amputated. Dodd waited as long as he could before amputating his little finger because, as he said, “I needed something to oppose my thumb.” On August 3, 1905, at the age of forty-six, Elizabeth Fleischmann, the most experienced woman radiographer in the world, died from X-ray-induced cancer after a series of amputations. Fleischmann had gained international renown for her X-rays of soldiers in the Philippines during the Spanish-American War. Upon her death, almost every major newspaper published eulogies about “America’s Joan of Arc.

Dr. Melissa Kanes is a compassionate and dedicated doctor passionate about providing quality healthcare to her patients. With a strong background in internal medicine, she combines her medical expertise with a caring approach to ensure the well-being of those under her care. Outside of her busy career, Melissa enjoys spending time with her family, reading mystery novels, and practicing yoga to maintain a healthy work-life balance.

You may consider me sentimental or realistic since I perceive that the world's scientists of Intelligence Agencies can develop such as coronavirus, cancer, and other chemicals to harm humans, especially its political foes, whether those hold high status or low grade. In such fields, every option is possible. I suffered from two incidents in my life by the International Intelligence Agencies, first in 1980 and second in 2016, first causing esophagus damage and stomach hernia, and second metastatic prostate cancer. I tried for years and years to investigate the first incident, but Dutch police refused even to write a report about that. Such refusal created doubts in my mind that Dutch Secret Agencies played an evil role in damaging and destroying my life since why the authorities had been ignoring and refusing. Before diagnosing metastatic prostate cancer, when urologists were not paying attention, I went to a Brazilian Homeopath, Miriam Sommer, in The Hague; after a month's discussion, she told me that she was sure that I was poisoned in 1980, not to kill, but severe physical damage and it happened. She put a couple of tablets under my tongue to suck, and I did that. However, later I became suspicious of why she did do that. Dutch urologists, one year from the start of 2016 to 2017, refused to check what I requested per International Medical Guidelines, they overlooked it, and consequently, in February 2017, they diagnosed as last stage prostate cancer, which was not curable. The Dutch medical system is very awkward; it does not meet International Medical Guidelines; they let the patients suffering from the disease and treat them in a gravely poor way, paying no proper care and attention. In this regard, I am unaware of others' experiences. I want that both incidents, which caused me unexplained damage and the destruction of my career and life, the Dutch authorities should investigate on a high-level scale as guidelines before criminals disappear, can lead to a positive result; otherwise, I am right to realize that Institutions of the Dutch government had victimized me, violating International Law and human rights.

First, I am thrilled that paramedics are finally getting the respect they deserve for being the professionals they can be. The scope of practice is expanding, and patient care modalities are improving, seemingly by the minute. Patient outcomes are also improving as a result, and EMS is passing through puberty and forging into adulthood. On the other hand, autonomy in the hands of the “lesser-motivated,” can be a very dangerous thing. You know as well as I do that there are still plenty of providers who operate from a subjective, complacent, and downright lazy place. Combined with the ever-expanding autonomy, that provider just became more dangerous than he or she ever has been – to the patients and to you. Autonomy in patient care places more pressure for excellence on the provider charged with delivering it, and also on the partner and crew members on scene. Since the base hospital is not involved like it once was, they are likewise less responsible for the errors and omissions of the medics on the scene. Now more than ever, crew members are being held to answer for the mistakes and follies of their coworkers; now more than ever, EMS providers are working without a net. What’s next? I predict (and hope) emergency medical Darwinism is going to force some painful and necessary changes. First, increasing autonomy is going to result in the better and best providing superior patient care. More personal ownership of the results is going to manifest in outcomes such as increased cardiac arrest survival rates, faster and more complete stroke recovery, and significantly better outcomes for STEMI patients, all leading to the brass ring: EMS as a profession, not just a job. On the flip side of that coin, you will see consequences for the not-so-good and completely awful providers. There will be higher instances of licensure action, internal discipline, and wash-out. Unfortunately, all those things will stem from generally preventable negative patient outcomes. The danger for the better provider will be in the penumbra; the murky, gray area of time when providers are self-categorizing. Specifically, the better provider who is aware of the dangerously poor provider but does nothing to fix or flush him or her, is almost certain to be caught up in a bad situation caused by sloppy, complacent, or ultimately negligent patient care that should have been corrected or stopped. The answer is as simple as it is difficult. If you are reading this, it is more likely because you are one of the better, more committed, more professional providers. This transition is up to you. You must dig deep and find the strength necessary to face the issue and force the change; you have to demand more from yourself and from those around you. You must have the willingness to help those providers who want it – and respond to those who need it, but don’t want it – with tough love by showing them the door. In the end, EMS will only ever be as good as you make it. If you lay silent through its evolution, you forfeit the right to complain when it crumbles around you.

The key word here is recurrence. A review of 11 large-scale studies covering some 65,000 patients, published in the JAMA (Journal of the American Medical Association) Internal Medicine, showed no evidence that statins had any benefits for heart disease prevention in patients who had not been previously diagnosed with a cardiovascular condition.2 Even worse, you may have to endure some unpleasant side effects—such as muscle aches, headaches, and bloating—without any definite benefit.

When Richard Cooper went to medical school at the University of Arkansas in the late 1960s, he was stunned at how many of his black patients were suffering from high blood pressure. He would encounter people in their forties and fifties felled by strokes that left them institutionalized. When Cooper did some research on the problem, he learned that American doctors had first noted the high rate of hypertension in American blacks decades earlier. Cardiologists concluded it must be the result of genetic differences between blacks and whites. Paul Dudley White, the preeminent American cardiologist of the early 1900s, called it a “racial predisposition,” speculating that the relatives of American blacks in West Africa must suffer from high blood pressure as well. Cooper went on to become a cardiologist himself, conducting a series of epidemiological studies on heart disease. In the 1990s, he finally got the opportunity to put the racial predisposition hypothesis to the test. Collaborating with an international network of doctors, Cooper measured the blood pressure of eleven thousand people. Paul Dudley White, it turned out, was wrong. Farmers in rural Nigeria and Cameroon actually had substantially lower blood pressure than American blacks, Cooper found. In fact, they had lower blood pressure than white Americans, too. Most surprisingly of all, Cooper found that people in Finland, Germany, and Spain had higher blood pressure than American blacks. Cooper’s findings don’t challenge the fact that genetic variants can increase people’s risk of developing high blood pressure. In fact, Cooper himself has helped run studies that have revealed some variants in African Americans and Nigerians that can raise that risk. But this genetic inheritance does not, on its own, explain the experiences of African and European Americans. To understand their differences, doctors need to examine the experiences of blacks and whites in the United States—the stress of life in high-crime neighborhoods and the difficulty of getting good health care, for example. These are powerful inheritances, too, but they’re not inscribed in DNA. For scientists carrying out the hard work of disentangling these influences, an outmoded biological concept of race offers no help. In the words of the geneticists Noah Rosenberg and Michael Edge, it has become “a sideshow and a distraction.