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By X. Dennis. University of California, Hastings College of Law. 2018.

The law says that animals must be examined every day discount 100 mg lasix mastercard blood pressure medication used for adhd, and a vet must be on call at all times discount lasix 100mg without a prescription arrhythmia upon exertion. Any animal judged to be in pain which cannot be relieved must be immediately given pain relief or painlessly killed, regardless of whether or not the purpose of the research has been achieved. These advise on whether licences should be granted,and also carry out spot checks on laboratories. Inspectors carry out about 2,500 visits a year and can turn up at any time,unannounced. There are 12 members, at least two- thirds of whom must be doctors or veterinary surgeons. Animal welfare groups are represented,and at least half the members will be people who have not done animal experiments, or have not done so for six years. Most scientists care about animals and work to longstanding principles of care generally known as the 3Rs. The approach was first outlined in 1959 by researchers William Russell and Rex Burch. The 3Rs call for the replacement of animals by non-animal methods where possible;the reduction of numbers to the minimum necessary to obtain valid results where replacement is not possible, and refinement of all procedures to minimise adverse effects. Refinement means modifying procedures to minimise stress, boredom or suffering experienced by an animal,and enhance its well-being. Improving bedding, cage space and providing more varied food and making environments more interesting could come under this heading. In other cases the use of more sophisticated diagnostic tests can be employed to detect a disease early, to allow an experiment to end before an animal suffers. Where procedures are likely to be painful, anaesthetics or pain relief is provided. Where animals have to be killed,they are killed humanely, following strict regulations and standards. Reduction covers any strategy that will result in fewer animals being used to obtain the same information. In some cases, for instance, 32 experiments can be designed so that a smaller batch of mice, intensively studied,can answer a wider range of questions. As well as the law, and the voluntary 3Rs approach,the Government recently laid down that from April 1999 a local ethical review process is required in all establishments using animals. The aim is to strengthen the Home Office’s assessment of proposed experiments with a separate, formal, consideration of the justification for using animals, and the scope to replace, reduce or refine use. For instance any new procedure which reduces the numbers of animals needed,or the severity of procedures, should be communicated to other researchers. Published papers should include information which would be likely to help others conducting similar experiments. Some large institutions have full-time vets and smaller ones use local vets with a contract. We are interested in the well-being of individual animals, and if they get sick we do something about it,but we also have to be concerned for the well-being of the whole herd or colony. You look at what is being done and weigh whether the benefit for mankind outweighs the cost to the animals. Sometimes things don’t work as you hoped – equally you get astonishing discoveries when you least expect. It has now been found that these work in every stage of development of the embryo. Cell lines and organ baths are tremendous, but there comes a point where you need to put this information in a living system to see how it works. But he points out that the similarities with human conditions in some animals are very close. You can do a lot of work in insects but there comes a time when you need to bring it into a mammalian system. The Boyd Group is a forum for open exchange of views on the use of animals in science. It has a broad membership which aims to recommend practical steps to achieving common goals. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

There is an apparently limitless amount of The first step has to be a genuine there can never be a clear boundary best 40mg lasix blood pressure normal high, money to be made from marketing disentanglement of the medical so the definition of disease is inevitably pharmaceutical remedies for diseases profession from the pharmaceutical both arbitrary and fluid order 100mg lasix amex pulse pressure glaucoma. It is in the and even more from remedies to industry—there really is no such thing interests of pharmaceutical companies reduce risk factors for disease. The pharmaceutical to extend the range of the abnormal emphasis on the treatment of disease industry spends millions of dollars so that the market for treatments is minimises political responsibility for supporting the “education” of doctors proportionately enlarged. We have seen those fundamental causes of disease because it is in its economic interest this process operating, for example, in that are located within the structure of the continual lowering of thresholds society, and substantial and lucrative Disease mongering for treatment of blood pressure and professional careers have been built on lipids—the most recent guidelines from exploits the deepest the endless pursuit of new diseases or the European Society of Cardiology risk factors for disease. If prescribing Throughout history, humanity has that instead of defining an arbitrary activities and industry profits were kept such fears at bay by accepting threshold of abnormality, governments not affected by this support, it would burdens and sacrifices in the present not be offered. Now, for those without Competing Interests: The author has declared that to be completely independent of other religious belief, death has become no competing interests exist. Politicians genuinely more final, and salvation must be interested in the welfare of patients and Citation: Heath I (2006) Combating disease sought before death in an ever- mongering: Daunting but nonetheless essential. This is an open-access demand more explicit acknowledgment article distributed under the terms of the Creative influence, an ability to acknowledge, Commons Attribution License, which permits of the limits of medical knowledge, accommodate, and move beyond these unrestricted use, distribution, and reproduction in less extrapolation beyond research any medium, provided the original author and source findings, and much more responsible are credited. These predicted disadvantages where individualised solutions become have become more and more apparent, prevalent, societal, population-based so there has been a systematic attempt interventions tend to fall away, and the to improve motivation through the result is worsening health inequalities. Percentage of Doctors That Use you don’t take more exercise, improve limits to medical intervention. There Information Provided by Drug Company your diet or take this medication, is a clear and urgent need for more Representatives in Their Clinical Practice you actively put yourself at risk of an research into the psychological impact Data derived from [3]. Male preventive technologies for currently The second approach is to interpose pattern baldness and shyness, to take healthy populations, and set the some new, supposedly protective just two examples, are not diseases thresholds for intervention accordingly. The current use of diagnostic drift in a whole range of population most at risk of ischaemic pharmaceuticals for public health conditions, from depression [12] to heart disease, and could then calculate policy falls into this category. As more hypertension [13], with pressure for the thresholds of blood pressure and and more risk factors are identified, more and more people to be included cholesterol, which would identify this closely followed by a pharmaceutical within the range of abnormal and most vulnerable 10% of the population. The justification Clearly, these thresholds would be shift the whole bell curve legitimises for these treatments is often based much higher than those recommended the wholesale drug treatment of on short-term studies, which are today. There is insufficient Preventing Disease through There is a clear need to reiterate Rose’s recognition of the fact that the less Population-Based Measures distinction and prioritise the reduction the need for treatment, the higher The seeds of the current situation of exposure to biological hazards above the number needed to treat for given were already present 21 years ago, the application of pharmaceutical outcomes and the higher the risk when Geoffrey Rose wrote his seminal prophylaxis. In this paper, exponential spending on preventive he showed that risk factors for health pharmaceuticals, justified by potential The Challenge to Politicians are almost always distributed across a long-term benefits to an unidentifiable, Politicians are charged with overseeing bell curve and argued that more could but statistically significant, number the organisation of society for the be achieved by attempting to shift of people in the population. A major political the whole of the bell curve than by doctors treat patients with diseases, achievement of Western societies, targeting those at highest risk (Figure progress can be assessed and the with the very notable exception 2). This means of the United States, has been the number of people at low risk may give that if the patient responds to provision of universal health-care rise to more cases of disease than the treatment, it can be continued; if systems available and accessible to small number who are at high risk. There is now a pressing need There has been general acceptance of When doctors treat people who are for politicians to recognise the this argument, but Rose’s own warnings merely at risk of disease, the outcome threat to these systems, and to the seem to have been lost. Authentic health care companies bring—against the for the old and frail has much more increasing capacity of this industry to to do with helping to preserve their bankrupt universal health-care systems. The costs of alongside doctors and many others, to health care are highest during the year make such care available, and this in before death, regardless of the age at itself will be an important part of the which death occurs. The aim economic importance of treatment of preventive health care should be technologies, particularly for those the reduction of untimely deaths in illnesses that primarily affect poorer relatively young people, but the fear people in poorer countries [18]. This of accusations of ageism in health care has meant a shift of attention from means that doctors are encouraged the sick to the well and from the poor to go on prescribing preventive to the rich [19]. This effect of global pharmaceuticals to people well into markets requires a response in the their late eighties and nineties [15]. Health inequalities matter predicated on social solidarity, the Always Distributed across a Bell Curve globally as well as locally. A way forward rights of individuals to treatment have Geoffrey Rose argued that more could be might be through taxation or other to be balanced against the duties of achieved by attempting to shift the whole of means, to make the sale of preventive citizens to provide the appropriate the bell curve (the “population approach” to prevention) than by targeting those at highest technologies in countries with above- level of funding. Human societies are riven by the effects benefits in terms of reducing suffering Population-based interventions favour of greed and fear.

Animal Diseases Currently Causing Concern in Wetlands] were largely compiled from literature produced by the veterinary trusted lasix 100mg blood pressure extremely low, wildlife management order 100mg lasix otc blood pressure up heart rate down, agriculture and public health sectors together with the technical expertise of the contributors. The information has been re-packaged (with acknowledgment) into factsheets specifically for wetland managers and supplemented, where appropriate, with information from scientific articles on wetland management and wetland management guidelines as published by the Ramsar Convention. A summary of the impacts of wetland disease on biodiversity and the environment, livestock and human health and its economic implications. They support a high diversity and abundance of plants, birds, mammals, reptiles, amphibians, fish and invertebrates, as well as the millions of people who rely directly on wetlands for their health, livelihoods, welfare and safety. In addition, wetlands provide tremendous economic benefits, for example: Water supply (quantity and quality); Fisheries (over two thirds of the world’s fish harvest is linked to the health of coastal and inland wetland areas); Agriculture, through the maintenance of water tables and nutrient retention in floodplains; Timber production; Energy resources, such as peat and plant matter; Wildlife resources; Transport; and Recreation and tourism opportunities. Yet, in spite of their obvious importance, wetlands continue to be among the world’s most threatened ecosystems, owing mainly to ongoing drainage, conversion, pollution and over- exploitation of their resources. Many of these impacts have obvious and immediate effects, such as drainage and conversion. However, some effects, such as those from chemical pollutants, waste or excess nutrients, are more insidious, and their impacts may be more difficult to understand and quantify. One aspect which is increasingly being recognised by wetland scientists and managers as an important threat is disease. Diseases affecting wetlands have increased in both frequency and severity within the last few decades and have had major impacts on human health, livelihoods, domestic animal health and biodiversity. Yet, considering the underlying causes of disease emergence it is surprising that disease prevention is often under-recognised in management plans and actions. Health and disease population ecology and ecosystems and is Health: a positive state of physical and one mechanism by which population mental well-being. However, anthropogenic activities can often create Disease: a departure from a state of health; novel disease problems or increases in any impairment to health resulting in prevalence and frequency of existing disease physiological dysfunction; “dis-ease” tipping a ‘balanced’ system into one where means literally a departure from a losses are increased. Overall, it is important to understand that the effects of disease are often much more subtle than life or death but nonetheless can have wide ranging consequences for populations. Types of disease Diseases of wetlands include a wide-variety of disease types including: Infectious: Disease due to the presence of an infectious agent that is capable of being transmitted to another host, e. Immunological: Disease caused by disruption or abnormal function of the immune system, e. A developmental disease may affect a specific part of the body or affect multiple systems. Congenital/ Disease that is inherited genetically or caused by loss in heterozygosity, e. This category includes both infectious diseases (those that can be transmitted between host organisms) and some non-infectious diseases (those that cannot be transmitted between host organisms). An example of an infectious biotic disease is brucellosis: caused by bacteria of the genus Brucella and spread between animals by direct contact with contaminated body fluids. An example of a non-infectious biotic disease is avian botulism: toxins released by the bacterium Clostridium botulinum cause a non-infectious disease in organisms that consume it. Examples of how diseases can be categorised according to their ability to be transmitted between organisms, causal agents and ability to infect humans. Yet wetlands are at particular risk of emerging and re-emerging diseases due to a number of specific attributes: Their association with high population densities of people, agriculture including aquaculture, and industry; Pollution from the above; Sites providing interfaces between livestock, wildlife and people; Having been subject to substantial habitat modification; Sites rarely being isolated, instead usually being connected within catchments; Trade; The high diversity of host taxa; The high proportions of invasive alien species with their associated parasites; and The specific impacts of climate change on wetlands, their hosts, vectors and pathogens. In effect, wetlands are ‘meeting places’ where humans, domestic animals and wildlife are increasingly coming into contact, creating interfaces, which together with other threats are resulting in disease emergence or re-emergence affecting public health, livestock productivity, ecosystem health, biodiversity and economies at multiple scales. The dynamics of diseases in wetland ecosystems are changing rapidly; the most important driver is unequivocally the dramatic growth of the human population and the rapid ecological change driven, directly or indirectly, by human activity. In numerous areas of the world, infectious diseases of domestic animals that were previously endemically stable (vector, host and environment co-existing with the virtual absence of clinical disease) are now unstable due to anthropogenic changes (e. Selected factors driving disease emergence in wetland systems (adapted from Morse, 2004). Factor Examples of specific factor Examples of diseases in wetlands Agriculture Production systems Highly pathogenic avian Dams influenza, e. Animal translocations (of livestock and wildlife) have increased substantially in recent decades and have often resulted in serious disease outbreaks. Such movements drive disease emergence directly through the following mechanisms: Infection is spread to a new area by the movement of infected animals or fomites; Disease vectors are spread to a new area e.

Control of glycaemia Issue Does control of glycaemia reduce cardiovascular risk in patients with diabetes? Evidence Cardiovascular disease accounts for about 60% of all mortality in people with diabetes discount 100 mg lasix blood pressure in legs. The risk of cardiovascular events is 2–3 times higher in people with type 1 or type 2 diabetes (354 cheap lasix 100 mg heart attack mortality rate, 355) and the risk is disproportionately higher in women (354, 356). Patients with diabetes also have a poorer prognosis after cardiovascular events compared with non-diabetics (357, 358). Epidemiological evidence also suggests that the association between blood glucose and cardiovas- cular disease begins before diabetes manifests itself (357–361). In a meta-analysis of non-diabetic subjects, those with the highest blood glucose levels had a relative risk for cardiovascular disease events of 1. This suggests that cardiovas- cular risk increases as glucose tolerance becomes impaired and then progresses to diabetes (362). However, the difference in the number of events in the two groups was not significant. Each 1% increase in HbA1c level was associated with a 14% increase in the incidence of fatal or nonfatal myocardial infarction (368). However, intensive treatment of patients with newly diagnosed type 2 diabetes, with sulfonylureas or insulin, resulted in a 16% reduction (P = 0. There was no “threshold” of glycaemia at which there was a significant change in risk for any of the clinical outcomes examined. The rate of increase of microvascular disease with hyperglycaemia was greater than that of macro- vascular disease. Metformin is safe and effective for treatment of type 2 diabetes, either as monotherapy or in com- bination with other drugs. The role of the newer insulin secretagogues, the thiazolidinediones, is still being evaluated in clinical trials. In most circumstances, metformin is the drug of choice for initial therapy of obese patients with type 2 diabetes and mild to moderate hyperglycaemia (370). For each patient the risk of hypoglycaemia must be considered when determining the target HbA1c level, especially in people treated with insulin and those with type 1 diabetes. Health care practitioners should be aware that more intensive glycaemic control increases the risk of hypo- glycaemia. However, it is important to set targets appropriate to the individual and in consultation with him or her. It is also important to recognize that adherence to medicines is much lower in real-life settings than in clinical trials. The results of controlled trials are unlikely to be achieved in clinical practice unless specific measures are taken to improve compliance with treatment. In summary, good glycaemic control should be a key goal of treatment of diabetes, to delay the onset and progression of microvascular and macrovascular disease. Treatment should aim to achieve: ● a fasting blood glucose level of 4–7 mmol/l (72–126 mg/dl); ● an HbA1c level of 6. The first approach to controlling glycaemia should be through diet alone; if this is not sufficient, oral medication should be given, followed by insulin if necessary. Aspirin therapy Issue Does long-term treatment with aspirin reduce cardiovascular risk? The numbers of women enrolled in most of these trials were too small to allow robust con- clusions to be drawn about the role of aspirin in primary prevention for women. In the Women’s Health study (376), women aged 45 years or older (n = 39 876) were randomly assigned to receive low-dose aspirin therapy or placebo, and followed up for 10 years. A review of observational studies (380) suggested that the background risk of major gastrointestinal complications is about 1–2 per 1000 per year at age 60 years. The excess risks attributable to aspirin are therefore 1–2 per 1000 per year at age 60. Among unselected people under 60 years, therefore, the expected benefit in terms of myocardial infarction (2 per 1000 per year avoided) does not exceed the expected risk of a major gastrointestinal bleed.