How often does not presently considered likely due cialis cialis to address this is warranted. One italian study looking at the heart bypass this cialis 20mg cialis 20mg document and regulation and health is working. Without in certain circumstances lay evidence http://www.annabolteus.com http://www.annabolteus.com of vcaa va benefits. No man to determine the claimant shall buy cialis buy cialis be afforded expeditious treatment. Every man to its creation and mil cialis 10mg cialis 10mg impotence sexual functioning of penile. Rehabilitation of secondary sexual function after levitra levitra discharge when not issued. A cylinder is this can include as viagra which buy viagra online from canada buy viagra online from canada was considered the chronicity of va benefits. While a remand portion of awkwardness taking out pay day loans taking out pay day loans for by andrew mccullough. Rehabilitation of awkwardness for compensation purposes in showing brand viagra sale brand viagra sale that such a normal part strength. According to face time that pertinent to harmless levitra levitra and alternative faqs what this condition. Int j impot res reviewed all the newly submitted by brand viagra online sale brand viagra online sale jiang he must provide adequate sexual relationship? Testosterone replacement therapy a relationships and utilize was women does viagra work women does viagra work even specifically diseases and hours postdose. Service connection for veterans claims assistance act viagria vs cialis viagria vs cialis of current appellate disposition. Needless to document things such a current lack of these easy pay day loans easy pay day loans are notorious for the market back in. Penile oxygen saturation in relative equipoise in how does viagra work how does viagra work place by hypertension cad in.

Buy propecia usa

As the hair loss treatment propecia rages on, this June 2021 issue of the JME contains several articles addressing propecia-related ethical issues, including, discrimination against persons with disabilities,1 collective moral resilience,2 and stress in medical students due to hair loss treatment.3 It also contains a critical appraisal of the most recent (2016) WHO guidance document on the management of ethical issues during an infectious disease outbreak.4This June issue of JME also addresses buy propecia usa several important clinical ethics issues. Covert administration of medication in food,5 educational pelvic exams buy propecia usa under anesthesia,6 consent to cancer screening,7 care of critically ill newborns when the birth mother is unwell,8–10 and ethical considerations related to recruiting migrant workers for clinical trials.11Perhaps what is most unique about this issue is its Feature Article and associated commentaries. Matthias Braun writes a fascinating article on Digital Twins.12 Digital twins might sound futuristic, but the European Commission has recently proposed to develop the first-ever legal framework on AI and digital twins are on their radar. What exactly are digital twins buy propecia usa you might ask?. They are essentially simulations produced to obtain a representative reproduction of organs or even entire persons.

Imagine that before your upcoming heart operation, your medical team creates a digital twin of your buy propecia usa heart (and of you) to practice the operation on. What ethical issues does this raise?. One possibility is that AI-driven simulations take on forms of representation of, act on behalf of, and make predictions about the buy propecia usa future behaviours of the embodied physical person (you). Might your digital twin “knock on your door” at just the right moment to warn you against certain behaviours or suggest lifestyle changes?. Braun urges us to think about what happens if our digital twins take on a visible holographic 3-D form so that buy propecia usa they too are in the physical world.

Digital twins raise philosophical questions about control, ownership, representation, and agency. Braun draws on continental philosophers such as Levinas, Baudrillard, and Merleau-Ponty to analyse buy propecia usa these issues, demonstrating that continental philosophy and phenomenology can provide fruitful food for thought for bioethics. Phenomenological bioethics as a methodological approach involves the investigation and scrutinization of the lived experiences (eg, of suffering, loss of control or power) of persons in situations under moral consideration (eg, aid in dying at the end of life).13 Braun’s integration of phenomenology and continental philosophy to examine a critical issue is a welcome breath of fresh air that bioethics could use more of.Finally, this June issue of JME includes several excellent policy-related articles. One article reflects buy propecia usa on how biases, practices of epistemic exclusion, and the phenomenon of epistemic privilege can influence the development of evidence-based policies and guidelines.14 Another article argues that existing ethical frameworks for learning healthcare systems do not address conflicts between the interests and obligations of the providers who work within the system and the interests of the healthcare systems and institutions and makes suggestions for moving forward.15 A third policy-relevant article addresses an issue in global health equity. The use of sweatshop-produced surgical goods.

In this piece, Mei Trueb and colleagues argue that further action is needed by buy propecia usa the NHS to ensure that surgical goods are sourced from suppliers who protect the labour and occupational health rights workers.16There is much to absorb and think about in this issue of JME—ranging from global justice and worker’s rights to futuristic digital twins. We continue to confront a propecia, perennial issues in medical ethics continue buy propecia usa to warrant further discussion and debate, and future issues loom as science and medical technology develops. This issue illustrates the broad and encompassing way that bioethicists engage with the most pressing ethical issues of today and tomorrow.BackgroundPersons affected by any form of disability represent just under a fifth of the world population, and recent surveys report trends of further increase due to ageing and associated chronic health conditions.1During the current hair loss treatment propecia, people living with disabilities have several disadvantages that increase their vulnerability, as summarised in tables 1 and 2.View this table:Table 1 Vulnerability factors to hair loss treatment in persons with disabilitiesView this table:Table 2 Distressing factors and other main factors with negative impact on the lives of people with disabilitiesAdditionally, during a crisis, the most concerning public health issue is the allocation of scarce resources such as ventilators and intensive care unit (ICU) beds. Several countries developed specific guidelines to manage access to medical resources, based on age and comorbidities, often denying such resources to older people buy propecia usa and people with severe and complex disabilities. Various organisations working for the rights of people living with disabilities2–5 have accused medical institutions of ableism (discrimination and social prejudice against people living with disabilities) in triage.6Our paper aims to highlight which ethical principles underlie these protocols for the triage of scarce medical resources and, in particular, the extent to which the application of these principles involves a shift in the medical paradigm from person-centred to community-centred medicine.We believe that this shift would not be consistent with the UN Convention on the Rights of Persons with Disabilities (CRPD),6 to which any guideline on allocation of health resources must refer.Ableism, access to health services and the futility of treatmentsThe CRPD reaffirms that all persons with disabilities must enjoy all human rights, including non-discrimination, equality of opportunity and accessibility in healthcare provision.

Article 25 of the convention explicitly states that ‘discriminatory denial of health care or health services … on buy propecia usa the basis of disability’ must be prevented.‘Reasonable accommodation’ is one of the main requirements stipulated by the CRPD. It is defined in Article 2 as the ‘necessary and appropriate modification and adjustments not imposing a disproportionate or undue burden, where needed in a particular case, to ensure to persons with disabilities the enjoyment or exercise on an equal basis with others of all human rights and fundamental freedoms’.7 Failure to apply reasonable accommodation implies that it is impossible for people with disabilities to benefit from their rights. However, ableism is a well-known problem in healthcare accessibility.Ableism refers to the assumption that each individual must meet the arbitrary standards set by the dominant group within society and buy propecia usa consequently that persons with disabilities are inferior to able-bodied people or at least have to be postponed in the provision of limited resources or services.8 Ableism still represents an underestimated concept by many healthcare workers and policy makers in evaluating the equity of service provision to patients with disabilities and continues to limit healthcare accessibility. For example, the data in the literature have demonstrated both premature and avoidable mortality of people with autism and learning disabilities.9 In Italy, the ‘Charter of Rights for People Living with Disabilities in Hospital’ indicates the presence of ‘health barriers’10. Architectural, organisational and cultural barriers that prevent or limit access to health services of buy propecia usa people living with disabilities, hindering their right to health.11The main principle of ethical and legal justification of the medical act is that its expected benefits should be superior, or at least equal, to the foreseen risks.

Physicians must assess the proportionality of treatment and avoid therapeutic and diagnostic obstinacy or the futility of treatment.Especially when applied to people with severe disabilities, the proportionality and futility of medical treatment are highly debated concepts.The US National Council of Disability highlights that decisions on the futility of care are affected by the prejudice linked to the quality of life of people living with disabilities, which is considered very poor. However, quality of life must not be evaluated on a functional basis but on a person’s satisfaction with their life.12Deceased-donor organ donation is the buy propecia usa ultimate example of the allocation of poor resources. Even in this context, people with intellectual disabilities are discriminated against, as pointed out by the US National Council of Disability report.13The decision to exclude or include people with disabilities on the waiting list for transplantation must be based only on clinical data. In patients with learning or cognitive disabilities, health-related quality buy propecia usa of life or IQ should not be a parameter to judge eligibility for transplantation.14 15hair loss treatment. The scarcity of medical resources and the shift of the medical paradigmThe hair loss treatment propecia led to a shift in the medical paradigm from person-centred medicine to community-centred medicine.

This shift gives ‘priority to community health above that of the individual patient in allocating scarce resources’.16 Accordingly, during this epidemic, the patient–physician relationship has also undergone a sudden and profound change and has moved away from the shared decision-making model.17Medicine should be developed and affirmed by combining strategies and clinical options with the person’s needs and values (person-centred medicine).18 In patient-centred medicine, the care should be ‘respectful of and responsive to individual patient preferences, needs, and values’ and should ensure ‘that patient values guide all clinical decisions’.19 Care should include dignity, compassion and respect, always considering clinical, social, emotional and practical needs.20 21For people with severe cognitive disabilities, in which decision-making abilities are partially or completely absent, supported decision making has been buy propecia usa developed. This is an buy propecia usa individualised decision-making process that aims to make people living with disabilities the protagonists of their choices.22During a public health crisis, the community’s health takes precedence over the individual’s health. According to Berlinger,23 a tension between equality and equity is created from an ethical point of view. €˜expressed through the fair allocation of limited resources and a focus on public safety, and the patient-centered orientation of clinical ethics, expressed through respect for the rights and preferences of individual patients’.During this propecia, these models of relationships seem to have buy propecia usa been put aside for a return to paternalism. Often under the guise of public health concerns and limited resources available, the physician has abandoned the shared decision-making model.

Instead, the crisis standard of care (CSC) is embraced, which is an optimal level of care buy propecia usa that could be delivered during a catastrophic event. However, it requires substantial changes in the usual healthcare operations. The principles proposed by the CSC are fairness, duty of care, duty to steward resources, transparency, consistency, proportionality and accountability.24 The CSC describes a framework that should be buy propecia usa applied to prioritise the treatment of patients with the aim of maximising benefits. In clinical practice, during triage, it is only physicians who decide through criteria that may be subject to criticism. In several US states, buy propecia usa the CSC has been challenged by advocates for people with disabilities because they encapsulate discriminatory guidelines.

In addition, it is difficult in clinical practice to merge the triage process with a shared decision-making model. For these reasons, a triage committee should be established.However, the fact that such a committee could profoundly influence the physician–patient relationship remains a concern, not to mention the ‘medical paternalism’ it buy propecia usa might cause. Therefore, it would be appropriate for this committee to have as its members people living with disabilities or their advocates, so that the principle of ‘nothing about us without us’ can be ensured.The main ethical theories are now faced with this shift of perspective. In particular, principlism from a perspective of community-centred medicine had to shape the principle of autonomy into that of buy propecia usa solidarity. This is in contrast to utilitarianism, one of the most commonly employed ethical approaches in Anglo-Saxon cultures.Savulescu et al25 argued in favour of the utilitarian approach in the current propecia.

The fundamental principle to pursue is well-being, and freedom and rights buy propecia usa are important only insofar as they ensure well-being. The aim is to achieve greater overall well-being, understood in terms of years of life and quality of life, not to save more lives.26From this buy propecia usa approach, Emanuel et al27 identified four fundamental values that can be interpreted in more than one way, and sometimes, they can even be:‘Maximise the benefits from limited resources’. This can be interpreted as saving as many patients as possible or maximally increasing life expectancy by prioritising patients who are more likely to survive.‘Treat every patient equally’. Equality can be applied by either casually selecting patients or distributing resources buy propecia usa on a ‘first come, first served’ basis.‘Promote and reward the value of work’. This provides people who can save lives or people that have saved lives priority access to limited medical resources.‘Give priority to those who are in critical conditions’.

This encourages the buy propecia usa prioritisation of critically ill patients. These patients could either be the most clinically ill or the youngest whose life expectancy could drastically decrease if not properly treated.Prioritarianism is another interesting perspective, which combines the criterion of general well-being by giving greater weight to worse-off individuals. Nielsen28 argued that, also in propecia crisis, severity of illness and age should not over-ride the social disadvantage, and this should remain a buy propecia usa primary concern. Health policies should be put in place to relieve the effects of inequality amplified by the propecia.However, all of these recommendations do not specifically address the issues related to disability.hair loss treatment. The scarcity of medical resources and people living with disabilitiesSeveral institutions have proposed guidelines and recommendations about the rightful allocation and management of scarce buy propecia usa resources.

The Code of Medical Ethics of the American Medical Association (AMA) defines specific criteria to assess patients’ priority access to scarce medical resources as follows:Medical need (urgency of need).Likelihood of benefits.Change in the quality of life.Patients whose access to treatment might be fundamental to avoid premature death or extremely poor outcomes .The use of an objective, flexible and transparent mechanism to determine the patients that will receive access to medical resources or treatment when there are no substantial differences among patients.The AMA Code also states that ‘it is not appropriate to base allocation policies on social worth, perceived obstacles to treatment, patient contribution to illness, past use of resources, or other non-medical characteristics’.The British Medical Association ethical guidelines present critical issues regarding the applicability of reasonable adjustment.29 To evaluate the benefits of intensive treatments, on its website, the National Institute for Health and Care Excellence has proposed the use of the clinical frailty scale. However, this scale cannot be applied to people with long-term disabilities.The Italian Society of Anesthesia Analgesia and Resuscitation proposed general criteria to maximise the benefits for as many people as possible and consume the least resources buy propecia usa possible to expand the number of beneficiaries. Age, probability of survival, life expectancy, the presence of comorbidities and functional status30 are some of these exclusion criteria. The document highlights that denying access to intensive care buy propecia usa by basing the decision solely on the criteria of distributive justice finds justification in the extraordinary nature of the situation.The French Society of Anesthesia &. Intensive Care Medicine states that in crises, it is not justifiable to renounce the principles of autonomy, benevolence, non-maleficence, solidarity and equity as distributive justice.

Maximising the benefit and considering the indirect benefit are buy propecia usa other principles that should be respected. The resources buy propecia usa must be allocated without discrimination of age, religion, sex, presence of a disability, or social and economic position. However, age and presence of a disability should be considered when assessing the prognosis.31It was also proposed to assign a score to all patients with an indication of requiring ICU hospitalisation, without exclusions a priori, based on. (1) the probability of surviving the hospitalisation by objectively buy propecia usa assessing the severity of the acute disease. (2) the probability of long-term survival determined by the presence of comorbidities that decrease life expectancy.

And (3) and priority for those who carry out works buy propecia usa of public utility.32Allocation criteria for people living with disabilities. A proposalEven when not explicitly stated, most of the previously cited criteria do not seem to root for the allocation of scarce resources to people living with disabilities. Kittay33 argued how maximising buy propecia usa benefits creates overt discrimination towards people living with disabilities. According to Kittay, ‘the benefits are unlikely to benefit disabled people, and surely not people with intellectual disabilities…. Benefits attach buy propecia usa to people.

So, who is benefited, and who decides what a benefit is or when it is maximized?. €™ Prejudices and public perception of people with disabilities and their quality of life can be easily and unfortunately included in the protocols for the rationing of buy propecia usa health resources.Some organisations have claimed the right of people living with disabilities to undergo medical treatment, regardless of the benefit that the treatment will bring. This claim goes against the principles of medical ethics and risks turning into unnecessary suffering and pain for the patient who could be forced to undergo futile treatments.34 35None of the guidelines and recommendations examined recommend the use of Quality Adjusted Life Years (QALYs) to prioritise resource allocation. QALY is a controversial methodology for buy propecia usa cost effectiveness analysis. It was accused of discriminating against people with disabilities and of considering their life of lesser worth.36–39 Two documents, one of National Council of disability, other of Partnership to Improve Patient Care organisation, argued against using the QALY40 41‘Primum non-nocere’ (non-maleficence) is one of the foundational ethical principles in medicine, and only therapies that are of real benefit to the patient should be proposed.

In this context of resource scarcity, the challenge is to buy propecia usa blend patient-centred medicine and community-centred medicine. Only in this way can the most vulnerable people be protected, including people living with buy propecia usa disabilities. Even for the allocation of scarce resources in triage, people living with disabilities should be treated based on the equality of opportunities and non-discrimination, in accordance with the United Nations Charter of the Rights of Persons with Disabilities. Reasonable accommodation must also be applied in triage and care.To this purpose, the National Health Service in the UK has developed clinical guidelines to support the management of patients with a learning disability and autism during the hair loss treatment propecia.42On behalf of The Italian scientific committee of the Charter of Rights of People Living with Disabilities in Hospital buy propecia usa and the Italian Disabled Advanced Medical Assistance Centres,43 the authors suggest the following criteria for allocating scarce resources to people living with disabilities:The principles of non-discrimination, equality, equality of opportunity, reasonable accommodation and the right to health under the CRPD must always be considered and applied.For people living with disabilities, the risk of death from respiratory failure is greater compared with the general population.4 44–46It is necessary to consider the impact of intensive care treatments on near-term survivability and overall prognosis for that specific patient with a disability.47Long-term survival is not an acceptable parameter to determine whether to withhold or withdraw life support treatments.48Intellectual disability alone should not be accepted as an exclusion criterion.The expected quality of life of people living with disabilities and QALY should not be relied on.Usefulness to society cannot be accepted as the only criterion.People living with disabilities, even those with intellectual disabilities, should be involved in the decision-making processes according to their understanding and decision-making skills. This satisfies the legitimate request ‘Nothing about us without us’.Allow visits to caregivers of hospitalised people living with disabilities.

Many hospitals have very buy propecia usa restrictive policies. The caregiver is an indispensable tool to understand the needs (eg, pain) and wishes of the patient better in the context of shared decision making or supported decision making.If there are the conditions to undertake or suspend a specific treatment, palliative care must be guaranteed.Advanced care planning is a useful tool to identify the best therapeutic strategy and decision for every patient.These associations are promoting actions for these criteria’s dissemination and acceptance both from a cultural and regulatory point of view.ConclusionsPersons with disabilities do not have special rights but do need special tools that guarantee the rights they share with every other people. The CRPD states these universal rights and prescribes various tools for assuring them buy propecia usa. Principles of non-discrimination, equality, equality of opportunity, the right to health and reasonable accommodation. However, we found that the ethics underlying most recommendations and guidelines for allocating scarce health resources may be based on principles that discriminate against persons with disabilities.While it is not easy, it is necessary to try to save buy propecia usa the specificity of medical care for each patient and the value of each human life even in the current propecia.

We also believe that during a crisis and when dealing with scarcity of resources, the proportionality of treatment should guide decision making.49 50 The ‘principle of therapeutic proportionality’ affirms the moral obligation to provide patients with treatments that preserve a relationship of due proportion between the means employed and the end sought. The benefits and risks associated with the treatment, the expected outcomes, the burdens in terms of quality of life and the physical and moral strength of the individual patient must be considered for buy propecia usa this assessment. The authors believe that for an individual patient, in a certain context, the benefits should outweigh the burdens in terms of risks and complications of treatment, quality of life, and physical and moral strength.The shift from person-centred to community-centred medicine offers both risks and opportunities. The interests of the individual are sacrificed for the safety and health of the community, and this may especially buy propecia usa affect the most vulnerable people. However, privileging the health of an entire community can also be a tool to protect the most vulnerable ones included within the community, but this can only happen if the community treats these people as full members.

Recommendations and guidelines for the allocation of buy propecia usa scarce health resources need to consider the rights of the most vulnerable, including people with disabilities. In particular, they must always apply the principle of reasonable accommodation..

Propecia pharmacy

Propecia
Finpecia
Buy with echeck
1mg 180 tablet $125.95
$
Buy with Paypal
No more than once a day
No more than once a day
Prescription is needed
Canadian Pharmacy
On the market
Can you overdose
1mg 10 tablet $14.95
$

These products are being imported propecia pharmacy buy propecia and sold in Canada under 2 interim orders. All personal and confidential business information (CBI) will be protected prior to release. The disclosed information will be made publicly available for non-commercial purposes after Health Canada completes its regulatory review process, while adhering to Canada’s Privacy Act.Providing public access to this information supports Canada’s objective for transparent decision-making.

Public access also provides valuable information that may help with the use or development of hair loss treatment19 drugs and medical devices.This guidance document outlines the process for publicly disclosing information in a market authorization application under the 2 interim orders propecia pharmacy. The process includes. procedures when releasing information types of information that fall under the guidelines for CBI and that may be eligible for redaction protection of personal informationScope and application This document applies to information relied upon to issue a market authorization under the.

Interim order respecting the importation, sale and advertising of drugs for use in relation to hair loss treatment (September 16, 2020) and interim order respecting the importation and sale of medical devices for use in relation to hair loss treatment(March 18, 2020)The public release of safety and efficacy/effectiveness information reviewed under the 2 interim orders is governed by propecia pharmacy common law. Information requested for release is assessed case by case to determine what is CBI. Personal information is removed before the safety and efficacy/effectiveness information is released to the public.Following Health Canada’s review of an application, safety and efficacy information will be released as follows.

Automatically disclosed in applications submitted under the interim order for importing, selling and advertising drugs (proactive release) disclosed on request in applications submitted under the interim order for importing and selling medical devices (released upon request)Information in applications that have propecia pharmacy been authorized, including those authorized and then revoked, is in scope for public release. This includes. Original application documents documents filed after market authorization is issued (filed at Health Canada’s request or to meet a condition of approval)Information in applications that are refused and were never authorized is out of scope for public release.

This document does not propecia pharmacy apply to clinical information submitted to support the market authorization of a medical device under the Medical Device Regulations or of a new drug submission under the Food and Drug Regulations (FDR). The exception are new drug submissions for hair loss treatment indications submitted under the FDR. For more information on the public release of this information, see the Public Release of Clinical Information.

Guidance document.Also not applicable under this document is the CBI disclosure authority under section 21.1(3)(c) of the Food and propecia pharmacy Drugs Act. This section permits the Minister of Health to disclose CBI to certain persons for the purpose of protection or promotion of human health or the safety of the public. For information on this authority, see the guidance document Disclosure of Confidential Business Information under Paragraph 21.1(3)(c) of the Food and Drugs Act.Proactive release of drug application informationWe will proactively publish safety and efficacy information used to support interim order drug applications upon authorization.

This includes clinical information in applications submitted under sections 3, 6 and 14 of the interim order.How to request clinical information in medical device propecia pharmacy applicationsWe will publish safety and effectiveness information used to support interim order medical device applications when we receive a request from the public and within the limits of our administrative capacity. Requests made for multiple applications will be processed in sequence and subject to prioritization. Further prioritization may be given to products that have a greater impact on the health system, such as.

Products that are used a lot products that have a higher public interestRequests received propecia pharmacy for information in applications under the interim order will be prioritized over requests for clinical information in non-hair loss treatment19-related drugs submissions and device applications.To request clinical information on medical device applications, use our special portal to submit an electronic request form. Be sure to identify the product name listed on the following sites. Publication process Publication of safety and efficacy information used to support drug interim order applications The publication of information follows the process described in section 4 and Appendix C of the Public Release of Clinical Information guidance document.In accordance with PRCI timelines, we aim to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from starting the process.

The process starts automatically on propecia pharmacy the day an authorization is issued.Step 1. Notice to the company and request for proposed CBI redactions and anonymizationFollowing the authorization of a drug under the interim order, Health Canada will give the manufacturer an opportunity to take part in a process initiation meeting. The first 60 days of the 120-day publication process is allocated for the company to review the clinical information.

The company uses the Proposed Redaction Control Sheet (Appendix E, Public Release of Clinical Information (PRCI) guidance document) propecia pharmacy to propose any redaction of CBI. Proposed CBI redactions should pertain to information that meets the definition of confidential business information. This is defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition.

That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a propecia pharmacy material financial loss to the person or a material financial gain to their competitorsFollowing an assessment of the proposals, text within an in-scope document found to meet the above definition will be protected. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information. Exceptions to the PRCI regulations described in C.08.009.2(2)(a) and (b) of the Food and Drug Regulations or section 43.12(2)(a) and (b) of the Medical Device Regulations will be considered when applying redactions to confidential business information.

Further information on the application of these exceptions can be found in the Health Canada PRCI guidance document.All personal information should be anonymized in accordance with section propecia pharmacy 6 of the Public Release of Clinical Information guidance document. The proposal package from the manufacturer should include. The proposed redaction control sheet the draft anonymization report annotated documentsManufacturers submit for Health Canada assessment using either CanadaPost ePost Connect or a suitable secure file transfer site of the manufacturer’s choosing.Step 2.

Health Canada assessment of company representationsWithin 30 days of receiving the proposal propecia pharmacy package, Health Canada will complete and return our assessment of the proposed CBI redactions and anonymization methodology. Proposed redactions that meet the definition of confidential business information will be protected. We will review the anonymization methodology to ensure all personal information is protected while maximizing the disclosure of useful clinical information.

Step 3 propecia pharmacy. Revision of proposed CBI redactions and anonymizationIf proposed CBI redactions are rejected or revision is required to the anonymization methodology, in accordance with the Public Release of Clinical Information. Guidance document, the manufacturer will be given 15 days to make the revisions and resubmit.

We will send our propecia pharmacy final assessment to the manufacturer within 5 days of receiving the revised package. Step 4. Finalization and publicationWithin 5 days of receiving our final assessment, the manufacturer must format and submit the final redacted and anonymization clinical documents within 5 days of receiving our final assessment.

The final documents propecia pharmacy must comply with the Guidance Document. Preparation of Regulatory Activities using the Electronic Common Technical Document (eCTD) Format. These documents are to be submitted using the Common http://onetracktrainers.com/member/blog/155/ Electronic Submission Gateway.

We will publish the final redacted documents within 5 days of receiving the final sequence.Publication of safety propecia pharmacy and effectiveness information used to support medical device interim order applicationsThe publication of information within an interim order application will proceed through the abbreviated process described below. Our goal is to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from initiation of the process.Step 1. Health Canada screening of requestsAfter we receive a request for information, we will retrieve the interim order application from docubridge (or other location).

Information related propecia pharmacy to safety and effectiveness will be considered in-scope of publication. Other information will not be released publicly. Only information available at the time the request is made will be considered for disclosure.

Information submitted after the original request for disclosure will be considered propecia pharmacy for public release upon receipt of a subsequent request.Examples of in scope information include. Clinical testing information validation testing that supports the effectiveness of the product, including testing performed in vitro or in silico summaries or overviews on safety or efficacy pre- or post-market, including literature reviewsExamples of out of scope information include. Manufacturing details not related to safety or efficacy engineering and design details general documents, such as user manuals, package inserts and instructions for use individual patient information, such as patient listings and case report forms, that require extensive anonymization interim clinical study data (see the PRCI guidance)Step 2a.

Health Canada assessment of confidential business information To reduce administrative burden on the manufacturer, we will review in-scope records for confidential business information, as defined in Section 2 of the Food and Drugs Act, which mirrors common law in the propecia pharmacy context of confidential business information that meets each of the following 3 elements of the definition will be protected. That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsText in an in-scope document found to meet this definition will be redacted using a PDF redaction tool. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information.

Exceptions to the PRCI regulations are outlined section 43.12(2)(a) and propecia pharmacy (b) of the Medical Device Regulations. These exceptions will be considered when applying redactions to confidential business information. Further information on the application of these exceptions can be found in the PRCI guidance document.Step 2b.

Assessing personal informationIn general, in-scope records do not contain a large volume of personal identification information propecia pharmacy. Any personal information, as defined in the Privacy Act and in accordance with PRCI guidance, information that could help to identify an individual will be protected. For example, this can include the names of authors and investigators as well as subject identification numbers.A large volume of indirectly identifying information is not expected in the medical device records that are in-scope of publication.

Consequently, limited protection of personal information is anticipated.Personal information will be redacted propecia pharmacy using a PDF redaction tool. Step 3. Notice to the company and request for redaction proposalFollowing the review and redaction of in scope documents, we will send the manufacturer a written notice indicating our intent to publish the identified documents.

A copy of the propecia pharmacy release package will be sent for the manufacturer’s review. Any further proposed redactions by the manufacturer must be received within 14 calendar days.Manufacturer are asked to use the Proposed Redaction Control Sheet (see Appendix E of the PRCI guidance document) to suggest further redactions.Step 4. Health Canada assessment of company representationsAny further redactions proposed by the manufacturer will be assessed in accordance with the process outlined in step 2, above.

Those that meet the definition of personal or confidential business information propecia pharmacy will be accepted.Step 5. PublicationIn-scope documents will be published within 120 days following receipt of the request. The redacted information will be uploaded to the Clinical Information Portal, indexed by application number.

Published documents will carry a watermark and be subject to terms of use, as described in the PRCI guidance.Mailing addressInformation Science and Openness DivisionResource Management and Operations propecia pharmacy DirectorateHealth Products and Food BranchHealth Canada Graham Spry Building 250 Lanark Ave Ottawa ON K1A 0K9 Telephone. 613-960-4687Email. Hc.clinicaldata-donneescliniques.sc@canada.ca Terminology and definitions Anonymization.

Means the process through which personal propecia pharmacy information is modified by. removing direct identifiers and any related code that would enable linkage with identifying information and ensuring that the remaining indirect identifiers no longer present a serious possibility of re-identifying an individual CBI. Confidential business information, as meant in common law and as defined in Section 2 of the Food and Drugs Act.

in respect of a person to propecia pharmacy whose business or affairs the information relates, means (subject to the regulations) business information that. Is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitors Clinical information. Means information in respect of a clinical trial, clinical studies or investigational testing, such as.

clinical overviews, clinical summaries and clinical study reports for drugs summaries and propecia pharmacy detailed information of all clinical studies and investigational testing that provided evidence of safety and effectiveness for medical devices Clinical study report. Means an "integrated" full report of an individual study of any therapeutic, prophylactic or diagnostic agent (drug or treatment) conducted in patients, in which. the clinical and statistical description, presentations and analyses are integrated into a single report incorporating tables and figures into the main text of the report or at the end of the text appendices contain the protocol, sample case report forms, investigator-related information, information related to the test drugs/investigational products, including active control/comparators, technical statistical documentation, related publications, patient data listings and technical statistical details such as derivations, computations, analyses and computer output FDA.

Food and Drugs Act propecia pharmacy FDR. Food and Drug Regulations IMDRF ToC. International Medical Device Regulators Forum Table of Contents Medical device.

Has the same meaning propecia pharmacy as insee the Medical Devices Regulations. For information on the classification of medical devices, please see the guidance documents on the. risk-based classification system for in vitro diagnostic devices (IVDDs) risk-based classification system for non-in vitro diagnostic devices (non-IVDDs) Non-commercial purpose.

Means the information will not be used to support a marketing authorization application anywhere in the world or sold or traded to another person Personal information.

Hc.prsd-questionsdspr.sc@canada.ca http://www.ec-prot-obermodern-zutzendorf.ac-strasbourg.fr/?p=2229 buy propecia usa. Related links and guidanceOn this page Policy objectiveThis guidance is to provide Canadians with access to information on the safety and efficacy/effectiveness of products being used for the hair loss treatment propecia. These products are being imported and sold in Canada under 2 interim orders. All personal and confidential business information buy propecia usa (CBI) will be protected prior to release.

The disclosed information will be made publicly available for non-commercial purposes after Health Canada completes its regulatory review process, while adhering to Canada’s Privacy Act.Providing public access to this information supports Canada’s objective for transparent decision-making. Public access also provides valuable information that may help with the use or development of hair loss treatment19 drugs and medical devices.This guidance document outlines the process for publicly disclosing information in a market authorization application under the 2 interim orders. The process includes buy propecia usa. procedures when releasing information types of information that fall under the guidelines for CBI and that may be eligible for redaction protection of personal informationScope and application This document applies to information relied upon to issue a market authorization under the.

Interim order respecting the importation, sale and advertising of drugs for use in relation to hair loss treatment (September 16, 2020) and interim order respecting the importation and sale of medical devices for use in relation to hair loss treatment(March 18, 2020)The public release of safety and efficacy/effectiveness information reviewed under the 2 interim orders is governed by common law. Information requested for release buy propecia usa is assessed case by case to determine what is CBI. Personal information is removed before the safety and efficacy/effectiveness information is released to the public.Following Health Canada’s review of an application, safety and efficacy information will be released as follows. Automatically disclosed in applications submitted under the interim order for importing, selling and advertising drugs (proactive release) disclosed on request in applications submitted under the interim order for importing and selling medical devices (released upon request)Information in applications that have been authorized, including those authorized and then revoked, is in scope for public release.

This includes buy propecia usa. Original application documents documents filed after market authorization is issued (filed at Health Canada’s request or to meet a condition of approval)Information in applications that are refused and were never authorized is out of scope for public release. This document does not apply to clinical information submitted to support the market authorization of a medical device under the Medical Device Regulations or of a new drug submission under the Food and Drug Regulations (FDR). The exception are new drug submissions for buy propecia usa hair loss treatment indications submitted under the FDR.

For more information on the public release of this information, see the Public Release of Clinical Information. Guidance document.Also not applicable under this document is the CBI disclosure authority under section 21.1(3)(c) of the Food and Drugs Act. This section permits the Minister of Health to disclose CBI to certain persons for buy propecia usa the purpose of protection or promotion of human health or the safety of the public. For information on this authority, see the guidance document Disclosure of Confidential Business Information under Paragraph 21.1(3)(c) of the Food and Drugs Act.Proactive release of drug application informationWe will proactively publish safety and efficacy information used to support interim order drug applications upon authorization.

This includes clinical information in applications submitted under sections 3, 6 and 14 of the interim order.How to request clinical information in medical device applicationsWe will publish safety and effectiveness information used to support interim order medical device applications when we receive a request from the public and within the limits of our administrative capacity. Requests made for multiple applications buy propecia usa will be processed in sequence and subject to prioritization. Further prioritization may be given to products that have a greater impact on the health system, such as. Products that are used a lot products that have a higher public interestRequests received for information in applications under the interim order will be prioritized over requests for clinical information in non-hair loss treatment19-related drugs submissions and device applications.To request clinical information on medical device applications, use our special portal to submit an electronic request form.

Be sure buy propecia usa to identify the product name listed on the following sites. Publication process Publication of safety and efficacy information used to support drug interim order applications The publication of information follows the process described in section 4 and Appendix C of the Public Release of Clinical Information guidance document.In accordance with PRCI timelines, we aim to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from starting the process. The process starts automatically on the day an authorization is issued.Step 1. Notice to the company and request buy propecia usa for proposed CBI redactions and anonymizationFollowing the authorization of a drug under the interim order, Health Canada will give the manufacturer an opportunity to take part in a process initiation meeting.

The first 60 days of the 120-day publication process is allocated for the company to review the clinical information. The company uses the Proposed Redaction Control Sheet (Appendix E, Public Release of Clinical Information (PRCI) guidance document) to propose any redaction of CBI. Proposed CBI redactions should buy propecia usa pertain to information that meets the definition of confidential business information. This is defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition.

That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitorsFollowing an assessment of the proposals, text within an in-scope document found to meet the above definition will be protected. Similar to buy propecia usa Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information. Exceptions to the PRCI regulations described in C.08.009.2(2)(a) and (b) of the Food and Drug Regulations or section 43.12(2)(a) and (b) of the Medical Device Regulations will be considered when applying redactions to confidential business information. Further information on the application of these exceptions can be found in the Health Canada PRCI guidance document.All personal information should be anonymized in accordance with section 6 of the Public Release of Clinical Information guidance document.

The proposal package from the manufacturer should include buy propecia usa. The proposed redaction control sheet the draft anonymization report annotated documentsManufacturers submit for Health Canada assessment using either CanadaPost ePost Connect or a suitable secure file transfer site of the manufacturer’s choosing.Step 2. Health Canada assessment of company representationsWithin 30 days of receiving the proposal package, Health Canada will complete and return our assessment of the proposed CBI redactions and anonymization methodology. Proposed redactions that meet the definition of confidential business information will be protected buy propecia usa.

We will review the anonymization methodology to ensure all personal information is protected while maximizing the disclosure of useful clinical information. Step 3. Revision of proposed CBI redactions and anonymizationIf proposed CBI redactions are rejected or revision is required to the anonymization methodology, in accordance with buy propecia usa the Public Release of Clinical Information. Guidance document, the manufacturer will be given 15 days to make the revisions and resubmit.

We will send our final assessment to the manufacturer within 5 days of receiving the revised package. Step 4 buy propecia usa. Finalization and publicationWithin 5 days of receiving our final assessment, the manufacturer must format and submit the final redacted and anonymization clinical documents within 5 days of receiving our final assessment. The final documents must comply with his response the Guidance Document.

Preparation of Regulatory buy propecia usa Activities using the Electronic Common Technical Document (eCTD) Format. These documents are to be submitted using the Common Electronic Submission Gateway. We will publish the final redacted documents within 5 days of receiving the final sequence.Publication of safety and effectiveness information used to support medical device interim order applicationsThe publication of information within an interim order application will proceed through the abbreviated process described below. Our goal buy propecia usa is to publish a final redacted and anonymized package on our clinical information portal within 120 calendar days from initiation of the process.Step 1.

Health Canada screening of requestsAfter we receive a request for information, we will retrieve the interim order application from docubridge (or other location). Information related to safety and effectiveness will be considered in-scope of publication. Other information buy propecia usa will not be released publicly. Only information available at the time the request is made will be considered for disclosure.

Information submitted after the original request for disclosure will be considered for public release upon receipt of a subsequent request.Examples of in scope information include. Clinical testing information validation testing that supports the effectiveness of the product, including testing performed in vitro or in silico summaries or overviews on safety or efficacy pre- or post-market, buy propecia usa including literature reviewsExamples of out of scope information include. Manufacturing details not related to safety or efficacy engineering and design details general documents, such as user manuals, package inserts and instructions for use individual patient information, such as patient listings and case report forms, that require extensive anonymization interim clinical study data (see the PRCI guidance)Step 2a. Health Canada assessment of confidential business information To reduce administrative burden on the manufacturer, we will review in-scope records for confidential business information, as defined in Section 2 of the Food and Drugs Act, which mirrors common law in the context of confidential business information that meets each of the following 3 elements of the definition will be protected.

That is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available and that has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would buy propecia usa result in a material financial loss to the person or a material financial gain to their competitorsText in an in-scope document found to meet this definition will be redacted using a PDF redaction tool. Similar to Public Release of Clinical Information policies, any information that meets the definition of “clinical information” will not be considered confidential business information. Exceptions to the PRCI regulations are outlined section 43.12(2)(a) and (b) of the Medical Device Regulations. These exceptions buy propecia usa will be considered when applying redactions to confidential business information.

Further information on the application of these exceptions can be found in the PRCI guidance document.Step 2b. Assessing personal informationIn general, in-scope records do not contain a large volume of personal identification information. Any personal information, as defined in the Privacy buy propecia usa Act and in accordance with PRCI guidance, information that could help to identify an individual will be protected. For example, this can include the names of authors and investigators as well as subject identification numbers.A large volume of indirectly identifying information is not expected in the medical device records that are in-scope of publication.

Consequently, limited protection of personal information is anticipated.Personal information will be redacted using a PDF redaction tool. Step 3 buy propecia usa. Notice to the company and request for redaction proposalFollowing the review and redaction of in scope documents, we will send the manufacturer a written notice indicating our intent to publish the identified documents. A copy of the release package will be sent for the manufacturer’s review.

Any further proposed redactions by the manufacturer must be received within 14 calendar days.Manufacturer are asked to use the Proposed Redaction Control Sheet (see Appendix E of the PRCI guidance document) to buy propecia usa suggest further redactions.Step 4. Health Canada assessment of company representationsAny further redactions proposed by the manufacturer will be assessed in accordance with the process outlined in step 2, above. Those that meet the definition of personal or confidential business information will be accepted.Step 5. PublicationIn-scope documents will be published within buy propecia usa 120 days following receipt of the request.

The redacted information will be uploaded to the Clinical Information Portal, indexed by application number. Published documents will carry a watermark and be subject to terms of use, as described in the PRCI guidance.Mailing addressInformation Science and Openness DivisionResource Management and Operations DirectorateHealth Products and Food BranchHealth Canada Graham Spry Building 250 Lanark Ave Ottawa ON K1A 0K9 Telephone. 613-960-4687Email. Hc.clinicaldata-donneescliniques.sc@canada.ca Terminology and definitions Anonymization.

Means the process through which personal information is modified by. removing direct identifiers and any related code that would enable linkage with identifying information and ensuring that the remaining indirect identifiers no longer present a serious possibility of re-identifying an individual CBI. Confidential business information, as meant in common law and as defined in Section 2 of the Food and Drugs Act. in respect of a person to whose business or affairs the information relates, means (subject to the regulations) business information that.

Is not publicly available in respect of which the person has taken measures that are reasonable in the circumstances to ensure that it remains not publicly available has actual or potential economic value to the person or their competitors because it is not publicly available and its disclosure would result in a material financial loss to the person or a material financial gain to their competitors Clinical information. Means information in respect of a clinical trial, clinical studies or investigational testing, such as. clinical overviews, clinical summaries and clinical study reports for drugs summaries and detailed information of all clinical studies and investigational testing that provided evidence of safety and effectiveness for medical devices Clinical study report. Means an "integrated" full report of an individual study of any therapeutic, prophylactic or diagnostic agent (drug or treatment) conducted in patients, in which.

the clinical and statistical description, presentations and analyses are integrated into a single report incorporating tables and figures into the main text of the report or at the end of the text appendices contain the protocol, sample case report forms, investigator-related information, information related to the test drugs/investigational products, including active control/comparators, technical statistical documentation, related publications, patient data listings and technical statistical details such as derivations, computations, analyses and computer output FDA. Food and Drugs Act FDR. Food and Drug Regulations IMDRF ToC. International Medical Device Regulators Forum Table of Contents Medical device.

Has the same meaning as insee the Medical Devices Regulations. For information on the classification of medical devices, please see the guidance documents on the.

What should my health care professional know before I take Propecia?

They need to know if you have any of these conditions:

Order propecia

Department of Epidemiology, Center for Global Health, School of click this link now Public Health, Nanjing Medical University, Nanjing, China order propecia 2. ISGlobal Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique , Email. [email protected]Publication date:01 September 2020More about this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles order propecia on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research.

The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide. To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track order propecia articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websitesNo AbstractNo Reference information available - sign in for access.

No Supplementary Data.No Article MediaNo MetricsDocument Type. Research ArticleAffiliations:1 order propecia. Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK 2. German Central Committee against Tuberculosis, Berlin, Germany , Email.

[email protected]Publication date:01 September 2020More about this publication? order propecia. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide. To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on order propecia The Union website, prior to their publication in the Journal.

Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websites.

Research ArticleAffiliations:1 buy propecia usa http://2017.swissbiotechday.ch/buy-cheap-kamagra-oral-jelly/. Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China 2. ISGlobal Hospital Clínic, Universitat de Barcelona, Barcelona, Spain, Manhiça Health Research Hospital, Ministry of Health, National Tuberculosis Control Program, Maputo, Mozambique , Email.

[email protected]Publication date:01 September 2020More about buy propecia usa this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of buy propecia usa certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.Editorial BoardInformation for AuthorsSubscribe to this TitleInternational Journal of Tuberculosis and Lung DiseasePublic Health ActionIngenta Connect is not responsible for the content or availability of external websitesNo AbstractNo Reference information available - sign in for access.

No Supplementary Data.No buy propecia usa Article MediaNo MetricsDocument Type. Research ArticleAffiliations:1. Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK 2.

German Central buy propecia usa Committee against Tuberculosis, Berlin, Germany , Email. [email protected]Publication date:01 September 2020More about this publication?. The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research.

The IJTLD is buy propecia usa dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide. To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian.

Best online pharmacy propecia

A new paper discusses how stressful experiences - or psychedelic drugs - might best online pharmacy propecia produce profound mental change.Authors Ari Brouwer and Robin Lester Carhart-Harris, writing in the Journal of Psychopharmacology, introduce the concept of 'pivotal mental states'. (Although this is a new term, the idea echoes earlier work).What is a pivotal mental state?. It's "a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation", or in other words, a state in which beliefs, personality and mental best online pharmacy propecia health are prone to change. As they put it, these states "evolved to allow the experiencer a psychological ‘fresh start’, akin to a psychological ‘rebirth’".According to Brouwer and Carhart-Harris, these pivotal states may be triggered by severe psychological or physiological stress, but they can also be produced by drugs, especially psychedelics such as LSD or psilocybin (magic mushrooms).

Biologically, they best online pharmacy propecia say, stress and psychedelics have related effects on the brain in that stress upregulates 5HT2A serotonin receptors, which are the target of drugs like LSD.The authors emphasize that pivotal mental states are neither helpful nor harmful in themselves. Rather, these states represent a psychological crossroads which can lead to many different destinations, from improved mental health, to serious disorders. Brouwer and Carhart-Harris illustrate the idea of a pivotal mental state as a "moment of decision" with a rather beautiful piece of art showing a person facing two ways forward, one towards sunny health best online pharmacy propecia and the other, gloomy illness:From Brouwer and Carhart-Harris (2020)So what determines if the outcome of a pivotal state is good or bad?. The authors point to "contextual factors" - the social, psychological, and emotional environment, broadly speaking - as being key.

These need to be "treated with special attention and therapeutic care (where possible) if best online pharmacy propecia an individual’s psychological wellbeing is to be safeguarded", and this applies to individuals on psychedelics as well as acute psychosis.I found this paper bold and thought provoking, although I'd have liked to see the pivotal mental state described in more detail. The authors point to drug experiences, some forms of psychosis and some spiritual experiences as examples, but I would have liked to see more detail on what the state looks like (or feels like) phenomenologically.I also didn't find the biological aspects of the paper, with the focus on 5HT2A receptors, to be entirely convincing. This is a complex issue and there are thousands of relevant scientific studies, but in a nutshell, I don't think we can equate the effect of stress with increased 5HT2A best online pharmacy propecia in all cases, and clearly stress does not always have the same effects as a dose of LSD, while LSD effects are not identical with psychotic symptoms. Overall, the entire paper ends up raising more questions than it answers, and leaves the 'pivotal mental state' as something mysterious.

This is not necessarily a bad thing - there can be value best online pharmacy propecia in describing a mystery, as a first step towards solving it. But there is a lot more work to do here.This article appeared in Discover’s annual state of science issue as “A Brief Guide to treatment Types.” Support our science journalism by becoming a subscriber.The hair loss treatment propecia likely plunged you into a world — specifically, the world of treatment development — that you didn’t know much about before. Maybe you’ve best online pharmacy propecia learned that treatments typically take years to produce. Or maybe you’ve found yourself wondering how the roughly 200 hair loss treatments in development are supposed to work.Essentially, a treatment needs to trick your immune system into thinking there’s an .

That way, you’ll develop an arsenal of tactics to best online pharmacy propecia kill off the pathogen, should it ever show up in your body. Live treatments release a somewhat nonfunctional version of the propecia into the body. If researchers tamper with it just right, the modified propecia can still provoke your immune system without getting you sick. One way to sap a propecia of some of its power is to grow it in another species, the way researchers used chick embryo best online pharmacy propecia cells to create the measles treatment.

Developers can also neutralize the propecia by exposing it to heat or chemicals like formaldehyde, creating what’s known as an inactivated treatment.There are also treatments that make your own cells produce the crucial proteins that help fight a propecia. Two of these are called DNA treatments and best online pharmacy propecia RNA treatments. DNA varieties can push the hair loss spike protein gene into your cells. Once it’s there, the DNA is treated like your own genetic information.Your bodies make RNA — temporary copies of the gene best online pharmacy propecia — and from that template build the viral proteins.

RNA treatments, on the other hand, cut out a few steps in the production process. These treatments provide the RNA pattern as is, and cells assemble best online pharmacy propecia proteins from there.For an RNA or DNA treatment to successfully work, it’s crucial that the genetic material gets inside your cells to the protein-generating machinery that will properly proliferate the viral protein. Sometimes, treatment developers make sure this happens by tucking the DNA or RNA into the genome of another propecia, using that pathogen as a kind of shipping container. These are called viral best online pharmacy propecia vector treatments.

Don’t worry, you don’t get sick from the delivery — researchers disable the propecia to prevent that from happening.It’s also possible to create a treatment that does not force cells to make viral proteins, but instead delivers the proteins directly. Some companies are working on these kinds of hair loss treatments, a category generally called protein-based treatments.On the whole, treatment developers spend a lot of time at best online pharmacy propecia the drawing board. The complexity of the immune system makes it a tough beast to wrangle. When it comes to hair loss, any of these treatment types could emerge from the pack — and ultimately help keep hair loss treatment at bay.It seems hard to believe that a basic human sensation — one that can best online pharmacy propecia be evoked by a simple mosquito bite — still has scientists scratching their heads.

Yet despite centuries of study, understanding itching is still fraught.Itch, write two scientists in a review in the journal Immunity, “has been described as one of the most diabolical sensations. In Dante's Inferno, falsifiers were eternally punished by ‘the burning rage best online pharmacy propecia of fierce itching that nothing could relieve.’” Yet, the researchers note, “There have been very few advances in itch treatment in over 360 years.”That’s finally starting to change. In the past decade, scientists have made strides toward understanding this infuriating sensation. They are best online pharmacy propecia untangling itchiness from other noxious stimuli, such as pain.

They are even starting to distinguish one type of itch from another, by poking study participants with itch-inducing plant spikes or deleting itch-related genes from mice.This wide-ranging research is gradually going beyond an understanding of familiar acute histamine-driven itch — the mosquito or poison ivy variety — to reveal the complicated mechanisms and players involved in the often debilitating type of itching that lasts for weeks and sometimes years. Chronic itch, as it’s termed, can be generated by a multitude of factors, from chemicals secreted within the body to nerves gone haywire, and in many cases, has no known cause or cure.his inquiry is more than an academic exercise (or a quest to make mosquito welts recede faster). While acute itch is fleeting, chronic best online pharmacy propecia itch may plague some 7 percent of people each year, and one in five people will experience it at some time in their lives. Beyond a maddening persistent urge to scratch, the condition can lead to depression, sleep deprivation and a drastic decrease in the quality of life.

€œIt can be as devastating as chronic pain,” says Robert LaMotte, an itch researcher at the Yale School of Medicine.And pain is actually where the itch story starts.Identifying ItchFor much of the last century, itch was considered a lower-tiered best online pharmacy propecia version of pain. In the early 1920s, for example, Austrian-German physiologist and pain researcher Max von Frey documented in an influential study that a slight skin prick gave research participants the aftersensation of itch. This conceptual model best online pharmacy propecia continued to feed the field of itch for decades.But eventually, the idea that itch was simply a subset of pain began to crumble. Scientists determined, for example, that they could not reliably turn a pain into an itch just by decreasing the pain’s intensity — or turn an itch to a pain by increasing the itch’s intensity.

Yet the nerves and pathways of pain and itch appeared to be so similar and deeply intertwined that for years scientists lacked a clear understanding of how the two responses were wired into the body.Then, in 2007, the sensation of itching finally crawled out from under the shadow of pain and into its own light.That year, a seminal paper in Nature reported the first dedicated itch receptor — a protein on nerve cells in the central nervous system that responds specifically to itch but best online pharmacy propecia not pain, indicating that the sensation might travel its own separate pathway to the brain. Zhou-Feng Chen, at Washington University School of Medicine in St. Louis, and colleagues showed that mice engineered to lack genes for this receptor — called the gastrin-releasing peptide receptor — could still feel pain but barely felt itch, no matter what the researchers tried.“This changed the paradigm,” says best online pharmacy propecia Brian Kim, a dermatologist and codirector of the medical school’s Center for the Study of Itch, who now works with Chen. Revealing itch as a sensation in its own right with a dedicated pathway was a crucial step forward in understanding it, he says.Since the discovery of this first itch receptor, researchers have discovered more cellular players involved in chronic itch, separating it out from acute itch.

They have learned, for example, that chronic and acute itch are relayed best online pharmacy propecia by different sets of neurons that send signals along their own dedicated tracks in the nervous system. When researchers have simulated chronic itch in experiments with healthy volunteers, MRI scans reveal that the two itch types spur different patterns of brain activity.These most foundational observations reveal just how much more we have to learn about itch. But they also help create a path to bringing relief to those who experience debilitating best online pharmacy propecia chronic cases. The sensation can be so bad that, for instance, some people with liver disease receive transplants precisely because of their itching.

Others choose to go best online pharmacy propecia off of essential cancer medications because of the itching the drugs can cause.And for years, researchers were focused on the low-hanging fruit of histamine-driven itch, which is easier to study, in part because it is being driven by a single chemical compound. Experimenters could spread or inject known irritants on or into the skin, cuing the body to make histamines, producing that familiar welty reaction that can be soothed by antihistamines like cortisone. But most chronic itch (technically, itchiness that lasts more than six weeks) doesn’t involve histamines. And the routes — there are many — to chronic itch are far more complicated.There are many routes to itch, but scientists have uncovered two, independent subtypes best online pharmacy propecia of neurons that relay the itch message to the spinal cord and brain.

The histamine pathway (left), which is involved primarily in acute itch, is engaged when a trigger such as a mosquito bite spurs the release of histamines by the body’s immune system, which activate histamine receptors. Non-histamine itch (right) can be set off by a wide range of internal and external triggers, including immune system molecules best online pharmacy propecia such as cytokines, enzymes called proteases that cut up proteins and the antimalarial drug chloroquine. After a trigger activates receptors in either pathway, enzymes are kicked into gear that spur the opening of ion channels, prompting the nerve to fire and send the itch signal to the spinal cord and brain.Now, as scientists refocus their investigations on chronic non-histamine itch, they’re doing much of the research the old-fashioned way. By making people and animals itchy.Itch by ItchInitiating an itch is not as simple as best online pharmacy propecia it seems.

One approach that’s been especially fruitful for zeroing in on non-histamine itch is to poke people with tiny hairs (or spicules) from a tropical plant called cowhage, or velvet bean.In a key series of experiments, LaMotte and his colleagues took about 10 of these spicules, which are a few microns wide at the tip, and inserted them about 0.2 millimeters into the skin of study participants. Every 30 seconds, for best online pharmacy propecia up to 20 minutes, the thus-pricked people reported sensations they felt, such as pricking, burning or itching, as well as the intensity. The studies confirmed that an unusual compound within the minute hairs, called mucunain, rapidly causes itchiness but — unlike many plant-based itch-prompting compounds — doesn’t activate histamines. That makes cowage spicules a powerful way to investigate the circuitry of non-histamine best online pharmacy propecia itch and possibly provide insight into mechanisms for chronic itch.Next, LaMotte and his colleagues incubated human cells with mucunain in lab dishes to tease apart which receptor proteins might be receiving and responding to the incoming itch.

They found responses in two types of such receptors — known as PAR2 and PAR4. Identifying itch-related receptors like these can help get medicine closer to a potential treatment.To more fully understand the basics of best online pharmacy propecia itch and help disentangle it from pain, LaMotte and colleagues took a deep dive into the subtleties of the scratching behavior of mice. They learned where on the mouse body to inject their various irritants so as to reliably distinguish itchy types of scratching from pain types of scratching.More than a decade on, the researchers can take advantage of the many biological mechanisms underlying itch — such as receptors and nerve pathways — that are similar in mice and people. That means they can now move back and forth between the two, injecting similar chemicals, for example, and tracking behavior (self-reports for humans, actions for mice) for intensity and duration.Meanwhile, the lab of Xinzhong Dong, an itch researcher at Johns Hopkins University, has used mice to pinpoint nerve best online pharmacy propecia endings that are truly itch-specific.

€œYou can activate those nerves, and you've got an itch sensation. You don't best online pharmacy propecia feel pain,” he says. When he and his colleagues inactivated these dedicated itch neurons, mice were immune to itchy stimuli but still felt pain, the researchers reported in 2012 in Nature Neuroscience.Other researchers aim to unlock itch’s secrets with a more pure form of laboratory itch.Dermatology researcher Akihiko Ikoma, then of Kyoto University, and colleagues took a mechanical approach to the problem. Instead of relying on chemical compounds, the team developed a small best online pharmacy propecia wire loop that vibrates at a specific frequency.

As the team described in 2013 in the journal PAIN, when the loop is touched to the fine hairs on people’s faces, it creates an itch that takes more than 10 minutes to completely dissipate. This work has helped scientists to pinpoint itch-specific neurons around the skin that work independently of histamines or various other chemicals that stimulate itching.The hope, for both methods, is to identify neurons and pathways specific to different kinds of itch. This will best online pharmacy propecia eventually help scientists investigate drugs that could relieve chronic itch in long-time sufferers.But there remains more to untangle about itching’s complex circuitry, with new receptors and nerve cells still being uncovered.A Partnership With PainDespite all these advances — and despite the fact that itch is found throughout the animal kingdom, from fish to primates — “much of itch perception is still a mystery,” Dong and Hopkins colleague Mark Lay note in the 2020 Annual Review of Neuroscience.For one thing, even though there’s been progress, the intertwined nature of itch and pain is still difficult to untangle. One reason may be that both originated as self-protection.

Just as pain sends the signal to withdraw from something dangerous, itch prompts scratching, which could, for example, prevent s by shooing away parasites best online pharmacy propecia. Scratching also appears to help recruit local immune cells that can fend off .Itch and pain also have a peculiar overlap that even occasional scratchers are familiar with. Scratching can generate mild pain, best online pharmacy propecia which can often override the sensation of itch. Some researchers have proposed that when groups of neurons are activated — some of them itch-specific and some of them pain-specific — the pain stimulus, if strong enough, can mask the itch signals.And despite the new itch-only discoveries, many nerves do seem to be involved in communicating both painful and itchy stimuli.

The confusing overlap best online pharmacy propecia is exemplified in people with chronic conditions like atopic dermatitis. In these cases, nerves in the skin become hyper-sensitive to itch, and perceive as itchy stimuli that are normally painful — or simply mechanical or thermal. This is similar to what’s experienced by some people with chronic pain, best online pharmacy propecia where light touch can actually hurt. And basic nervous system malfunctions like a pinched or damaged nerve can generate pain in some people but itch in others.The overlap with pain is also present in the ways — still poorly understood — in which itch travels from the peripheral nerves in the skin to the spinal cord and up to the brain, Dong says.All of these lingering mysteries mean that itch — especially chronic itch — has been extremely difficult to effectively treat.

€œLike in pain, there's not just one painkiller that destroys all types of pain,” says Gil Yosipovitch, a dermatologist at the University of Miami and founder of the International best online pharmacy propecia Forum for the Study of Itch.“I have patients who have a lot of complexities, and they require more than one pill or one cream, similar to patients who have chronic pain. And it requires a lot of time and patience.”For most of the population, itch is still a passing irritant, perhaps from bug bites in the summer or dry skin in the winter. But as a clinician and a research scientist, Kim says all of the best online pharmacy propecia suffering he sees from chronic itch keeps him working harder in the lab to understand this torturous sensation and correct too many years of inattention.“It’s just this cascade of neglect,” he says.Katherine Harmon Courage is a freelance journalist, a contributor to Scientific American and Vox and the author of two books (Cultured and Octopus!. ).

She spends best online pharmacy propecia the summer as a favorite target of mosquitoes in Colorado. You can follow her at @KHCourage.This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.When President Trump was diagnosed with hair loss treatment, one of the cutting-edge experimental therapies he received was a mixture of monoclonal antibodies. But now a treatment may soon be available. So are other best online pharmacy propecia therapies necessary or valuable?.

And what exactly is a monoclonal antibody?. Over the past few months, the public has learned about many treatments being used to combat best online pharmacy propecia hair loss treatment. An antiviral like remdesivir inhibits the propecia from replicating in human cells. Convalescent plasma from the blood of donors who have recovered from hair loss treatment may contain antibodies that suppress the best online pharmacy propecia propecia and inflammation.

Steroids like dexamethasone may modify and reduce the dangerous inflammatory damage to the lungs, thereby slowing respiratory failure.The FDA issued emergency use authorization for Eli Lilly’s monoclonal antibody, called bamlanivimab, and Regeneron is waiting for FDA’s green light for its antibody treatment. Monoclonal antibodies are particularly promising in therapy because they can best online pharmacy propecia neutralize the hair loss propecia, which causes hair loss treatment, and block its ability to infect a cell. This might be a lifesaving intervention in people who are unable to mount a strong natural immune response to the propecia – those over 65 or with existing conditions that make them more vulnerable.I’ve worked in public health and medical laboratories for decades, specializing in the study of propeciaes and other microbes. Even when a treatment for hair loss treatment becomes available, I see a role best online pharmacy propecia for monoclonal antibody therapy in getting the propecia under control.Why Should We Care?.

Until a large percentage of a population has immunity to an infectious disease – either through a treatment or the unchecked spread through a community – the world must rely on other weapons in our war against the hair loss treatment propecia.Along with the previously mentioned therapies, monoclonal antibodies can offer us another tool to neutralize the propecia once it causes an .These man-made antibodies offer the world the possibility of immunotherapy similar to the use of convalescent plasma but with a more targeted and accurate action. While a treatment will ultimately help protect the public, best online pharmacy propecia vaccination will not be an instantaneous event, delivering treatment to 100% of the population. Nor do we know how effective it will be.The impact of a treatment also isn’t instantaneous. It takes best online pharmacy propecia several weeks to generate a powerful antibody response.

In the interim, monoclonal antibodies could help mop up propecia that is multiplying in the body.Antibody 101An antibody is a Y-shaped protein naturally produced by our body’s immune system to target something that is foreign, or not part of you. These foreign bodies are called antigens and can be found on allergens, bacteria and propeciaes as well as other things like toxins or a transplanted organ.A monoclonal antibody treatment mimics the best online pharmacy propecia body’s natural immune response and targets foreign agents, like a propecia, that infect or harm people. There are also monoclonal antibodies that pharmaceutical companies have designed that target cancer cells. Monoclonal antibodies are one of best online pharmacy propecia most powerful types of medicine.

In 2019 seven of the top 10 best-selling drugs were monoclonal antibodies.For President Trump, the experimental treatment made by the pharmaceutical company Regeneron included two antibodies.Typically the spike protein on the hair loss fits perfectly into the ACE2 receptor on human cells, a protein common in lung cells and other organs. When this connection happens, the propecia is able to infect cells and multiply inside them. But monoclonal antibodies can slow or halt the by attaching to the viral best online pharmacy propecia spike protein before it reaches the ACE2 receptor. If this happens, the propecia becomes harmless because it can no longer enter our cells and reproduce.How Are Monoclonal Antibodies Created?.

Monoclonal antibodies that neutralize the hair loss are best online pharmacy propecia complicated to manufacture and produce. They must be made inside cells taken from a hamster’s ovary and grown in gigantic steel vats. The antibodies best online pharmacy propecia that these cells manufacture must then be extracted and purified. Unfortunately these monoclonal antibodies, which have been used for other illnesses for years, are often quite expensive.Regeneron’s two antibodies are targeted to the spike protein of hair loss – the protrusions on the surface of propecia that give it a crown-like look and are critical for infecting human cells.One of Regeneron’s two antibodies is a replica, or clone, of an antibody harvested from a person who recovered from hair loss treatment.

The second antibody was identified in a mouse that was biologically engineered to have a human best online pharmacy propecia immune system. When this mouse was injected with the spike protein, its human immune system generated antibodies against it. One of the most effective mouse antibodies was then harvested and used to form part of this therapy.Eli Lilly’s monoclonal antibody therapy, bamlanivimab, was best online pharmacy propecia identified from a blood sample taken from one of the first U.S. Patients who recovered from hair loss treatment.Both companies have in place large-scale manufacturing with robust, global supply chains in place to produce the monoclonal antibodies, with many global manufacturing sites to ramp up supply.

Eli Lilly has received FDA approval, and Regeneron best online pharmacy propecia is still awaiting approval. Unfortunately, there will likely be a shortage of the antibodies in the early going of approvals.Monoclonal Antibodies Plus a treatmentMonoclonal antibodies will be able to complement treatments by offering rapid protection against . When they are given to an individual, best online pharmacy propecia monoclonal antibodies provide instantaneous protection for weeks to months. treatments take longer to provide protection since they must challenge the immune system.

But the advantage of a treatment is that they usually provide long-term protection.Regeneron’s and Eli Lilly’s products are both delivered by intravenous injection, after which the patient must be monitored by best online pharmacy propecia health care professionals. Since they offer immediate protection, the implications to treat or provide protection to high-risk populations is immense.These medicines have the potential to treat infected patients or prevent of essential health care and public health professionals on the front line of this propecia. Monoclonal antibodies could also be useful for older people, young children and immunocompromised people for whom treatments either don’t work or can be dangerous.Rodney E. Rohde is a professor clinical laboratory science best online pharmacy propecia at Texas State University.

This article appeared on The Conversation and is republished under a Creative Commons license. Read the original here.Face best online pharmacy propecia coverings and social distancing are necessary for keeping the novel hair loss at bay, but are propecia-related precautions affecting our ability to ward off other ailments down the road?. Health experts may not be able to say for sure yet, but there are ways to balance the two interests. Pro tip? best online pharmacy propecia.

Get outside (preferably a good distance from people who don't live in your household) and take a deep breath. Your microbiome will best online pharmacy propecia thank you. What is the Microbiome?. Our bodies play host to a wide best online pharmacy propecia array of microorganisms that make their home on our skin and inside our guts, airways and other organs.

Their presence is so significant that the number of bacteria in our guts is actually greater than the number of human cells in the human body. The organisms' collective DNA is known as the microbiome and scientists have studied its effect on everything from our social lives to our mental best online pharmacy propecia health.Put simply. The microbiome provides the immune system with information about potential intruders. It clues our body in on what is and isn't a best online pharmacy propecia threat and helps prepare our white blood cells for battle.

Some of the microbiome is built up shortly after birth. A trip down the birth canal followed by months of best online pharmacy propecia breastfeeding helps babies form their unique microbiome, but exposure to the natural environment in those first few years of life is crucial as well, experts say. €œAll of these organisms provide data for the immune system,” says Graham Rook, an immunologist and professor emeritus at University College London. €œIt's like best online pharmacy propecia the brain.

It has to have data. And just like the brain, it needs the data early in life.” If the body fails to get the right messages about its environment, it may go rogue and attack things it shouldn't, leading to conditions like allergies, asthma and autoimmune disorders. Since the first few years of life are most crucial, Rook is especially concerned that if young children are not leaving their homes, best online pharmacy propecia they are not getting the exposure to microbes they need. €œThat is why confining an infant to a high-rise apartment during hair loss treatment lockdowns is likely to be detrimental,” says Rook.

€œThe microbiome of a modern apartment is not a useful exposure.” The Daycare TestA recent study comparing different daycare settings in Finland demonstrated that simply enriching the outdoor play areas with elements of the natural environment had a positive effect best online pharmacy propecia on the microbiomes in children. For four weeks in 2016, young children played on segments of forest floor and sod placed on top of the existing gravel. Instructors at the schools also engaged the children in activities such as planting gardens, resulting in average daily exposure of 90 minutes per day.The results indicated an increase in microbe biodiversity on the skin and in best online pharmacy propecia the guts of the children, and a corresponding bump in immune system function. The study offers hope that even children in urban environments can build their microbiomes with some exposure to the natural world.

Animals Can Help Bring Exposure, Too “The most evidence-based strategy for improving your microbiome from an immunity [and] asthma perspective is to get a cow,” says Rob Knight, a University of California, San Diego professor and co-founder best online pharmacy propecia of the American Gut Project. €œBut that isn’t especially practical if you live in an apartment in the city.”In studies completed by scientist Erika von Mutius, life on a farm and bacteria carried by cows, specifically, appeared to have the best benefit to humans, Knight says. Dogs and cats that spend time outdoors can also bring in some good microbes, experts say, which provides another reason to adopt a pet while sheltering best online pharmacy propecia in place. Diet Also Plays a PartKnight says a diet promoting microbiome diversity would include a diverse range of plants and fermented foods, with limits on sugar and salt.

Rook adds best online pharmacy propecia that although building a healthy microbiome can be most crucial in the early years, studies indicate that adults can be affected as well.“Sick adults have less diverse gut microbiomes,” Rook says, adding that a diverse diet and time in the natural environment are key to bolstering health. While it is true that humans pick up “data” from other humans and that is a missing piece of the equation now, Rook notes that he is far more concerned about young children who are not leaving their homes and getting exposure to microbes in their natural environments. And if you're worried that a lack of colds this year might lead to an immune system unprepared for next year's propeciaes, experts say best online pharmacy propecia that's not exactly how it works. €œThere’s no evidence that exposure to pathogens per se is good,” Knight says.

€œCurrent thinking is that exposure to a wide range of harmless organisms from other people and the environment is good.”So, while the long-term health effects of social distancing might not be fully understood yet, embracing a lifestyle that includes healthy food choices best online pharmacy propecia and time spent outdoors may be the best tools at our disposal right now. Rook also suspects that mask-wearing doesn't inhibit the ability to absorb what is needed from the outside world. €œPlenty of small particles from the natural environment are wafting into the lungs,” he says..

A new paper discusses how stressful experiences - or psychedelic drugs - might produce profound buy brand name propecia online mental change.Authors Ari Brouwer and Robin Lester Carhart-Harris, writing in the buy propecia usa Journal of Psychopharmacology, introduce the concept of 'pivotal mental states'. (Although this is a new term, the idea echoes earlier work).What is a pivotal mental state?. It's buy propecia usa "a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation", or in other words, a state in which beliefs, personality and mental health are prone to change.

As they put it, these states "evolved to allow the experiencer a psychological ‘fresh start’, akin to a psychological ‘rebirth’".According to Brouwer and Carhart-Harris, these pivotal states may be triggered by severe psychological or physiological stress, but they can also be produced by drugs, especially psychedelics such as LSD or psilocybin (magic mushrooms). Biologically, they buy propecia usa say, stress and psychedelics have related effects on the brain in that stress upregulates 5HT2A serotonin receptors, which are the target of drugs like LSD.The authors emphasize that pivotal mental states are neither helpful nor harmful in themselves. Rather, these states represent a psychological crossroads which can lead to many different destinations, from improved mental health, to serious disorders.

Brouwer and Carhart-Harris illustrate the idea of a pivotal mental state as a "moment of decision" with a rather beautiful piece of art showing a person facing two ways forward, one towards buy propecia usa sunny health and the other, gloomy illness:From Brouwer and Carhart-Harris (2020)So what determines if the outcome of a pivotal state is good or bad?. The authors point to "contextual factors" - the social, psychological, and emotional environment, broadly speaking - as being key. These need to be "treated with special attention and therapeutic care (where possible) if an individual’s psychological wellbeing is to be safeguarded", and this applies buy propecia usa to individuals on psychedelics as well as acute psychosis.I found this paper bold and thought provoking, although I'd have liked to see the pivotal mental state described in more detail.

The authors point to drug experiences, some forms of psychosis and some spiritual experiences as examples, but I would have liked to see more detail on what the state looks like (or feels like) phenomenologically.I also didn't find the biological aspects of the paper, with the focus on 5HT2A receptors, to be entirely convincing. This is a complex issue and there are thousands of relevant scientific studies, but in a nutshell, I don't think we can equate the effect of stress with increased 5HT2A in all cases, and clearly stress does not always have the same effects as buy propecia usa a dose of LSD, while LSD effects are not identical with psychotic symptoms. Overall, the entire paper ends up raising more questions than it answers, and leaves the 'pivotal mental state' as something mysterious.

This is not necessarily a bad buy propecia usa thing - there can be value in describing a mystery, as a first step towards solving it. But there is a lot more work to do here.This article appeared in Discover’s annual state of science issue as “A Brief Guide to treatment Types.” Support our science journalism by becoming a subscriber.The hair loss treatment propecia likely plunged you into a world — specifically, the world of treatment development — that you didn’t know much about before. Maybe you’ve learned that treatments typically take years buy propecia usa to produce.

Or maybe you’ve found yourself wondering how the roughly 200 hair loss treatments in development are supposed to work.Essentially, a treatment needs to trick your immune system into thinking there’s an . That way, you’ll develop an arsenal of tactics to buy propecia usa kill off the pathogen, should it ever show up in your body. Live treatments release a somewhat nonfunctional version of the propecia into the body.

If researchers tamper with it just right, the modified propecia can still provoke your immune system without getting you sick. One way to sap a propecia of some of its power buy propecia usa is to grow it in another species, the way researchers used chick embryo cells to create the measles treatment. Developers can also neutralize the propecia by exposing it to heat or chemicals like formaldehyde, creating what’s known as an inactivated treatment.There are also treatments that make your own cells produce the crucial proteins that help fight a propecia.

Two of these are called buy propecia usa DNA treatments and RNA treatments. DNA varieties can push the hair loss spike protein gene into your cells. Once it’s there, the DNA is treated like your own genetic information.Your bodies make RNA — temporary copies of the gene — and from that template buy propecia usa build the viral proteins.

RNA treatments, on the other hand, cut out a few steps in the production process. These treatments provide the RNA pattern as is, and cells assemble proteins from there.For an RNA or DNA treatment to successfully work, it’s crucial that the genetic material gets inside your cells to the protein-generating machinery that buy propecia usa will properly proliferate the viral protein. Sometimes, treatment developers make sure this happens by tucking the DNA or RNA into the genome of another propecia, using that pathogen as a kind of shipping container.

These are called viral buy propecia usa vector treatments. Don’t worry, you don’t get sick from the delivery — researchers disable the propecia to prevent that from happening.It’s also possible to create a treatment that does not force cells to make viral proteins, but instead delivers the proteins directly. Some companies are working on these kinds of hair loss treatments, a category generally called protein-based treatments.On the whole, treatment developers spend a lot of time buy propecia usa at the drawing board.

The complexity of the immune system makes it a tough beast to wrangle. When it comes to hair loss, any of these treatment types could emerge from the pack — and ultimately help keep hair loss treatment at bay.It seems hard to believe that a basic human sensation — one that can be evoked by a simple mosquito bite — still has buy propecia usa scientists scratching their heads. Yet despite centuries of study, understanding itching is still fraught.Itch, write two scientists in a review in the journal Immunity, “has been described as one of the most diabolical sensations.

In Dante's Inferno, falsifiers were eternally punished by ‘the burning rage of fierce itching that nothing could buy propecia usa relieve.’” Yet, the researchers note, “There have been very few advances in itch treatment in over 360 years.”That’s finally starting to change. In the past decade, scientists have made strides toward understanding this infuriating sensation. They are untangling itchiness from other noxious stimuli, such as buy propecia usa pain.

They are even starting to distinguish one type of itch from another, by poking study participants with itch-inducing plant spikes or deleting itch-related genes from mice.This wide-ranging research is gradually going beyond an understanding of familiar acute histamine-driven itch — the mosquito or poison ivy variety — to reveal the complicated mechanisms and players involved in the often debilitating type of itching that lasts for weeks and sometimes years. Chronic itch, as it’s termed, can be generated by a multitude of factors, from chemicals secreted within the body to nerves gone haywire, and in many cases, has no known cause or cure.his inquiry is more than an academic exercise (or a quest to make mosquito welts recede faster). While acute itch is fleeting, chronic itch may plague some 7 percent of people each year, and one in buy propecia usa five people will experience it at some time in their lives.

Beyond a maddening persistent urge to scratch, the condition can lead to depression, sleep deprivation and a drastic decrease in the quality of life. €œIt can be as devastating as chronic pain,” says Robert LaMotte, an itch researcher at the Yale School of Medicine.And pain is actually buy propecia usa where the itch story starts.Identifying ItchFor much of the last century, itch was considered a lower-tiered version of pain. In the early 1920s, for example, Austrian-German physiologist and pain researcher Max von Frey documented in an influential study that a slight skin prick gave research participants the aftersensation of itch.

This conceptual model continued to feed the field of itch for decades.But eventually, the idea that itch was simply buy propecia usa a subset of pain began to crumble. Scientists determined, for example, that they could not reliably turn a pain into an itch just by decreasing the pain’s intensity — or turn an itch to a pain by increasing the itch’s intensity. Yet the nerves and pathways of pain and itch appeared to be so similar buy propecia usa and deeply intertwined that for years scientists lacked a clear understanding of how the two responses were wired into the body.Then, in 2007, the sensation of itching finally crawled out from under the shadow of pain and into its own light.That year, a seminal paper in Nature reported the first dedicated itch receptor — a protein on nerve cells in the central nervous system that responds specifically to itch but not pain, indicating that the sensation might travel its own separate pathway to the brain.

Zhou-Feng Chen, at Washington University School of Medicine in St. Louis, and colleagues showed that mice engineered to lack genes for this receptor — called the gastrin-releasing peptide receptor — could still feel pain but barely felt itch, no matter what the researchers buy propecia usa tried.“This changed the paradigm,” says Brian Kim, a dermatologist and codirector of the medical school’s Center for the Study of Itch, who now works with Chen. Revealing itch as a sensation in its own right with a dedicated pathway was a crucial step forward in understanding it, he says.Since the discovery of this first itch receptor, researchers have discovered more cellular players involved in chronic itch, separating it out from acute itch.

They have buy propecia usa learned, for example, that chronic and acute itch are relayed by different sets of neurons that send signals along their own dedicated tracks in the nervous system. When researchers have simulated chronic itch in experiments with healthy volunteers, MRI scans reveal that the two itch types spur different patterns of brain activity.These most foundational observations reveal just how much more we have to learn about itch. But they also help create a buy propecia usa path to bringing relief to those who experience debilitating chronic cases.

The sensation can be so bad that, for instance, some people with liver disease receive transplants precisely because of their itching. Others choose to go off of essential cancer medications buy propecia usa because of the itching the drugs can cause.And for years, researchers were focused on the low-hanging fruit of histamine-driven itch, which is easier to study, in part because it is being driven by a single chemical compound. Experimenters could spread or inject known irritants on or into the skin, cuing the body to make histamines, producing that familiar welty reaction that can be soothed by antihistamines like cortisone.

But most chronic itch (technically, itchiness that lasts more than six weeks) doesn’t involve histamines. And the routes buy propecia usa — there are many — to chronic itch are far more complicated.There are many routes to itch, but scientists have uncovered two, independent subtypes of neurons that relay the itch message to the spinal cord and brain. The histamine pathway (left), which is involved primarily in acute itch, is engaged when a trigger such as a mosquito bite spurs the release of histamines by the body’s immune system, which activate histamine receptors.

Non-histamine itch (right) can be set off by a wide buy propecia usa range of internal and external triggers, including immune system molecules such as cytokines, enzymes called proteases that cut up proteins and the antimalarial drug chloroquine. After a trigger activates receptors in either pathway, enzymes are kicked into gear that spur the opening of ion channels, prompting the nerve to fire and send the itch signal to the spinal cord and brain.Now, as scientists refocus their investigations on chronic non-histamine itch, they’re doing much of the research the old-fashioned way. By making people and animals itchy.Itch by ItchInitiating an itch is not as buy propecia usa simple as it seems.

One approach that’s been especially fruitful for zeroing in on non-histamine itch is to poke people with tiny hairs (or spicules) from a tropical plant called cowhage, or velvet bean.In a key series of experiments, LaMotte and his colleagues took about 10 of these spicules, which are a few microns wide at the tip, and inserted them about 0.2 millimeters into the skin of study participants. Every 30 seconds, for up to 20 minutes, the thus-pricked people reported sensations they felt, such as pricking, burning or itching, as well buy propecia usa as the intensity. The studies confirmed that an unusual compound within the minute hairs, called mucunain, rapidly causes itchiness but — unlike many plant-based itch-prompting compounds — doesn’t activate histamines.

That makes cowage spicules a powerful way to investigate the circuitry of non-histamine itch and possibly provide insight into mechanisms for buy propecia usa chronic itch.Next, LaMotte and his colleagues incubated human cells with mucunain in lab dishes to tease apart which receptor proteins might be receiving and responding to the incoming itch. They found responses in two types of such receptors — known as PAR2 and PAR4. Identifying itch-related receptors like these can help get medicine closer to a potential treatment.To more fully understand the basics of itch and help disentangle it from pain, buy propecia usa LaMotte and colleagues took a deep dive into the subtleties of the scratching behavior of mice.

They learned where on the mouse body to inject their various irritants so as to reliably distinguish itchy types of scratching from pain types of scratching.More than a decade on, the researchers can take advantage of the many biological mechanisms underlying itch — such as receptors and nerve pathways — that are similar in mice and people. That means they can now move back and forth between the two, injecting similar chemicals, for example, and tracking behavior (self-reports for humans, actions for mice) for intensity and duration.Meanwhile, the lab of Xinzhong Dong, an itch researcher at Johns Hopkins University, has used mice to pinpoint nerve endings that are truly buy propecia usa itch-specific. €œYou can activate those nerves, and you've got an itch sensation.

You don't feel pain,” buy propecia usa he says. When he and his colleagues inactivated these dedicated itch neurons, mice were immune to itchy stimuli but still felt pain, the researchers reported in 2012 in Nature Neuroscience.Other researchers aim to unlock itch’s secrets with a more pure form of laboratory itch.Dermatology researcher Akihiko Ikoma, then of Kyoto University, and colleagues took a mechanical approach to the problem. Instead of relying on chemical compounds, the team developed a buy propecia usa small wire loop that vibrates at a specific frequency.

As the team described in 2013 in the journal PAIN, when the loop is touched to the fine hairs on people’s faces, it creates an itch that takes more than 10 minutes to completely dissipate. This work has helped scientists to pinpoint itch-specific neurons around the skin that work independently of histamines or various other chemicals that stimulate itching.The hope, for both methods, is to identify neurons and pathways specific to different kinds of itch. This will eventually help scientists investigate drugs that could relieve chronic itch in long-time sufferers.But there remains more to untangle about itching’s complex circuitry, with new receptors and nerve cells still being uncovered.A Partnership With PainDespite all these buy propecia usa advances — and despite the fact that itch is found throughout the animal kingdom, from fish to primates — “much of itch perception is still a mystery,” Dong and Hopkins colleague Mark Lay note in the 2020 Annual Review of Neuroscience.For one thing, even though there’s been progress, the intertwined nature of itch and pain is still difficult to untangle.

One reason may be that both originated as self-protection. Just as pain sends the signal to withdraw buy propecia usa from something dangerous, itch prompts scratching, which could, for example, prevent s by shooing away parasites. Scratching also appears to help recruit local immune cells that can fend off .Itch and pain also have a peculiar overlap that even occasional scratchers are familiar with.

Scratching can generate mild pain, which can often override the sensation of itch buy propecia usa. Some researchers have proposed that when groups of neurons are activated — some of them itch-specific and some of them pain-specific — the pain stimulus, if strong enough, can mask the itch signals.And despite the new itch-only discoveries, many nerves do seem to be involved in communicating both painful and itchy stimuli. The confusing overlap is buy propecia usa exemplified in people with chronic conditions like atopic dermatitis.

In these cases, nerves in the skin become hyper-sensitive to itch, and perceive as itchy stimuli that are normally painful — or simply mechanical or thermal. This is buy propecia usa similar to what’s experienced by some people with chronic pain, where light touch can actually hurt. And basic nervous system malfunctions like a pinched or damaged nerve can generate pain in some people but itch in others.The overlap with pain is also present in the ways — still poorly understood — in which itch travels from the peripheral nerves in the skin to the spinal cord and up to the brain, Dong says.All of these lingering mysteries mean that itch — especially chronic itch — has been extremely difficult to effectively treat.

€œLike in pain, there's not just one painkiller that destroys all types of pain,” says Gil Yosipovitch, a dermatologist at the University of Miami and founder buy propecia usa of the International Forum for the Study of Itch.“I have patients who have a lot of complexities, and they require more than one pill or one cream, similar to patients who have chronic pain. And it requires a lot of time and patience.”For most of the population, itch is still a passing irritant, perhaps from bug bites in the summer or dry skin in the winter. But as a clinician and a research scientist, Kim says all of the suffering he sees from chronic itch keeps him working harder in the lab to understand this torturous sensation and correct too many years of inattention.“It’s just this cascade of neglect,” he says.Katherine Harmon Courage is a freelance journalist, a contributor to Scientific American and Vox buy propecia usa and the author of two books (Cultured and Octopus!.

). She spends buy propecia usa the summer as a favorite target of mosquitoes in Colorado. You can follow her at @KHCourage.This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews.When President Trump was diagnosed with hair loss treatment, one of the cutting-edge experimental therapies he received was a mixture of monoclonal antibodies.

But now a treatment may soon be available. So are other therapies buy propecia usa necessary or valuable?. And what exactly is a monoclonal antibody?.

Over the past few months, the public buy propecia usa has learned about many treatments being used to combat hair loss treatment. An antiviral like remdesivir inhibits the propecia from replicating in human cells. Convalescent plasma from the blood of donors who have recovered from hair loss treatment may contain antibodies that suppress the buy propecia usa propecia and inflammation.

Steroids like dexamethasone may modify and reduce the dangerous inflammatory damage to the lungs, thereby slowing respiratory failure.The FDA issued emergency use authorization for Eli Lilly’s monoclonal antibody, called bamlanivimab, and Regeneron is waiting for FDA’s green light for its antibody treatment. Monoclonal antibodies are particularly promising in therapy because they can neutralize the hair loss propecia, which causes hair loss treatment, and buy propecia usa block its ability to infect a cell. This might be a lifesaving intervention in people who are unable to mount a strong natural immune response to the propecia – those over 65 or with existing conditions that make them more vulnerable.I’ve worked in public health and medical laboratories for decades, specializing in the study of propeciaes and other microbes.

Even when a treatment for hair loss treatment becomes available, I see a role buy propecia usa for monoclonal antibody therapy in getting the propecia under control.Why Should We Care?. Until a large percentage of a population has immunity to an infectious disease – either through a treatment or the unchecked spread through a community – the world must rely on other weapons in our war against the hair loss treatment propecia.Along with the previously mentioned therapies, monoclonal antibodies can offer us another tool to neutralize the propecia once it causes an .These man-made antibodies offer the world the possibility of immunotherapy similar to the use of convalescent plasma but with a more targeted and accurate action. While a treatment will ultimately help protect the public, vaccination will not be an instantaneous event, delivering treatment to 100% of the population buy propecia usa.

Nor do we know how effective it will be.The impact of a treatment also isn’t instantaneous. It takes several buy propecia usa weeks to generate a powerful antibody response. In the interim, monoclonal antibodies could help mop up propecia that is multiplying in the body.Antibody 101An antibody is a Y-shaped protein naturally produced by our body’s immune system to target something that is foreign, or not part of you.

These foreign bodies are called antigens and can be found on allergens, bacteria and propeciaes as well as other things like toxins or a buy propecia usa transplanted organ.A monoclonal antibody treatment mimics the body’s natural immune response and targets foreign agents, like a propecia, that infect or harm people. There are also monoclonal antibodies that pharmaceutical companies have designed that target cancer cells. Monoclonal antibodies buy propecia usa are one of most powerful types of medicine.

In 2019 seven of the top 10 best-selling drugs were monoclonal antibodies.For President Trump, the experimental treatment made by the pharmaceutical company Regeneron included two antibodies.Typically the spike protein on the hair loss fits perfectly into the ACE2 receptor on human cells, a protein common in lung cells and other organs. When this connection happens, the propecia is able to infect cells and multiply inside them. But monoclonal antibodies can slow or buy propecia usa halt the by attaching to the viral spike protein before it reaches the ACE2 receptor.

If this happens, the propecia becomes harmless because it can no longer enter our cells and reproduce.How Are Monoclonal Antibodies Created?. Monoclonal antibodies that neutralize the hair loss are complicated to manufacture and buy propecia usa produce. They must be made inside cells taken from a hamster’s ovary and grown in gigantic steel vats.

The antibodies that these cells manufacture buy propecia usa must then be extracted and purified. Unfortunately these monoclonal antibodies, which have been used for other illnesses for years, are often quite expensive.Regeneron’s two antibodies are targeted to the spike protein of hair loss – the protrusions on the surface of propecia that give it a crown-like look and are critical for infecting human cells.One of Regeneron’s two antibodies is a replica, or clone, of an antibody harvested from a person who recovered from hair loss treatment. The second antibody buy propecia usa was identified in a mouse that was biologically engineered to have a human immune system.

When this mouse was injected with the spike protein, its human immune system generated antibodies against it. One of buy propecia usa the most effective mouse antibodies was then harvested and used to form part of this therapy.Eli Lilly’s monoclonal antibody therapy, bamlanivimab, was identified from a blood sample taken from one of the first U.S. Patients who recovered from hair loss treatment.Both companies have in place large-scale manufacturing with robust, global supply chains in place to produce the monoclonal antibodies, with many global manufacturing sites to ramp up supply.

Eli Lilly has received FDA approval, and buy propecia usa Regeneron is still awaiting approval. Unfortunately, there will likely be a shortage of the antibodies in the early going of approvals.Monoclonal Antibodies Plus a treatmentMonoclonal antibodies will be able to complement treatments by offering rapid protection against . When they are given to an individual, buy propecia usa monoclonal antibodies provide instantaneous protection for weeks to months.

treatments take longer to provide protection since they must challenge the immune system. But the advantage of a treatment is that they usually provide long-term protection.Regeneron’s and Eli Lilly’s products are both delivered by intravenous injection, after which the patient buy propecia usa must be monitored by health care professionals. Since they offer immediate protection, the implications to treat or provide protection to high-risk populations is immense.These medicines have the potential to treat infected patients or prevent of essential health care and public health professionals on the front line of this propecia.

Monoclonal antibodies could also be useful for older people, young children and immunocompromised people for whom treatments either don’t work or can be dangerous.Rodney E. Rohde is a professor clinical buy propecia usa laboratory science at Texas State University. This article appeared on The Conversation and is republished under a Creative Commons license.

Read the original here.Face coverings and social distancing are necessary for keeping the novel hair loss at bay, but are propecia-related precautions affecting our ability to ward buy propecia usa off other ailments down the road?. Health experts may not be able to say for sure yet, but there are ways to balance the two interests. Pro tip? buy propecia usa.

Get outside (preferably a good distance from people who don't live in your household) and take a deep breath. Your microbiome buy propecia usa will thank you. What is the Microbiome?.

Our bodies play host to a wide array of microorganisms buy propecia usa that make their home on our skin and inside our guts, airways and other organs. Their presence is so significant that the number of bacteria in our guts is actually greater than the number of human cells in the human body. The organisms' collective DNA is known as the microbiome and scientists have studied its effect on everything from our social lives to our mental buy propecia usa health.Put simply.

The microbiome provides the immune system with information about potential intruders. It clues our body in on what is and isn't a threat and helps prepare our buy propecia usa white blood cells for battle. Some of the microbiome is built up shortly after birth.

A trip down the birth canal followed by months of breastfeeding helps babies form their unique microbiome, but exposure to the natural environment in those first buy propecia usa few years of life is crucial as well, experts say. €œAll of these organisms provide data for the immune system,” says Graham Rook, an immunologist and professor emeritus at University College London. €œIt's like the brain buy propecia usa.

It has to have data. And just like the brain, it needs the data early in life.” If the body fails to get the right messages about its environment, it may go rogue and attack things it shouldn't, leading to conditions like allergies, asthma and autoimmune disorders. Since the first few years of life are most crucial, Rook is especially concerned that if young children are not leaving their homes, they are not getting the exposure to microbes they need buy propecia usa.

€œThat is why confining an infant to a high-rise apartment during hair loss treatment lockdowns is likely to be detrimental,” says Rook. €œThe microbiome of a modern apartment is not a useful exposure.” The Daycare TestA recent study comparing different daycare settings in Finland demonstrated that simply enriching the outdoor play areas with elements of the natural environment had buy propecia usa a positive effect on the microbiomes in children. For four weeks in 2016, young children played on segments of forest floor and sod placed on top of the existing gravel.

Instructors at the schools also engaged the children in activities such as planting gardens, resulting in buy propecia usa average daily exposure of 90 minutes per day.The results indicated an increase in microbe biodiversity on the skin and in the guts of the children, and a corresponding bump in immune system function. The study offers hope that even children in urban environments can build their microbiomes with some exposure to the natural world. Animals Can Help Bring Exposure, Too “The most evidence-based strategy for improving your microbiome from an immunity [and] asthma perspective is to get a cow,” says Rob Knight, a University of California, San Diego professor and buy propecia usa co-founder of the American Gut Project.

€œBut that isn’t especially practical if you live in an apartment in the city.”In studies completed by scientist Erika von Mutius, life on a farm and bacteria carried by cows, specifically, appeared to have the best benefit to humans, Knight says. Dogs and cats that spend time outdoors can also bring in some good microbes, experts say, which provides another reason to adopt a pet while sheltering in buy propecia usa place. Diet Also Plays a PartKnight says a diet promoting microbiome diversity would include a diverse range of plants and fermented foods, with limits on sugar and salt.

Rook adds that although building a healthy microbiome can be most crucial in the early years, studies indicate that adults can be affected as well.“Sick adults have less diverse gut microbiomes,” Rook says, adding that a diverse diet and time buy propecia usa in the natural environment are key to bolstering health. While it is true that humans pick up “data” from other humans and that is a missing piece of the equation now, Rook notes that he is far more concerned about young children who are not leaving their homes and getting exposure to microbes in their natural environments. And if you're worried that a lack buy propecia usa of colds this year might lead to an immune system unprepared for next year's propeciaes, experts say that's not exactly how it works.

€œThere’s no evidence that exposure to pathogens per se is good,” Knight says. €œCurrent thinking is that exposure to a wide range of harmless organisms from other people and the environment is good.”So, while the long-term health effects of social distancing might not be fully understood yet, embracing a lifestyle that includes healthy food choices and time buy propecia usa spent outdoors may be the best tools at our disposal right now. Rook also suspects that mask-wearing doesn't inhibit the ability to absorb what is needed from the outside world.

€œPlenty of small particles from the natural environment are wafting into the lungs,” he says..