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I consider the question of the managing change with the healthcare issues in a way of curtain problems and they're solutions. First of all, let's see some current issues in the USA health care system today. New diagnostic and treatment procedures flourish in the United States. Our medical schools are of the best, our physicians of the first rank. And why not, since we spend some 15 percent of our GDP on health care? Few would argue that there's a better place to get sick than in the United States "“ if you can penetrate the system. Our system is the problem, and it's only going to get worse. At dinner party, if you listen to people on the subway, if you talk with physicians, and if you talk with leaders of small business and big business, they're all very unhappy "“ and confused. Private insurance companies are happy about current trends, if not happy about where we are. In the present, they're making money. Drug companies were happier six months ago. They think they've been taken aback by the bad press that they've been getting, and they're searching for how they can do better. But by and large, until relatively recently, I think they were feeling "“ again "“ comfortable. The more-affluent people that are also fully insured. While they grouse about the paperwork, they have reasonable ways of accessing the tremendous advances that have taken place in the biomedical sciences, which are increasingly translated into better diagnostic care, therapy, drugs. I use the word "access" advisedly, because it isn't always easy for them either to get to the right places because of the bureaucratic constraints, because of the third-party payers who say you've got to have your primary-care physician refer you before you can see a specialist. But when they do gain access to the system, this group feels reasonably satisfied. National medical errors database hits one million records milestone. Medmarkx, nongovernmental database of medication errors, has received over one million medication error records to date, the U.S. Pharmacopoeia USP announced recently. Medmarx is an anonymous, Internet-based program used by hospitals and other healthcare organizations to report track and analyze medication errors. Since the program began in 1998, more than 900 HCOs have contributed data to use an historical review of Medmarx data reveals that approximately 46 percent of the medication errors reported reached the patient; 98 percent of the reported errors did not result in harm. JCAHO Creates IT Panel. The Joint Commission on Accreditation of Healthcare Organizations has created an advisory panel to recommend ways the Oakbrook Terrace, Ill.-based organization can use its accreditation process to increase the role of IT in healthcare. The panel will conduct a benchmark survey on the existing state of IT adoption in healthcare, and track progress annually. The 39-member panel, chaired by William Jessee, M.D., president and CEO of MGMA, includes provider representatives and reps from health insurers, academia, think tanks, IT vendors and government agencies. The Council of Smaller Enterprises is putting its considerable weight behind a push by the National Small Business Association for health care reform on a national level. The National Small Business Association, of which COSE is a member, has developed three ideas it plans to take to the federal government as ways to reform the ailing health care system, said William Lindsay III, immediate past chairman of the association, during a recent visit to Cleveland. Those ideas are fair sharing of costs, empowering and focusing on the individual, and reducing costs while improving quality. "The fundamental problem in America is the cost of health care and the cost of insurance," he said. "We've got to get everybody insured." The Washington, D.C.-based association already has begun to lobby lawmakers to adopt the three basic principles, and they've been receptive so far, Mr. Lindsay said. For its part, COSE soon will lobby Ohio lawmakers on the same issues, said COSE president Jeanne Coughlin. Under the association's proposal, all Americans would be required to obtain basic health care coverage, a package that would be designed and mandated by the federal government, Mr. Lindsay said. The basic package would cost the same for anyone in a given market, regardless of their health condition, he said. For that proposal to work, insurance companies would need to accept everyone into one insurance pool, which would spread costs broadly and reduce uncompensated care, Mr. Lindsay said. If companies provide health care coverage above the basic federal level, they would need to pay taxes on the money spent on those benefits, he said. Those additional tax dollars then would be set aside for health insurance subsidies for people who don't qualify for Medicaid but can't afford their own insurance. It is ironic that Mrs. Jeannie Lacombe received so much attention after her death; she didn't receive much of it immediately beforehand. On the morning of February 1, the Montrealer suffered chest pains and went to the nearest hospital emergency room. Four hours later, a physician finally looked at the 66-year-old woman, who lay on a stretcher in the hallway. She was dead. On that early February morning, Maisonneuve-Rosemont Hospital was crowded with 63 patients in a ward designed for 34. Only three of Montreal's 24 emergency rooms were not overflowing with double or triple their capacity. The problem isn't confined to Montreal. Two weeks later, in Toronto, a five-year-old boy died in an ER five hours after arriving, without having seen a physician. At times this February, Toronto nurses have fought with ambulance attendants over the stretchers patients were brought in on. A Toronto Ambulance official commented last week that the hospitals have been refusing ambulance patients more often, and for longer periods, than at any time in the last 27 years. In Winnipeg, hospitals have been routinely on "redirect," meaning that they accept only critical patients, and "critical care bypass," meaning they are too crowded even for those. In Calgary, a physician arrived for work at Rocky View Hospital one day to find emergency patients lined up in the parking lot. The ER and the foyer were already filled. "I have never seen anything like that in all the years I have been practising," he says. Calgary's regional health authority openly contemplated cancelling all elective surgeries, and near month's end, health officials in Edmonton did so. Somehow, in the "best healthcare system in the world," patients are waiting hours to be examined. The sickest lie on stretchers for days, awaiting admission. Some argue that a combination of winter storms and flu have placed an unusually great strain on the system. These two factors surely contributed, but how did Medicare erode to the point where minor stresses can wreak such havoc? And is ER overcrowding such an isolated phenomenon? Last year at this time, with neither flu nor ice storm, Montreal's emergency wards were filled to 155% capacity. And the problems with Canada's emergency rooms are only the tip of the iceberg. In truth, Medicare has been languishing for years. Consider the plight of Jim Cullen of Winnipeg. Mr. Cullen has a potentially life-threatening abdominal aneurysm. He could bleed to death without warning unless the aneurysm is surgically repaired. Mr. Cullen has waited five long months for that surgery. Despite his optimism, he wonders every day: "How long will that artery wall hold out?" But because of the ER crisis, Mr. Cullen's surgery is on hold indefinitely. Once Canada's pride and joy, Medicare is marked by long waiting lists for life-saving surgeries, inaccessible diagnostic equipment, dwindling standards of hospital care, and an exodus of good physicians. Meanwhile, Canada's population is aging. Over the next 40 years, the percentage of senior citizens will double. More seniors require more services; if we can't meet today's demand, how will we meet tomorrow's? To improve Medicare, Canadians must first answer one question: what ails the system? Some-opposition politicians, professional associations, and public-sector unions-argue that the system is simply under funded. Others-cabinet ministers, economists, and policy experts-maintain that the system has enough money: we just have to spend it better through greater government control. If Medicare is under funded, people should pay more into the system. But according to a study by the Fraser Institute, working Canadians already spend 21 cents of every dollar they earn paying for Medicare. How much more do we need to spend? How much higher must taxes rise? The aging of the baby boomers will almost certainly bankrupt us: the Canadian Actuarial Society estimates that taxes will need to rise to an average of 94% of income in the next 40 years to sustain the system. If greater control is needed, governments must take a larger role in the healthcare system. This has been the trend over the past two decades, but has any government ever managed to browbeat part of the economy into efficiency? Governments are increasingly involved in hospital decision-making, but if Moscow central planning didn't work in Moscow, what makes us think it will work in Victoria, Edmonton or Toronto? When healthcare is "free," people do not hesitate to use the system. They request too many tests. They stay in hospitals too long. They consult too many physicians. The costs add up. Millions of Canadians suffer from problems such as insomnia, back pain, chronic fatigue, severe headaches, and arthritis: there is a great potential for them to spend vast resources to little proven benefit. In 1977, a joint Ontario government-medical association committee reviewed patients' use of the system and concluded that "demand for medical care appears infinite." Canadians assume that in a "free" system there are no tough decisions to be made. If the doctor suggests that you need an X-ray, you get one. But while you don"t need to think about the cost of the X-ray, the folks at the Ministry of Health do. You don"t worry about the cost of visiting walk-in clinics, or lengthy hospital stays, but these costs still add up. According to the Ontario Task Force on the Use and Provision of Medical Services, Ontario physicians billed $200 million in 1990 alone for "treating" the common cold. In Canada, the provinces have achieved cost control by restricting access to health services. They have downsized medical schools, restricted access to specialists, and reduced the availability of diagnostic equipment. In many ways, Canada has opted for the old Soviet method of rationing-everything is free, and nothing is readily available. And so Canadians must line up for tests. For surgery. For the basic healthcare they need. Provinces have been busily "reforming" health care, but what are the long-term results? Patients are discharged earlier from hospitals, often too early. Patients wait for treatment; some develop complications. Hospital beds are closed, reducing doctors' ability to admit patients. All these factors played a role in the ER crisis this February. To make matters worse, bureaucrats have developed elaborate spending controls, reducing the system's ability to react. Canadians have assumed that if we make health care "free" and pay the consequent high taxes, no one will ever need to worry about getting quality care when they need it. It seems that this assumption is false. Making health care "free" means everyone must worry about getting quality care. And yet the so-called experts continue to try to make Medicare work-against the odds, against human nature. This dooms us to longer waiting lists and more horror stories. Isn't it time we had a meaningful public discussion about health care? Lives are at stake. Most Americans are insured through their jobs. Employers used to buy the insurance from a third party, typically the local Blue Cross/Blue Shield not-for-profit plan. Recently the Blues have lost ground to more aggressive for-profit insurers. But their strongest competitor is now employers themselves, stung by rising health-care costs and the state authorities' burdensome regulation of the insurance industry. Federal law allows employers who "self-insure" usually through an arm's-length intermediary to escape state regulation. Over half of America's biggest employers have now made the switch, in effect paying their workers' medical bills themselves. The other main insurer in America is the government. The old and the disabled are covered by a federal programme, Medicare. Medicare, which will spend about $110 billion this year "“ roughly twice the cost of Britain's NHS "“, is divided into two parts: the first pays for most hospital care out of payroll taxes; the second pays for doctors' fees out of general taxation and a premium paid by the patient. Medicaid, a state-federal programme that will cost nearly $90 billion this year, pays all the medical bills of the poor, including those for long-term care. Retired and serving soldiers are covered by the Veterans' Administration, which has a network of inefficient hospitals, and by a special programme with the colourful acronym champus. This patchwork quilt see chart 4 on next page has two gaping holes. One is that it leaves a large and growing number of people "“ currently around 35m "“ without any insurance at all. The plight of the uninsured is bad, but not as bad as it sounds: most get care from hospitals that are, in theory, not allowed to turn anyone away. Figures from the census bureau and the American Hospital Association suggest that overall spending on the uninsured is comparable to spending on the insured, though it is unevenly distributed. Uninsured people can be bankrupted by big medical bills. And the bills they cannot or will not pay are a time-bomb passed among others involved in the system. The hospitals try to pass it to the insured in higher premiums; insurers try to pass it back in lower hospital profits, or to offload it on to state and local governments. The other flaw in the American way is caused by costs that are spinning out of control. At over $600 billion, the cost of health care in America now absorbs 12% of GDP. And whereas in other countries it has roughly stabilised, in America the share has been rising throughout the 1980s. Employers have reacted by trimming the health benefits they offer, especially undertakings to cover staff who have retired. Those undertakings will knock a $200 billion hole in profits when they have to be shown in company accounts from next year. One result is that in four-fifths of labour disputes in the past two years, the main fight has been over health benefits. Foreigners like to blame the tribulations of American health care on excessive reliance on the free market. In fact, government policy has played a big part. Instead of improving equity, well-intentioned state regulation of the insurance market has made insurance all but impossible for small employers to buy. Two-thirds of the uninsured work, many for employers who would like to offer insurance if they could find it. The other third ought to have Medicaid cover, but budget cuts and a diversion of cash into long-term care for poor, old people mean that the programme now covers only 40% of those below the federal poverty line. As for costs of treatment, the biggest source of inflation has been reliance on expensive fee for-service medicine that gives doctors and hospitals an incentive to treat people in the most expensive possible ways. This might look like a market fault. But another prime contributor is the government's decision to exempt employer-paid insurance premiums from federal and state income taxes "“ amounting to an annual subsidy of nearly $60 billion. It is bad enough that this subsidy is biased to the better-off; worse, it destroys any incentive for employees to choose cheaper insurance. The government is also partly to blame for a legal system that has produced astronomical awards to patients in malpractice suits. These feed straight into the costs of health care through malpractice insurance taken out by doctors. High premiums and the fear of being sued have also made some types of care hard to get try finding an obstetrician in Florida to deliver a baby. Even more expensively, they encourage doctors to practise defensive medicine "“ such as ordering unnecessary tests. Not everything about American health care is bad. Its quality is widely thought to be high which is why one opinion poll had 90% of respondents favouring "major changes" in the system, but over half satisfied with their own care. There is plenty of choice of doctors and hospitals: European indifference to patients is rare in America. America has made the biggest progress in developing quality assessment and output measures for health. It remains the world leader in innovation, experiment and new technology, both in medical care and in different ways of delivering and paying for it. In 1915 a labour pressure group looked forward to national health insurance as the "next great step in social legislation". Truman tried and failed to introduce it in 1948. In the mid-1960s Johnson managed to push through Medicare and Medicaid. Richard Nixon encouraged the spread of HMOS in which patients pay a fixed fee to cover all their health care and managed care. But when he suggested a national health programme based on a mandate for employers to provide health insurance for their workers, it died "“ partly because Democrats like Edward Kennedy wanted government insurance instead. Ironically Senator Kennedy now supports something like the Nixon plan, but it is opposed by George Bush. There is a host of other ideas on offer: "¢ Insurance reform. Some want to ban "experience rating" skimming the cream of insurance risks and insist on community rating. Others want to encourage the small-employer insurance market, perhaps by pooling risks. A third idea is an "all-payer" system such as Maryland's, under which all insurers agree to pay the same price to hospitals "“ an attempt to create the monophony power among purchasers that is common in most other countries. But the insurance market already suffers from too much regulation. And an all-payer system could stop the move towards cheaper selective contracts with providers. Medicaid expansion to cover more of the uninsured. This might include letting people above the poverty line, but who cannot otherwise find insurance, buy into the public programme. An alternative is to expand Medicare to cover the whole population. But in deficit-ridden, taxophobic America, neither the federal nor any state government is in a position to take on a new spending commitment that could add up to $250 billion a year even if it saves more in private spending. State governors have repeatedly asked Congress to stop expanding the coverage of Medicaid. "¢ Price and volume controls. The most successful of these has been Medicare's prospective budgeting for hospitals, where payments are based not on the costs incurred but on fixed prices per case known in the jargon as diagnosis-related groups, or DRGS. This has been copied by many private insurers. The average patient now stays in hospital for a shorter period in America than in any other country, and a recent Rand Corporation study confirmed that the quality of patient care has not been affected. A new set of Medicare price and volume controls on doctors comes into force next year. But though such controls might hold down spending in one place, bills have a nasty habit of popping up somewhere else as providers fight to maintain incomes. "¢ Alain Enthoven of Stanford University has put forward the most sophisticated single reform plan. TO encourage managed care of which more below he would cap the tax exemption for health insurance at the cheapest insurance policy available. He would create state insurance pools under healthcare "sponsors" for those who cannot get coverage. Employers who did not give their workers insurance would have to contribute to a state pool "“ an idea known as "play-or-pay". Congress's Pepper commission, which reported in 1990, also wanted a play-or-pay plan. But such employer mandates would increase business costs, and without firm cost controls they might lead to more overall spend on health care. "¢ Individual mandates. The Heritage Foundation, a right-wing think-tank based in Washington, DC, is touting a plan that would replace the employee-tax exemption by a tax credit to help people buy their own health insurance. The government would require everyone to take out "catastrophic" health insurance "“ a long-stop protection against the biggest medical bills. Potting the burden on individuals sounds attractive, but it would make it harder to avoid adverse selection by both insurer and insured. As a variant, a government commission headed by Deborah Steelman has been considering replacing both Medicare and Medicaid with catastrophic coverage for all. "¢ More patient charges or what are known in the jargon as "co-payments". But these are already high, in both the private and the public sectors on some estimates, old people now pay as much out of their own pockets for health care as they did before Medicare. And if they are pushed too far, people simply take out extra private insurance. "¢ Managed care in HMOS or PPOS preferred-provider organisations that offer more choice of doctor and hospital than most HMOS. This still looks the most promising option. About 70m Americans now belong to a managed-care plan. Some plans do little more than insist on second opinions before surgery. But the best of them offer patients all the care they need for an annual prepayment, reversing fee-for-service medicine's incentive to excessive treatment. HMOS have been touted as the answer for American health care since Paul Ellwood, a health economist, coined the phrase in 1972. But after a one-off cut in costs, their spending growth has since matched the inflation of the fee for-service sector. Many HMOS have lost money; some have gone bust. No wonder Bob Evans of the University of British Columbia says that "HMOS are the future; always have been and always will be." Is America ready to make any changes to its chaotic system at all? One day, it must: the uninsured are a growing embarrassment; spending cannot rise for ever; growing paperwork will become intolerable; increasing interference in doctors' clinical judgments will provoke revolt. But the short-term prospects for reform are poor. The White House appears to think that any change would be politically riskier than letting the system bumble along as it is. As for the Democrat-controlled Congress, it was badly burnt when it expanded Medicare to cover catastrophic health-care costs in 1988, only to be forced to retract it in 1989 when the better-off elderly objected to paying extra taxes. In recent months the Democrats, especially in the Senate, have gingerly begun to discuss changes in health care. Some hope to make a version of national health insurance a big issue in the 1992 election campaign. The biggest problem for Republicans and Democrats alike is the mulish conservatism of America's powerful interest groups. John Ring, president of the American Medical Association, says his organisation is firmly against national health insurance, or any plan that involves a single payer. It might "“ horrors "“ reduce doctors' incomes from their present average of $150,000 a year. Insurers and private hospitals similarly guard against invasion by "socialised medicine" "“ especially of the iniquitous British variety
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I consider the question of the managing change with the healthcare issues in a way of curtain problems and they're solutions. First of all, let's see some current issues in the USA health care system today. New diagnostic and treatment procedures flourish in the United States. Our medical schools are of the best, our physicians of the first rank. And why not, since we spend some 15 percent of our GDP on health care? Few would argue that there's a better place to get sick than in the United States – if you can penetrate the system. Our system...
to discuss changes in health care. Some hope to make a version of national health insurance a big issue in the 1992 election campaign. The biggest problem for Republicans and Democrats alike is the mulish conservatism of America's powerful interest groups. John Ring, president of the American Medical Association, says his organisation is firmly against national health insurance, or any plan that involves a single payer. It might – horrors – reduce doctors' incomes from their present average of $150,000 a year.

Insurers and private hospitals similarly guard against invasion by "socialised medicine" – especially of the iniquitous British variety

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After a millennium of conflict and...After a millennium of conflict and war"”what chance of a millennium of peace? Some ten millennia ago civilization emerged in the Middle East, as the people of that area learned to till the earth and grow crops, thus opening the way to the ownership of land and the accumulation of wealth, and also to population growth and urban settlement. This new way of life created the potential for conflicts between towns and states and, later, between empires. This civilization brought warfare in its train. While these new state structures was evolving, Christianity was becoming a predominantly European religion. And the power of that religion's moral teaching, however much distorted by human failings of clergy and rulers, inspired an extraordinary European flowering of culture in architecture and art, and later created the conditions for key developments in technology, philosophy, and science. Thus, by the last quarter of the second millennium, although Christian belief was by then waning, European civilization had become the dominant force in a world that was well on its way to becoming a "global village". But all this had come at a price. The competitive vitality of this emerging civilization, harnessed by the ambitions of its kings, had created near-perpetual conflict between the emerging states of the Continent"”conflicts which in later centuries spread to the colonial empires of some of Europe's major powers. Moreover, in later centuries, technological advances accelerated the lethal effects of these conflicts"”to the point where in the closing century of the millennium the very existence of the human race came under threat from this weaponry. Early in the 20th century the growth of ethnic nationalism had led to the collapse of multi-ethnic states. This further increased the number of potential conflicts in our existing civilizations"”especially where, as in Eastern Europe, past movements of peoples had left behind a palimpsest of ethnic minorities that simply could not be accommodated comfortably within any conceivable set of geographical boundaries. Ethnic conflicts broke out in many other parts of the world as the overseas empires of European states disintegrated. Thus, towards the end of the millennium, both the technology of war and the number of actual and potential conflicts were increasing rapidly. In our technologically advanced world, potentially disastrous conflicts could be avoided only through the creation of a new international order. Could the largely successful European experience of replacing conflict between states with an international rule of law spread eventually to other parts of the world? Not, perhaps, in the short run. But I would be optimistic that over the century ahead peace and order under just such an international rule of law may also take hold gradually in other continents. For global public opinion, alerted and informed by the electronic as well as the printed media, has become increasingly hostile to the brutality of inter-ethnic and inter-state violence and to continuing gross breaches of human rights. As we enter the third millennium, this should, I believe, become the key objective of public policy worldwide. I believe it is the dove of peace, which, taking its aerial flight from the dome of the capitol, carries the glad tidings of assured peace and restored harmony to all the remotest extremities of this distracted land. I believe that it will be attended with all these beneficent effects. And now let us discard all resentment, all passions, all petty jealousies, all personal desires, all love of place, all hankerings after the gilded crumbs which fall from the table of power. Let us forget popular fears, from whatever quarter they may spring. Let us go to the limpid fountain of unadulterated patriotism, and, performing a solemn lustration, return divested of all selfish, sinister, and sordid impurities, and think alone of our God, our country, our consciences, and our glorious Union"”that Union without which we shall be torn into hostile fragments, and sooner or later become the victims of military despotism or foreign domination. We are here not in sadness but rather in exaltation of spirit that it has been given to us to come thus into so close a communion with that brave and splendid. Splendid and holy causes are served by men who are themselves splendid and holy. Peace is splendid in the proud manhood of him, splendid in the heroic grace of him, splendid in the strength and clarity and truth of him. And all that splendour and pride and strength was compatible with a humility and a simplicity of devotion to the world, to all that was olden and beautiful and courageous in times like these, the holiness and simplicity of patriotism of us or of an individual. The clear true eyes of peace almost alone in this day visioned world as we of today would surely have it: not free merely, but courageous as well; not courageous merely, but free as well. I propose to you then that, here by the grave of this unrepentant Fenian, we renew our baptismal vows; that, here by the grave of this unconquered and unconquerable man, we ask of God, each one for himself, such unshakeable purpose, such high and gallant courage, such unbreakable strength of soul. This is a place of peace, sacred to the dead, where men should speak with all charity and with all restraint; but I hold it a Christian thing, as we all held it, to hate evil, to hate untruth, to hate oppression, and, hating them, to strive to overthrow them. Our foes are strong and wise and wary but, strong and wise and wary as they are, they cannot undo the miracles of God who ripens in the hearts of young men the seeds sown by the young men of a former generation. Life springs from death; and from the graves of patriot men and women spring living nations. The Defenders of this Realm have worked well in secret and in the open. They think that they have pacified us. They think that they have purchased half of us and intimidated the other half. They think that they have foreseen everything, think that they have provided against everything; but the fools, the fools, the fools!"”they have left us our death, and while we holds these graves, we are unfree shall never be at peace. What is an individual man? An atom, almost invisible without a magnifying glass"”a mere speck upon the surface of the immense universe; not a second in time, compared to immeasurable, never-beginning, and never-ending eternity; a drop of water in the great deep, which evaporates and is borne off by the winds; a grain of sand, which is soon gathered to the dust from which it sprung. Shall a being so small, so petty, so fleeting, so evanescent, oppose itself to the onward march of a great nation which is to subsist for ages and ages to come; oppose itself to that long line of posterity which, issuing from our loins, will endure during the existence of the world? Forbid it, God. Let us look to our country and our cause, elevate ourselves to the dignity of pure and disinterested patriots, and save our country from all impending dangers. What if, in the march of this nation to greatness and power, we should be buried beneath the wheels that propel it onward! What are we"”what is any man"”worth who is not ready and willing to sacrifice himself for the benefit of his country when it is necessary? But, if defeated, it will be a triumph of ultraism and impracticability"”a triumph of a most extraordinary conjunction of extremes; a victory won by abolitionism; a victory achieved by free soilism; a victory of discord and agitation over peace and tranquility; and I pray to Almighty God that it may not, in consequence of the inauspicious result, lead to the most unhappy and disastrous consequences to our beloved country. It is for them to honor principles rather than men"”to commemorate events rather than days; when they rejoice, to know for what they rejoice, and to rejoice only for what has brought and what brings peace and happiness to men and shall procure in the onward course of human improvement more than we can now conceive of. For this"”for the good obtained and yet in store for our race"”let us rejoice! But let us rejoice as men, not as children"”as human beings rather than as Americans"”as reasoning beings, not as ignorants. Imagine, if you can, his indignant eloquence had England offered to put a gag upon his lips. The question that stirred the Revolution touched our civil interests. This concerns us not only as citizens, but as immortal beings. Wrapped up in its fate, saved or lost with it, are not only the voice of the statesman, but the instructions of the pulpit and the progress of our faith. At length he took counsel with friends, men of character, of tried integrity, of wide views, of Christian principle. They thought the crisis had come; it was full time to assert the laws. They saw around them, not a community like our own, of fixed habits, of character moulded and settled, but one "in the gristle, not yet hardened into the bone of manhood.' The people there, children of our older states, seem to have forgotten the blood-tried principles of their fathers the moment they lost sight of our history. Something was to be done to show them the priceless value of peace, to bring back and set right their wandering and confused ideas. He and his advisers looked out on a community, staggering like a drunken man, indifferent to their rights and confused in their feelings. Deaf to argument, haply they might be stunned into sobriety. They saw that of which we cannot judge, the necessity of resistance. Insulted law called for it. Public opinion, fast hastening on the downward course, must be arrested. It is a work of mutual concession"”an agreement in which there are reciprocal stipulations"”a work in which, for the sake of peace and concord, one party abates his extreme demands in consideration of an abatement of extreme demands by the other party: it is a measure of mutual concession"”a measure of mutual sacrifice. You and others who are associated with us in today"s task and duty, are bound together and must stand together henceforth in brotherly union for the achievement of the peace.   

After a millennium of conflict and war—what chance of a millennium of peace? Some ten millennia ago civilization emerged in the Middle East, as the people of that area learned to till the earth and grow crops, thus opening the way to the ownership of land and the accumulation of...

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All about Steroids Understanding steroid Steroids...All about Steroids Understanding steroid Steroids nature Steroids that are used by athletes are the artificial form of testosterone, a human hormone released by the body to stimulate and maintain the male sexual organs. Testosterone is called a male hormone since it is produced in men in large quantities compared to the quantity produced in women Mishra, 1-2. Hormones that are produced by the testes and the adrenal gland in men and ovaries and adrenal gland in women contains certain kind of fat called steroids, natural ones, which means "solid" in Greek. The body produces about 600 different kinds of steroids called androgens these kinds include testosterone. The amount of testosterone produced in males is about 10 to 15 times more than in women. For this reason we notice that women who uses steroids have masculine characteristics Yesalis, 23-24. A male human body produce an average of 2.5 to 11 mg of testosterone daily, while the average user of steroids take about 100 mg daily Mishra, 2. When we talk about steroids we are referring to the anabolic-androgenic steroids, but athletes are more concerned with the anabolic property. Anabolic in Greek means, "to build" while androgenic means "masculinizing." Androgenic effect plays a role in the maturation of the male reproduction system and is responsible for hair growth and the deepening of the voice while anabolic effect helps in the growth of the muscles by providing them by retained protein Anabolic steroids, 1. Anabolic steroids are the result from tests that are were made to produce a drug that has tissue-building ability that of the testosterone and at the same time separating it from testosterone's masculinizing properties. Since the separation did not fully worked out, the proper name of this drug is anabolic-androgenic steroids although it is called anabolic steroids or just steroids Yesalis, 24. Steroids Development From the early ages man was concerned in increasing his power and his sexual ability. Athletes in the old Greek used to take some wine mixed with strychnine, stimulus of the CNS, taken from plants. Others ate hallucinogenic drugs Reuters, 1. In 140 BC Indians used to eat testicle tissue that gave them sexual ability and helped in overcoming impotence problems. During 2000 Babylonians noticed that castration did not only caused fertility problems but also they lose their aggressiveness and power Yesalis, 31-32. Steroids were first developed in the 1930s By Dr. Charles Kockakian, who was called the father of anabolic steroids, to prevent body tissues from breaking down due diseases, but the illegal use of steroids started in the Olympic games in the 1950s after the athletic committee has found that Russian athletes and some East European nations athletics won the majority of the medals and that was due to the use of steroids Mishra, 1. This was a result after Paul de Kruif a science writer suggested in 1940s the idea of using the tissue-building drug to be used in sports so that athletes could enhance their performance. However, the mystery of the movement of drugs from laboratory to sports is not discovered yet, since no one know how steroids invaded every kind of sports Yesalis, 34-36. After discovering the tissue-building property so many researches were done to isolate this property from androgenic property, but this was impossible. Researchers changed the testosterone's chemical structure by adding esters that is a combination of alcohol and acid after water is removed. These testosterone esters became the major drug for all athletes Yesalis, 34. Using Ways Steroids can be taken in many different ways; it could be orally pills or capsules, by injection with a syringe as a viscous liquid, or by skin creams or patches. Steroids that are taken orally have their chemical structure helps them to be quickly cleaned by the liver but at the same time it is toxic to the liver. Steroids users often take steroids in cycles each episode lasts from 6 to 12 weeks or more. During their cycles users begin with low doses then increase the doses to go back to lower doses Yesalis, 25. Moreover, users always stack, use different kinds of steroids and that to give more effect and reduce side effects and avoid detection Ringhofer, 174. Some steroids users take other drugs concurrently with steroids this is called array. The aim behind these drugs is to lessen the side effects of steroids. For example these drugs could contain diuretic to handle fluid retention, anti-estrogens to prevent breast development, chorionic gonadotrophine to reduce testicular atrophy and anti-acne medication. Athletes take dosage depending on each particular sport; sprinters take about 1.5 to 2 times than the normal average which is 7 mg of testosterone a day, while body builders who are seeking to "bulk up" take about 10 to 100 more than the normal average Yesalis, 26. Users and Causes of Using Steroids There are so many different kinds of people who use steroids; mainly they are athletes who want to compete, kids who are trying it for the first time and other school athletes, coaches in the GYM take steroids so they will look more muscular and huge from those who are training. On the other side, some people who perform hard work like policeman, fireman uses steroids to be more energetic. Models, dancers, and movie stars all of them take steroids for a better image Yesalis, 5. Steroids have a medical use too. They help many patients who are going to make a surgery, for the elderly how want to regulate their hormones and many others use steroids to fight problems resulting from HIV and AIDS. But all these will not be our issue of discussion in this paper since we will concentrate on athletes' use of steroids Yesalis, 6. The sociological aspect is the main reason behind using steroids. So many athletes and people mainly males think that large and strong muscles will give them a "masculine" look. Others accept nothing but winning and this put a lot of pressure on them; in such cases, they start taking steroids. Other reason behind steroids use is that some school or college athletes are looking forward for a scholarship and steroids can help a lot. Moreover, people are concerned more with short-term results than long-term health consequences Mishra, 3. Mechanism of Action There is one clear evidence that during hard training two things happen. First, the level of testosterone drops in the human body to the level of the castrated one. The other thing is that body release glucocrticoids which break down tissue, catabolic effect. We conclude that over training may cause muscle decrease. As a result the importance of steroids use while training is increasing. Steroids help in increasing protein syntheses through its interaction with the targeted tissue. So after the DNA in the cell, chromosome, interact with the anabolic steroids that have reached through the blood, various enzyme, structural and contractile proteins formation take place. This helps muscles to grow faster Yesalis, 27-29. The other thing is Placebo Effect; it is the physical or the psychological change that results from taking an inert substance, believing that this inert will have a therapeutic effect. This was the case even in ancient times. Placebo effects result from a person's imagination that he can achieve more, moreover in some cases there are improvements based on objective clinical standards Yesalis, 30-31. Finally, Nervous System and Psychological effects; our main concern is aggression that is associated with harsh sports, like wrestling, is looked at as an improving performance act. However, it is logical that more aggressiveness while training leads to more benefit, and makes the person achieve more and at the same time athletes would not feel their pain and fatigue. Never the less, studies indicated that steroids have biochemical foundation since in addition for the steroids effect on CNS and neuromuscular junction, a huge muscular man acting in an aggressive way will be noticed more than a small man acting aggressively since the larger man can do greater damage Yesalis, 30 Steroids Effect Athletes' Performance and appearance After some doses of steroids a person will witness an increase in appetite, aggression, energy and rapid recovery from workouts. All of this happens at the beginning and without noticing any side effects Ringhofer, 175. The main objective of athletes behind using steroids is that they need to increase their strength, increase muscle mass and reduce fat, also to increase their endurance and a faster recovery from exercise so they can practice more often Yesalis, 40. All relevant information about steroids' effect on performance is based on athletes experience and studies made on human. Based on these studies the effect is divided into three categories: Aerobic capacity and endurance, body composition, and strength performance Yesalis, 41. First, aerobic capacity performance is a result generated from the effect of steroids that it plays on the bone marrow thus providing more red blood cells that carry more oxygen VO2 Max Yesalis, 42. Second, strength performance where very athlete who is involved in taking steroids while training reported an increase in his strength, moreover high doses of steroids provide more effect Yesalis, 42-43. Finally, body composition; athletes who take steroids associated with training lead to increase in muscle and decrease in fat Yesalis, 42. Health consequences Physical effects Steroids have undesirable physical consequences, many changes happen for a person taking steroids starting from the appearance of acne on the face, oily skin, and increase in body hair and acceleration in male pattern boldness. Muscle and bone injuries: When athletes put on lots of muscle, the tendons will not have the ability to attach to the bones resulting in injures. Infertility: most men who use high doses become infertile while using steroids and for some time afterwards, perhaps six months or more. Several researchers believed that this is a risk of sterility with prolonged use high dosage levels, but no case has been documented Yesalis, 52-53. Heart Diseases: Doctors suspect that long-term abuse of steroids can cause unhealthy enlargement of the heart and a weakening of the main chamber, based on anecdotal reports. But no studies have demonstrated that link unequivocally. Stroke and heart attack: Steroids abuse has emerged as a possible cause of thrombotic stroke, the kind caused by a blood clot. If demonstrated, it would be the first life threatening short-term effect. But no direct evidence exists Yesalis, 53-56. Prostate disease: Men may be at a higher risk of prostate cancer for taking the muscle-building hormones, but no links has been firmly established. Liver Cancer and cancer: Specific steroids can cause a range of problems for the liver, including stop of the bile flow causing jaundice, yellowing of the skin and the whites of the eyes. Steroids taken orally are harder on the liver because the liver must process the hormones before reaching the blood system Yesalis, 56-58. Genital changes both in males and females. In women: male pattern baldness, hairiness, voice deepening, decrease breast size and menstrual irregularities Mishra, 4-5. In men: it reduces sperm count, impotence, development of breast, and shrinking of the testicles. From this we notice that steroids give men feminine characteristics, and give women masculine characteristics Anabolic steroids, 2-3. Others: Abdominal pains, hives. Chill, euphoria, diarrhea, fatigue, fever, muscle cramps, headache, unexplained weight loss/gain, nausea and vomiting, vomiting blood, bone pains, depression, gallstone Mishra, 4-5. Steroids effect on Adolescents: Steroids may stop the growth of the bones of the adolescents by closing the growth plates of the bones so kids will end up shorter than what they should have been Anabolic steroids, 3. Psychological effects Moreover, steroids have psychological effects starting with aggression; many steroid users reported feeling higher levels of aggression behavior. Some reported mood swings and psychotic episodes, or so-called "roid-range". Never the less, steroids users reported an addiction phenomenon since users became more dependent on steroids Yesalis, 58-61. In France a study made by Paris' Monte Cristo drug treatment indicated that 18% of the 5000 high-level athletes are drug dependent and this was a consequence of sports doping, and that out of 13 million registered athletes 10% of them take performance"“enhancing substances. Eventually this will lead to 300,000 addicted athletes Racing Demons, 1. Athletes after they are forced to leave the athletic elite due to steroids penalties they suffer many psychological problems. They will feel lost and with a great depression since they moved from a glorified life style to the real world Racing Demons, 2. Preventing and treating steroid use Obedience of the law Drug testing The use of anabolic steroids came to the international public attention after Ben Johnson, the 100-meter sprinter, was stripped from his gold medal and that was in the summer Olympics in Seoul 1988. After he was considered the symbol of the athletic world and raised the name of his country, Canada, high; tests indicated that Johnson used steroids and cheated in the competition Mishra, 1. Drug testing can be through testing blood, hair, saliva, and the most important one is urine test. And after they are tested they are not allowed to eat or drink any thing as long as it is sealed by the committee Yesalis, 77. The idea of drug testing was first implemented on racehorses in 1910 after finding alkaloids in the saliva Yesalis, 72. In the 1960 real drug testing came into action because of the use of chromatograph gas that is used to identify doping agents resulting in their metabolism effect on urine. Dr. Arnold Beckett, member of the International Olympic Committee IOC medical commission, was the first to work on drug testing and it's procedures. In 1963 the first list of the banned drugs was charted. After that drug testing officially started in 1968 Olympic winter games, but it was in a random and unorganized way Yesalis, 74-75. While testing, doctors look for the main components of steroids since the body metabolizes them. So the current and the most accurate way of testing is through gas chromatography-mass spectrometry GCMS. The components that are looked for is testosterone, but the body by itself produces testosterone and this does not indicate that the person is taking steroids. As a result testosterone is measured according to another hormone that is Epitestosterone T/E ratio. Athletes are penalized if exceeded 6/1 ratio Yesalis, 79-78. Drug testing is one of the ways to stop steroid using at schools, colleges, and Olympic and professional levels of sports. Drug testing indicates those who use banned drugs to increase performance and compete with those who use nothing, which is unfair. However, drug testing faces many barriers, one is that politics some times interfere to change some test results Yesalis, 71, and another thing is that drug testing is too much costly, at least two million dollars are spent at each Olympic game testing Yesalis, 103. And last but not least, some steroids last in the body for months, anther steroids for 36 hours, so if athletes who take steroids know the time when to be tested they just stop taking steroids for enough time just to clean their system Yesalis, 84. Federal and Committees Actions The IOC that was trying to control the use of the performance-enhancing drug took a great step after lunching its world anti-doping authority in the late 1999. This step was supported by enough money to make tests not necessary through competitions, and authorized the blood enhancing drug test. Sydney Olympics showed that authorities are no more turning a blind eye after preventing 35 Chinese from participating in the Olympics and lot of athletics were caught and stripped from their medals after showing positive steroids tests Noble, 1. Steroids users face so many disciplinary actions by the law and government of sports. First of all, athletes who test positive in steroids they are banned from going on in competing in his sport for two or more years. Second steroids trafficking were all state governments prevent trading or possession for steroids and for illegal use. Finally athletes who use steroids become so much aggressive and this cause them so many troubles with the law since they can not control their behavior, leading to illegal actions such as crimes and rapes Yesalis, 101. Educational Approach Education plays a major role in controlling steroids. Many schools added steroids wakefulness to their educational programs explaining their real dangers Yesalis, 87. Oregon Model of education against steroids carried by the Oregon health sciences university, Portland, says that neither scare tactics is a way to stop athletes from taking steroids, nor a lecture at the beginning of the sports season. Their work emphasized more on the behavioral intent, body image, incentives toward drug use and arresting drug traders. The program did not only involve the athletes but also the parents, the teams and coaches so they will be able to create a healthy social sphere Yesalis, 90. In addition, the ATLAS, Adolescents Training and Learning to Avoid Steroids, prevention program approved that participants, relative to a control group, were less dragged to steroids and trying it since they know its side effects in addition to its benefits, as a result they know how to avoid it and concentrate more on their nutrition. The ATLAS program has fourteen sessions with three main concepts. First, weight training skills. Second, nutrition information for sports. Last, anabolic steroids education, like that of Oregon Yesalis, 91. Treatment programs Some times stopping steroids may cause major consequences, so the most important thing is to keep a bond with the athlete and provide him with proper education, counseling, and reassurance. For this reason the doctor treating the athlete must not be judgmental, he must be knowledgeable and understanding Yesalis, 124. Anabolic steroids are considered to be addictive. A person taking steroids become dependent, since it changes their physical appearance and increase the effort to achieve more. Some athletes reported: " When faced with the syringe, even my own worst fears did not matter, I could not stop. 17-inch arms were not enough, I want 20. And when I got to 20, I was sure that I would want 22,"¦. ." Major problem with steroids treatment is that it costs so much of money Yesalis, 116. Depression symptoms caused from quitting steroids sometimes leads to suicide. There are certain characteristics that show that a person is in need for help: First, retarded behavior associated with depressive disorder. Second, sudden change in moods such as euphoria, irritability, depression or anxiety. Third, slower and disorganized thinking. Fourth, Suicidal thoughts and last but not least, hallucinations Yesalis, 121. Some patients experiencing uncontrolled aggression need anti-psychotic medication; others need hospitalization so they could have all the support needed. Yesalis, 121-22. Interpretation In my opinion, I consider that athletes are misusing steroids. The main reason behind establishing steroids was to prevent body tissues from breaking down, and to help the elderly in regulating their hormones and many others to help them fighting against HIV & AIDS. However, athletes adapted this invention for inappropriate purposes and to cheat and compete in an unfair way. Since, sport represents the finest in physical development and human striving and will, steroids use among athletes opposes this representation. Society still does not fully recognize the negative effects that steroids have on the health of athletes and the way sports are played. I believe that every one is responsible for preventing steroids use including athletes, coaches and parents. Steroids cause a lot of harm that we must be aware of. First, an athlete may suffer physical and psychological harm because of steroids. Second, the use of steroids for no medical purposes is a violation of federal laws. Third, using anabolic steroids is cheating and violates the rules of virtually every sport. Finally, yet importantly, steroids contaminate sports because results are obtained by unnatural means. Some people defend steroids use by stating that they give users a tremendous physical advantage. However, it is the price of that advantage that worries me. There are two important things to bear in mind about steroids. First, they are very powerful drugs that affect both mind and body. Second, when elite athletes take steroids to secretly enhance their physical sports performance they tarnish the purity of all sports competitions.   

All about Steroids Understanding steroid Steroids nature Steroids that are used by athletes are the artificial form of testosterone, a human hormone released by the body to stimulate and maintain the male sexual organs. Testosterone is called a male hormone since it is produced in men in large quantities compared...

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