Mark Corson

By J. Umul. Lees-McRae College. 2018.

Nevertheless discount xalatan 2.5 ml, as a gen­ eral proposition discount 2.5 ml xalatan amex, environm ental pollution creates three health hazards discount 2.5 ml xalatan overnight delivery. While not conclusive, there is growing recognition that the majority of cancers are due to chemical carcinogens in the environm ent. T he pan­ demic incidence of lung cancer in the United States and England has been unequivocally linked with smoking, al­ though air pollution is a contributing factor. The mastication of betel nuts and tobacco leaves results in the high incidence of oral cancers in Asia (oral cancers represent 35 percent of all cancers in Asia, but only 1 percent in Europe). Samuel Epstein, a bacteriologist and sociologist, adds: T h e high incidence o f liver cancer am ong th e B antu and in G uam is probably d u e to dietary contam ination w ith aflatoxin, a p o ten t fungal carcinogen, an d to eating C ycad plants, con- 104 Medicine: a. T h e high in­ cidence o f gastric cancer in Ja p a n , Iceland and C hile has been associated with high dietary intake o f fish; suggestions have been m ade im plicating nitrosam ines, form ed by reactions be­ tw een secondary am ines in fish an d nitrite preservations. T h e high incidence o f cancer o f th e esophagus in Z am bians d rin k ­ ing K achasu spirits m ay be related to its high nitrosam ine contam ination. T h ese include b lad d er cancer in the aniline dye an d ru b b e r industry, lu n g cancer in u ran iu m m in­ ers o f C olorado and in w orkers in nitrogen m u stard factories in Ja p a n , nasal sinus cancer in w ood w orkers. Pleural and peritoneal m esotheliom as in asbestos w orkers, an d skin cancer in shale oil w orkers. Since then the list has grown, and while the causal link is not complete, the likelihood of mutations through expanded use of mutagenic agents is clear. M uta­ tions can be either dom inant, such as early fetal death or abnormality, retinoblastoma, and sterility, or recessive as in the case o f albinism, some anemias, and phenylketonuria. Unfortunately, the impact of recessive m utations is not only deferred but may spread over many generations. Abnor­ malities may also include heightened susceptibility to leukemia, cancers, and alterations in sex ratios. Joshua Lederberg, a geneticist, reflects our current understanding of the relationship between genetics and health this way: If we give p ro p e r w eight to th e genetic com ponent o f m any com m on diseases w hich have a m ore com plex etiology than the textbook exam ples o f M endelian defects, we can calculate that at least 25 p ercent o f o u r health b u rd e n is o f genetic origin. T his figure is a very conservative estim ate in view o f the ge­ The Environment and Its Enemies 105 netic com p o n en t o f such griefs as schizophrenia, diabetes, atherosclerosis, m ental retard atio n , early senility and m any congenital m alform ations. In fact, th e genetic factor in disease is b o u n d to increase to an even larger p ro p o rtio n , for as we deal with infectious disease an d o th er environm ental insults, th e genetic legacy o f th e species will com pete only w ith tra u ­ m atic accidents as the m ajor factor in h ealth. T he most notorious example of a tetralogical abnormality was the thalidomide disaster of 1962. A summary of some of the work shows that there is epidemiologic support for a causal relationship be­ tween air pollution and lung cancer. T here are m arked re­ gional differences in lung cancer mortality related to increased urbanization and to increased levels of organic pollutants in the air. In a survey com pleted in 1958, the lung cancer rate in the United States, standardized for smok­ ing habits and age, was 39 per 100,000 population in rural areas and 52 per 100,000 in cities with populations in excess of 50,000. In later reports smoking and air contam inants are linked to chronic bronchitis, emphysema, spontaneous abortion, neo­ natal fatalities, lip and throat cancer, and other prob­ lems. An in the 1973 report, still another problem is highlighted—fetal and infant risks as consequences of smoking by pregnant women. Although smoking is far from discounted as a factor, other things may be able to kill faster. Tuberculosis, cholera, and typhoid, among other diseases, were soon brought under control by simple sanitary expedients. In Munich, where Pettenkofer im plem ented his sug­ gestions, the death rate from typhoid dropped from 150 deaths per year in 1871 to 14 in 1875. Although little definitive knowledge has em erged, John C alhoun’s in­ vestigations o f rat behavior are disturbing. U nder con­ ditions of overcrowding, the rat colonies became, in his words, “behavioral sinks. O ne factor distinguishes C alhoun’s re­ search from other studies on congestion: in his exper­ iments, the rats were given “space” in which to relieve the pressures of overcrowding, but they refused to disperse—their boundaries were psychological, not topographical. Tentative results reveal that noise alters endocrinal, cardiovascular, and neurologic functions. W hat is also involved is w hat h appens afte r th e brain receives th e so und signal. It depletes energy levels in the volum e o f th e blood circulation; it places a strain o n the h eart; it prevents restorative sleep and rest; it hin d ers 108 Medicine: a. It can so w eaken the body’s defense m echanism s th at diseases can m ore readily take hold. Certain sound-wave frequencies seem to be associated with illness in those exposed to the sound. As one example, Baron recounts Russian research that dem onstrates irregularities in heart func­ tion in workers exposed to sound within the 85 and 120 decibel frequency. Bureau of Community En­ vironmental M anagement, 14,000 instances o f rat bites were reported in 1970, together with 6000 cases of reported disease associated with rat infestation. But natural waters are not the only prob­ The Environment and Its Enemies 109 lem. T he water systems o f Ames, Iowa; Evansville, Florida; Dade County, Florida; and Duluth, Minnesota have been found to contain dangerous chemical con­ tam inants in am ounts in excess o f safe levels. Although the cause may be multifold, the report con­ cludes that “greater exposure to environm ental car­ cinogens must be suspected as the main cause for the faster increase of the black cancer mortality. This dem onstrably preventable disease, contracted chiefly from exposure to lead-based paint on housing surfaces, affects from 10 to 25 per­ cent o f children who live in urban slums.

News about The association is composed of graduates signifcant research buy 2.5 ml xalatan overnight delivery, promotions purchase xalatan 2.5 ml on-line, honors and of the School of Medicine generic xalatan 2.5 ml free shipping, past and present award presentations also is included. Scientifc papers by medical school, former faculty and staff, and staff members and alumni are presented at current medical school students and their the biennial meetings. Over 13,000 indi- recognize the critical importance of teaching viduals receive the publication which has a at Johns Hopkins. Robert Francis Siliciano of the Depart- terly and is jointly sponsored by the School of ments of Medicine and Molecular Biology Medicine, the Hospital, and the Medical and and Genetics. Surgical Association, and is the alumni news- The Graduate Student Association Award letter for the School of Medicine. Jeremy Nathans in Teaching is awarded annually to the teach- of the Departments of Molecular Biology and ers voted by the students in the preclinical Genetics, Neuroscience, and Ophthalmology. David Weishampel of the The Dean’s Special Recognition Award Center for Functional Anatomy and Evolution. Anthony lished the Tilghman Traveling Fellowship in the Derek Sung of the Department of Medicine. The Tilghman Traveling Fellowship will The Stuart Award was established in 1969 be awarded periodically to young members following the bequest of a grateful patient, of the medical faculty, who are native-born George J. The new theories, methods and techniques in selection is made by the senior students. Mitchell Goldstein of The recipients are to be selected by a com- the Department of Pediatrics. All full time and departments in the School of Medicine shall part time members of the faculty are eligible be eligible for consideration. Selection of the awardees is proposed work during the sabbatical year made by the Professors’ Award Committee. Nisha Chandra-Strobos of the Department of Guidelines are available at http://www. Applications may be submitted at Molecular Biology and Genetics for teach- any time, but should be submitted at least 60 ing in the basic sciences, and Dr. Hueppchen of the Department of Gynecology The Shing Yuk Yau Memorial Fund: The and Obstetrics for teaching in the basic and fund was established in 1984 in memory of clinical sciences. Cowles Andrus Distinguished Profes- exchanges between the School of Medicine sorship in Cardiology [2001]: Edward K. Michael Armstrong Professorship [2000]: of Medicine indicates that a sum of money Gregg L. Michael to generate income which supports a profes- Armstrong, to support medical research, with sor in a particular department. Frances and a member of the original faculty of the Baker is a pediatrician and Dr. Trustees and the Board of Johns Hopkins Funding provided by the Seraph Foundation Medicine. The Director of the This gift will be used to support research in Department of Oncology, Dean of the School macular degeneration and other disorders. Freida Derdeyn, a Leonard & Madlyn Abramson Profes- retired teacher who became acquainted with sorship in Neurodegenerative Diseases the work of the Wilmer Institute through a local [2004]: Ted M. Funding provided by Abramson Family Theodore and Ingrid Baramki Profes- Foundation. Theodore Baramki, The income from the principal will be used for a member of the faculty of the Department of prostate cancer research and held in the Sid- Gynecology and Obstetrics and the estate of ney Kimmel Comprehensive Cancer Center, Clarice Reiss. Health Care Professorship in Philip Bard Directorship in the Depart- Medicine Genetics [1996]: Garry Cutting, M. O’Connor, Vernon Mountcastle, Timothy Alzheimer’s Research in Psychiatry and Harrison, and various donors in honor of Behavioral Sciences [2006]: Constantine Philip Bard, Professor of Physiology, 1933 to Lyketsos, M. Funding provided for researching the cause, Baxley Professor of Pathology [1901]: J. Henry Willis Andelot Professor of Laryngology and Baxley (1824-1876) provided funding for the Otology [1962]: Unoccupied. The Andelot name was selected war practiced his profession in Baltimore and by Mr. Stanhope Bayne-Jones Professorship in Dana and Albert “Cubby” Broccoli Profes- Medicine [1974]: David L. As an expert in infectious used to endow a Professorship in Oncology, diseases, he served on the faculty of the Uni- having an initial focus on research and treat- versity of Rochester and Yale Medical Schools, ment of breast cancer. Brody Professorship in Radiol- he was made a brigadier general in the Army ogy [1992]: Martin G. Brody who was the Director Bendann-Iliff Professorship in Ophthal- of the Department of Radiology from 1987- mology [1995]: Nicholas T. Brody was appointed Pres- Funding provided by Constance, Maurice, ident of the Johns Hopkins University. Bernheim Research Pro- in the Division of Hand Surgery [2000]: fessorship in Surgery [1968]: James Black, Thomas M. Thornhill to provide faculty support in the by members of the Bernheim family to honor Division of Hand Surgery, Department of Bertram M. Professorship for of the faculty of the Department of Surgery, Alimentary Tract Diseases in the Depart- he was responsible for pioneering research ment of Surgery [2002] Richard D. Neurosurgery [2007]: Benjamin Carson, Funding for this Chair was by contributions M.

Note: A number of studies relating to the pain expe- • manipulation of the upper thoracic and cervical rienced in fibromyalgia are discussed later in this region using rotational and high velocity thrust chapter under the subheading ‘Pain’ purchase 2.5 ml xalatan visa. To what reported after both 15 and 30 treatments and were extent 2.5 ml xalatan with amex, in any given case discount 2.5 ml xalatan with mastercard, the soft tissue approaches sustained for at least 1 month following the end of the alone might be responsible for the resulting benefits treatment. Among those who did not report benefit after 30 Various mechanisms could be involved. Pain inhibi- treatments it was observed that there had been a less tion may be achieved as a result of: than 35% improvement by the end of 15 treatments, and that this: ‘suggests that a minimum 35% improve- • increased spinal mobility following ment in pain intensity must be observed after 15 treat- manipulation that tends to decrease central ments or it may no longer be appropriate to pursue transmission of pain from adjacent structures this form of treatment’. However, this does not clarify following manipulation whether the ischemic pressure, which calmed the • paraspinal muscles relaxing due to stretching trigger points, would have, on its own, achieved of apophyseal joint capsules during similar results. Ten patients received treatment between teaching (learning about the condition and self- three and five times per week for 4 weeks. During this help measures) and a third group received only time the remainder (the controls) received no treat- moist-heat treatment. Treatment consisted of: noted in the self-teaching group (Jiminez et al • soft tissue massage using a counterirritant 1993). Studies which showed the greatest improvement in their compare joint manipulation with soft tissue approaches quality of life (Rubin et al 1990). There is no evidence that the underlying condition is assisted As with chiropractic evidence it appears that osteo- by these methods, although they clearly have an pathic manipulation offers relative benefits to patients important role to play in management. A gradual had six visits/treatments and it was found decline in the increased myoglobin over a 1-year period that 12 of the patients concentration was observed over repeated responded well in that their tender points massage treatments as self-reported muscle became less sensitive (14% reduction in tension decreased over time. The 15 massages resulted in a self- 458 Naturopathic Physical Medicine reported reduction in pain in 85% of the on treatment with connective tissue massage (30% patients and a reduction in analgesic use by and 10%). Depression and self-rated One of the main findings in this pilot study of women quality of life improved but no improvements with initially severe pain due to long-standing and inca- were observed in sleep, ability for activities pacitating fibromyalgia was that they experienced a sub- and anxiety. Previously, it has been reported in a consisting of medical care from the clinic nurse double-blind study of 48 women with fibromyalgia or physician (Alnigenis et al 2001). However, that connective tissue massage gives pain relief in no impact on pain, depression, well-being and one-third of the treated women (Brattberg 1999). The greatest benefits were Exercise and fibromyalgia noted in areas of mood and depression, as well as in reduced pain levels (Field et al 2003). All symptoms showed favorable progress during a Supervised and graduated exercise 4-week period with manual lymph drainage therapy. Fibro- Relaxation and flexibility comprised upper and myalgia patients who attempt to begin an exercise lower limb stretches and relaxation techniques. As the program often experience an increase in muscle classes continued, more techniques were introduced, pain which may discourage them from continuing to progressing through progressive muscle relaxation, work on improving their level of fitness. Pellegrino release-only relaxation and visualization, cue- (1997) notes that a prescribed, supervised exercise controlled relaxation and differential relaxation. This program is beneficial for fibromyalgia patients, and occupied the whole 1-hour class. It is worth noting, however, that in both only groups the tender point counts had fallen significantly 2. Such a program After 12 months fewer participants in the aerobic can include walking, water aerobics, using an exercise group fulfilled the criteria for fibromyalgia; exercise bicycle, or performing a low impact by this time only 75 (55%) participants still met these aerobic program diagnostic criteria. The goal is to achieve improvement, but also to achieve a stable baseline For people with fibromyalgia prescribed graded aerobic exercise is an effective treatment that leads to 4. Compliance is a consider- relaxation and flexibility able problem, giving high dropout rates. Future strategies to (male and female, age range 18–70 years), evaluated increase the efficacy of exercise as an intervention the effect on their conditions of either graded cardio- should confront the issue of compliance. Potential vascular fitness exercise or relaxation and flexibility strategies include additional cognitive behavioral activities, to which they were randomly assigned. Both forms of intervention helped a good number Exercise therapy comprised an individualized of participants, although clearly aerobic activity pro- aerobic exercise program, mostly walking on tread- duced the most benefit. When people first started classes cost, high-benefit outcome should be seen as offering they usually did two periods of exercise per class a beacon for individuals in chronic pain. Sadly, despite periods of 25 minutes at an intensity that made them obvious benefits, individuals commonly slip back into sweat slightly while being able to talk comfortably in old habits, abandon exercise regimes and return to complete sentences. Exercise routines should be introduced condition and how to manage it, with a group who gradually – see the protocol used by Richards & Scott attended these same lectures but who also received (2002) described above (page 458) – with caution and six 1-hour sessions of physical training. Unsupervised home exercising is probably with doing nothing in similar patients) were untreated unwise until the individual has attended classes during this entire study but received treatment after where the degree, intensity and timing of exercise can it was over. Patients participated Fitness, flexibility and strengthening in the study for 3 weeks (total of 15 sessions). Patients were evaluated by the number In another study (Martin et al 1996) the benefits of of tender points, visual analog scale for pain, exercise (fitness, flexibility and strengthening) pro- Beck’s Depression Index and Fibromyalgia grams were compared with relaxation exercises in a Impact Questionnaire for functional capacity. In Both groups of patients (those doing active exercise, group 1, there were statistically significant and those doing relaxation) met three times a week differences in number of tender points, visual for 6 weeks to carry out their routines under supervi- analog scores, Beck’s Depression Index and sion. At the start, both groups had the same amount Fibromyalgia Impact Questionnaire scores after of pain, stiffness, etc. Six months exercises, 18 completed the course, along with 20 (of later, in group 1, there was still an the 30) in the relaxation group. Both groups showed improvement in the number of tender points (p an improvement in the number and sensitivity of <0. However, cises were much improved compared with the relax- there was no statistical difference in Beck’s ation group. What this study shows is that a number Depression Index scores compared to the of people (about a third) fall out of such programs for control group (p >0.