J. Saturas. Nova Southeastern University.
He leaves behind his equally proﬁcient in designing and constructing wife buy panmycin 500mg on-line antibiotics for uti not penicillin, Valentina, his children Svetlana, Maria and innovative parts for the elaborate model train Alexander, and his three grandchildren. He preferred to spend most of any leisure time with his family, Irene (the former Miss Cootay of Hilo, Hawaii) and they were very close through- out their life together. Nevertheless, Verne was a member of many professional societies, which he chose to support in the scientiﬁc arena rather than in the committee structure. The major exception was The American Orthopedic Association, which he served as Vice-President in 1964. His boundless enthusiasm quickly captured his audi- ences, which had no difﬁculty in following his crystal-clear presentations. He was a superb cli- nician, but the needs of his patients seemed almost to be forgotten in his zeal to understand and relate to the patients the intricacies of their disabilities. As he often said, “Once I have arrived at the solution of a patient’s problem, I am content to relegate the implementation to others. Above all, he was Verne Thomson INMAN possessed by a consuming curiosity that led him 1905–1980 continually to ask questions and seek solutions, all the while maintaining a resolute scepticism Born in San Jose, California, in 1905, Dr. Inman, MD, PhD, the scientist, prob- and provided him an education at its university ably did more than any individual before him to campuses in Berkeley and San Francisco. The exact- Department of Orthopedic Surgery from 1957 to ness of his measurements established demanding 1970. His remarkable and respected for his erudite investigative studies, ability to simplify concepts and formulate princi- those who knew him closely remember him as a ples enabled him to see clearly what others often light-hearted, congenial, informal individual who saw dimly. On gradua- greeting for secretaries, nurses, students, profes- tion from college in 1928, he initiated his master’s sors, cooks, and administrators was always on a program as a medical student, and ﬁled his thesis ﬁrst-name basis. After phone by a consultative call from Washington, graduation from medical school in 1932, he D. All of the visitors to his laboratory human fetal cranium and appendicular skeleton in 157 Who’s Who in Orthopedics relation to sitting height was published in 1934. Howard Naffziger, was completed during his residency and published in 1938. From that time forward a continuous stream of substantive reports was added to the medical literature. Shortly after his classic report, “Observations on the Function of the Shoulder Joint,” appeared in The Journal of Bone and Joint Surgery in 1944, Dr. Inman was approached by the Committee on Prosthetic Devices of the National Research Council and urged to accept a federal grant for the purpose of improving artiﬁcial limbs.
Medicare and Medicaid discount panmycin 250mg with visa antibiotic used to treat chlamydia, enacted in 1965, reﬂect decades of political ma- neuvering and compromises (Marmor 2000; Fox 1989, 1993). As with pri- vate health insurance, Medicare’s roots reach back to the Great Depression. Although President Roosevelt wanted to add health insurance to his 1935 Social Security bill, he did not, concerned that opponents (such as orga- nized medicine) could derail his entire Social Security plan. Decades later, Johnson administration officials underscored Medicare’s focus on acute care in short-stay hospitals to gain congressional support. Policymakers feared that adding chronic care would exacerbate concerns about uncon- trollable costs and derail political approval (Fox 1993, 75). The structure of the beneﬁts themselves, providing acute hospital care and intermittent physician treatment, was not tightly linked to the special circumstances of the elderly as a group. Left out were provi- sions that addressed the particular problems of the chronically sick elderly: medical conditions that would not dramatically improve and the need to maintain independent function rather than triumph over discrete illness and injury. What looks like a half-empty glass when beneﬁts are being designed may be a bottomless pit once the payments begin to ﬂow” (Vladeck et al. Medicare beneﬁciaries themselves pay for uncovered services or items, ﬁlling in two broad gaps: covered services for which Medicare pays only a portion of the expense; and services not covered at all (such as outpatient prescription drugs in traditional Medicare, sometimes covered by Medicare managed-care organizations). So if you’re in the hospital for, say, two days, can you imagine what 80 percent of that bill would be? Daigle kept working solely for private health insurance to supplement Fred’s Medicare. About three quarters of Medicare beneﬁciaries purchase these private “Medigap” policies, roughly one-third through employers (Rice 1999, 112). Enriched standardized Medigap packages cover home health and long-term care services, although because of high premiums they are less popular than cheaper options (McClellan and Kalba 1999, 144). Recognizing the inability of low income people to purchase care, Congress adopted broader beneﬁts for Medicaid than Medicare, including medications, preventive services, eye- glasses, and long-term care in nursing homes. Disabled enrollees do cost more than poor mothers and their young children. In 1995, 17 percent of Medicaid enrollees were blind or disabled, but they generated almost 34 percent of expenditures, costing $8,784 per year compared to $3,789 for the average recipient (Regenstein and Schroer 1998, 14). Few insurers pay for “wellness” care—services aimed at promoting gen- eral health rather than treating or preventing disease. Medicare explicitly does not cover “services related to activities for the general physical wel- fare of beneﬁciaries (for example, exercises to promote overall ﬁtness)” (42 C. Private insurers also rarely reimburse exercise services (Manning and Barondess 1996, 61).
They began as parallel and curved purchase 250 mg panmycin mastercard infection from cat bite, then they crossed in an effortless knot.... The knot was the signature 197 198 W heeled Mobility of every turn I had ever made.... Itwas the ﬁrst time I dared to be- lieve that a wheelchair could make something, or even be associated with something, so beautiful. Walter Masterson’s ALS was progressing, and he had climbed the mobility aid hierarchy, from cane through power wheelchair. They were both rather traumatic because each was an admission that I’d gotten to a point of no return, and I did not want to admit to points of no return. Masterson’s voice was failing because of the ALS, and he an- ticipated the day he could no longer breathe. And those places had to get closer and closer together, which meant that my range was really decreasing. Gerald walked slowly and tentatively, leaning constantly against the wall, his free hand extending a wobbling cane for counterbalance. He collapsed into a chair, collecting himself, before talking:“I’m so exhausted by the end of the day. Several months later, Gerald won his lawsuit, and shortly thereafter, he bought a scooter. Fortunately, we live in the United States, so there are lots of elevators and lots of handicapped ramps and accessibility. I can do lots of things that I used to dread, like going to the Registry of Motor Ve- hicles recently to get my driver’s license. I just rode up on my little cart, I waited in Wheeled Mobility / 199 line with everybody. I zipped around in my cart, got everything I needed, and I drove it right into the classroom. I saved all that physical energy, and afterward, instead of being ex- hausted—even after a three-hour class—I still had energy. The biggest thing is being careful not to drive too fast, especially in the build- ing. Cynthia Walker ﬂatly rejects a cane, openly blaming vanity and desire to keep pushing forward, but she has temporarily used a scooter and loved it: I was in Tennessee this past summer. Some people have a problem with that because you’re giving into your physical condition.
In a chapter devoted to ‘the smoking habit’ purchase 500 mg panmycin fast delivery do antibiotics for acne work, the second edition of the RCP report acknowledged discussion of ‘pharmacological dependence’ on nicotine (RCP 1971: 112) Though it suggested that this matter required further research, its general tone was dismissive: ‘evidence that the difficulty that many smokers find in giving up the habit is due to habituation to nicotine is scanty’ (RCP 1971:41). In the course of the 1960s and 1970s a wide range of programmes, using everything from behavioural and psychodynamic therapies to hypnotism and acupuncture, were established in the effort to encourage people to quit smoking. A review of these programmes in the USA in 1982 drew gloomy conclusions: 1 No one cessation technique or approach is clearly superior to any other; 2 Most people who join cessation programmes do not quit smoking; 110 THE EXPANSION OF HEALTH 3 Of those who do quit, most do not remain off cigarettes for any substantial period of time. In the course of the 1980s, the recognition of nicotine addiction allowed for the convergence of different forms of dependence in the concept of ‘substance abuse’, or in the less judgemental term increasingly favoured in medical circles, ‘substance misuse’. This provided a useful umbrella to cover not only alcohol, heroin and nicotine, but other illicit ‘substances’—such as cannabis, solvents, cocaine/crack, amphetamines, LSD and ecstasy, and others—which were in widespread use, but for which the evidence of ‘dependency’ was weak. Indeed they needed ‘nicotine replacement therapy’, a formulation paying richly ironic homage to the use of ‘hormone replacement therapy’ in post-menopausal women. A blood nicotine assay had become available for research purposes and nicotine chewing gum came on the market. In 1988 the US Surgeon-General’s report gave official approval to nicotine addiction as a condition requiring appropriate medical treatment (Berridge 1998). In Britain, however, some medical resistance to the concept of ‘nicotine replacement therapy’ was reflected in the decision not to make it available on prescription, either in the form of chewing gum or the more ‘medical’ skin patches. It was not until 1998 that an editorial in the BMJ called for ‘nicotine replacement therapy for a healthier nation’—and proposed that it should be made available on prescription (Smeeth, Fowler 1998). This demand was issued with the full authority of a Cochrane Library ‘systematic review’ of 47 trials involving more than 23,000 patients, claiming to demonstrate its efficacy (Silagy et al. However, patients in these trials were only followed up for 6–12 months, so whether the effect is sustained remains unknown—as does whether this approach would also be effective when extended to a wider, and inevitably less motivated population. Nevertheless the nicotine replacement bandwagon was on the roll, and, following the RCP’s enthusiastic endorsement, it seems set to allow the further medicalisation of individual behaviour. The roots of this movement, the subject of a penetrating study by John Steadman Rice, lie in the ‘Twelve Step’ recovery programme popularised by Alcoholics Anonymous (founded in Ohio in 1935, AA became widely established in the USA and internationally in the post-war period) (Steadman Rice 1998). Though groups concerned with the special problems of the spouses and families of alcoholics had long run in parallel with the mainstream AA meetings, in the 1980s there was a dramatic proliferation of such groups. They now rapidly expanded to include ‘survivors’ of other forms of victimisation (domestic violence, sexual abuse) and victims of other forms of addiction, such as gambling, shopping, sex. The central claim of this movement was that ‘co-dependency’ was a disease, an addiction, characterised by dependence on a pathological relationship with another person, a substance, or any ‘processes external to the individual’ (Steadman Rice 1998). Co-dependents are believed to experience ‘a pattern of painful dependence on compulsive behaviours and on approval from others in an attempt to find safety, self worth and identity’. As Steadman Rice observes, this is a concept of ‘virtually limitless applicability’ and it was not surprising to find it extending to cover, not only familiar bad habits, but even fads about novelties such as the internet, mobile phones and the National Lottery (all of which were linked with media scare stories about new forms of addiction in the late 1990s).
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