Clark College. P. Ballock, MD: "Purchase cheap Sildenafil no RX - Trusted Sildenafil online OTC".
Elsevier effective sildenafil 100 mg erectile dysfunction no xplode, Amsterdam Vleeming A purchase generic sildenafil pills erectile dysfunction nutritional treatment, Mooney V buy sildenafil once a day erectile dysfunction drugs don't work, Dorman T order 50mg sildenafil visa erectile dysfunction treatment devices, Snijders C, Stoeckart R (eds) 1997 Movement, stability and low Simons D 1996 Clinical and etiological update of back pain. Journal of Musculoskeletal Pain 4:93–121 Wall P, Melzack R 1989 Textbook of pain, 2nd edn. Churchill Livingstone, London Simons D, Mense S 1997 Understanding and measurement of muscle tone as related to clinical Ward R (ed) 1997 Foundations of osteopathic medicine. Pain 75(1):1–17 Williams & Wilkins, Baltimore Simons D, Travell J, Simons L 1999 Myofascial pain Weiss J 2001 Pelvic ﬂoor myofascial trigger points: and dysfunction: the trigger point manual, vol. In: Chaitow L (ed) Positional release Staubesand J, Li Y 1997 Begriff und Substrat der techniques, 2nd edn. Churchill Livingstone, Edinburgh, Faziensklerose bei chronisch-ven’ser Insufﬁzienz. Stanley ﬁbromyalgia and myofascial pain syndromes: a Thornes, Cheltenham preliminary study of tender points and trigger points in persons with ﬁbromyalgia, myofascial pain Swerdlow B, Dieter N 1992 Evaluation of syndrome and no disease. Pain 48:205–213 19(6):944–951 Travell J, Simons D 1983a Myofascial pain and Yahia L, Pigeon P, DesRosiers E 1993 Viscoelastic dysfunction: the trigger point manual, vol. Williams & Wilkins, Baltimore Biomedical Engineering 15:425–429 Travell J, Simons D 1983b Myofascial pain and Zink G, Lawson W 1979 An osteopathic structural dysfunction: the trigger point manual, vol 1: the upper examination and functional interpretation of the soma. Alexander technique) 256 Clinical prediction 206 Prolotherapy 257 Centralization/peripheralization categorization 206 [Manual] pump techniques – lymphatics, liver or Using directional preference in rehabilitation 207 spleen 261 Biopsychosocial factors: a broader classiﬁcation Rehabilitation methods 262 approach 207 Shiatsu, acupressure, etc. Examples of such ‘spe- physical medicine approaches employed in naturo- ciﬁc’ indicators are to be found later in this chapter pathic medicine. These modalities are commonly used where methods of categorization of low back pain to address local dysfunction, or they may be utilized (used as an example) are discussed. Evidence shows Constitutional approaches that manipulation of the ‘exercise sensitive’ class of In Chapter 8 various distinctively naturopathic, con- back pain would offer little beneﬁt and, likewise, spe- stitutional (whole-body) means of evaluating and ciﬁc exercises are unlikely to help ‘manipulation sen- treating general health, as well as locally dysfunc- sitive’ back problems (Flynn et al 2002). Of course tional conditions, are described and explored in the there are also back problems that are unlikely to context of the use of neuromuscular technique, or of respond to either manipulation or exercise, and some a general mobilization approach known as general that may respond to both. Individual modalities may be Efﬁcacy and safety interchangeable In numerous instances, many of the modalities dis- In this chapter evidence of efﬁcacy of individual cussed and outlined in this chapter may be seen to be methods, techniques and modalities will be graded in virtually interchangeable. For example, where an area a spectrum ranging from ‘very good’ (systematic of soft tissue dysfunction is characterized by excessive review evidence) to ‘poor’ (rumor, tradition). That tone and shortness in muscle, the choice between said, it is worth reminding ourselves that lack of proof employing muscle energy technique methods or of efﬁcacy does not represent proof of a lack of efﬁcacy. Instead, it approaches the discussion by out- of compression and distraction (lengthening) features lining the methods, their suggested physiological that are common to many other techniques (proprio- effects, and how these methods are best applied in the ceptive neuromuscular facilitation, muscle energy, context of musculoskeletal distress in particular, and etc. The relative advantages of incorporating different Chapter 7 • Modalities, Methods and Techniques 199 features in various clinical settings are explained the usefulness of massage, but questions spinal wherever evidence exists for such discussion. Spinal manipulation applicable technique, method, approach or modality generated no advantage over general practitioner care, that will always be helpful in restoring pain-free func- analgesics, physical therapy, exercise or back school. Unpicking this quoted statement brings sharply into An individualized approach is demanded, since two focus the danger of relying on such evidence. These would beneﬁt from quite different thera- of causes, ranging from biomechanical to peutic and rehabilitation strategies – one possibly pathological, psychological and functional requiring deactivation of myofascial trigger points features, possibly involving intervertebral followed by postural re-education, the other calling disc problems, facet joint dysfunction, for joint mobilization achieved by high velocity thrust hypermobility, muscular and/or ligamentous methodology, supported by appropriate soft tissue imbalances, sacroiliac restrictions, trigger normalization possibly involving stretching and/or points and disturbed emotion/somatization core stability training. These variables make use of the word ‘massage’ manipulative attention, at precisely the same potentially uninformative, since that word covers spinal region. Both balancing, muscle energy and strain/ approaches produced good to excellent results; counterstrain techniques (Yates et al 2002). As however, since the reader is left with the will become clearer to those unfamiliar with mystery as to what ‘gold standard physical these methods (see the descriptions later in this therapy’ is, and just how breathing chapter), there can hardly be more diverse rehabilitation is achieved, the chances of methods for modifying tissue status, or reproducing the results remains questionable. However, individual, appears to offer clear beneﬁt in a range of it is a criticism of reviewers who attempt to back and other problems. In these, the It is also important that we regularly refer to the elements of treatment used to help the patient underlying principles – as outlined in Chapter 1 – that are not tested – only the intervention of the inform clinical decision-making in naturopathic medi- discipline. This allows a greater opportunity cine in general and naturopathic physical medicine in for a non-linear dynamic interplay between particular. Chapter 7 • Modalities, Methods and Techniques 201 Tension Compression Rotation Bending Shearing Figure 7. Reproduced with permission from Lederman (1997a) Although there exist a wide range of variations of binations of these), the amount of time involved (con- manual techniques, each of these is made up of a tinuous, rhythmic, brief, lengthy, etc. Identify local and general imbalances (posture, joints this produces extension, ﬂexion and side- patterns of use, local dysfunction). Identify, relax and stretch overactive, tight • Shearing loading: translation (shear) movements muscles. Re-educate movement patterns (including induce joint play and articulation postural imbalances) on a reﬂex, subcortical • Combined loading: incorporation of basis. A variety of soft tissue disengagement from the barrier, or alternating com- normalization methods are incorporated into this 202 Naturopathic Physical Medicine musculoskeletal dysfunction in general, can be under- Box 7. This ‘integrative mechanistic’ model that Massage and soft tissue manipulation methods that addresses behavioral and structural aspects of dys- involve kneading, introduce torsional load forces. As function, as well as pain psychology, postural control tissues are kneaded, soft tissues are lifted, rolled and and neuroplasticity, strengthens the rationale for squeezed, involving compressive, bending, shearing multidisciplinary treatment protocols. This may have as an objective the include direct biomechanical tissue approaches, stretching of tissues or encouragement of ﬂuid movement re-education, psychosocial interventions movement within the tissues. Friction occurs between the sliding structures, potentially generating General health applications of physiological change by increasing connective tissue naturopathic physical medicine methods pliability (hysteresis; Norkin & Levangie 1992), as well A deﬁning feature of osteopathic and chiropractic as possibly inducing a mild therapeutic inﬂammatory methodology for well over 100 years has been that response (Mock 1997). This is equally true of performed on a local area, usually across the line of naturopathic medicine, which has, in regard to manual ﬁber direction. Friction will increase blood ﬂow to the area (and may induce edema if appropriate measures methods, been greatly inﬂuenced by both osteopathic are not taken to obviate this). Note: Whether friction or compression is employed in In this Position Paper the following key points are attempting to deactivate myofascial trigger points, a made: rapid inﬂow of oxygenated blood to the tissues occurs 1. The therapeutic beneﬁts that methods and therapies described as follow may variously involve reduction of ischemia, as well as release of local endorphins, and possibly naturopathic physical medicine in a safe, enkephalins (Baldry 1993, Kiser et al 1983), and also a healthful and clinically integrated manner degree of mechanoreceptor stimulation affecting pain consistent with naturopathic principles and transmission (Melzack & Wall 1994). Naturopathic manipulative treatment as a therefore follows in response to simple applications of traditional, integral and essential part of focused compression or repetitive shear loading. Naturopathic medical educational programs model in most schools of manual medicine educate and train naturopathic physicians to (DiGiovanna & Schiowitz 1991, Greenman 1989). Other proposed educate and train naturopathic physicians to models for effective management of musculoskeletal safely and effectively utilize physiotherapeutic dysfunction incorporate somatic as well as behavioral medical devices, modalities, procedures and features. Langevin & Sherman (2006) have described injection therapies a pathophysiological model in which a broader – and 5. Reproduced with permission from Langevin & Sherman (2006) integration, functional training and therapeutic Whether applying pressure to help deactivate a trigger exercise programs point, or to take out slack prior to application of a high 6. Naturopathic physical medicine continues to velocity thrust technique, or in mobilizing and articu- evolve and integrate new therapeutic methods lating joints, or in use of basic massage methods, load consistent with naturopathic principles and is a feature – indeed, these treatment methods are philosophy.
The preceding event is a life changing one that is associated with significant subjective distress and emotional disturbance purchase cheap sildenafil impotence ring. The major difference is that the anxiety that follows lasts longer and emanates from difficulty in adjusting to the prevailing situation buy sildenafil once a day impotent rage definition. Onset of symptoms is within one month of the event and duration is usually less than six months purchase sildenafil 75 mg visa erectile dysfunction see urologist. Brief (< one month) or prolonged mild depressive reaction might accompany the anxiety symptoms purchase sildenafil amex latest advances in erectile dysfunction treatment. Symptoms may impair functioning but do not meet the criteria for another psychiatric diagnosis. Community prevalence is about 5% and in the elderly, an adjustment disorder often follows physical illness or disability, moving into a residential or nursing home and bereavement. Supportive psychotherapy, social and occupational support are the mainstay of treatment. Psychological therapy is more effective than pharmacological therapy and should be used as first line where possible. Pharmacological therapy is also effective but should be used as second line for most anxiety disorders. High doses of medication are often required and there may be delay in onset of action of up to 12 weeks. Sensorium remains intact but deficits in cognitive function may manifest over time. The individual loses their sense of uniqueness and individuality with a persistent feeling that their innermost thoughts and ideas are being infiltrated upon and hijacked by others, with their actions and impulses under bizarre external influences and belief in the validity of these experiences may grow to become unwavering. There may be perceptual disturbances in terms of delusions and hallucinatory experiences most especially in the auditory modality. Sensory impairment (mainly deafness) Genetic predisposition and neurodevelopmental factors have lesser impact than in earlier onset psychosis. Clinical features Schizophrenia The symptoms of schizophrenia are divided into positive (symptoms that are typical only to schizophrenia, they include the group listed 1 to 5 below) and negative (symptoms that are 968 not typically found only in schizophrenia but may be found in other disorders, they are the symptoms listed on number 6 below). Auditory hallucinations- running commentary, 2 (includes command hallucinations) and rd 3 person or other hallucinatory voices coming from some part of the body. Delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations; delusional perception. Thought disorder- breaks in the train of thought resulting in incoherent or irrelevant speech or neologisms. Negative symptoms such as flat or blunted affect (apathy), poverty of thought and speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), lack of motivation (amotivation). Persistent hallucinations in other modality (olfactory and gustatory hallucinations) when accompanied by delusions without clear affective component, persistent overvalued ideas, occurrence every day for months on end. Catatonia (stupor, excitement, waxy flexibility, negativism, mutism and posturing). The diagnosis of schizophrenia should not be made if depressive or manic symptoms are prominent and extensive unless it is clear that psychotic symptoms predate the affective disturbance. If both psychotic and affective symptoms develop at the same time, then a diagnosis of schizoaffective disorder should be made. If affective symptoms predate the psychotic symptoms, then a diagnosis of either mania with psychotic symptoms or depression with psychotic symptoms should be made. Other associated symptoms are depression, agitation, cognitive impairment and soft neurological signs. New positive symptoms rarely develop in old age, but old hallucinations and delusions may persist. Patients may require inpatient admission if distress is high and medication compliance is an issue. Pharmacological treatment- Atypical antipsychotics are first-line, mainly Olanzapine and Risperidone. The required doses are much lower than for younger adults, as low as one tenth of the standard dose because the elderly are at a greater risk of developing extrapyramidal and other adverse effects, and ‘starting low and going slow’ is strongly advised. Social interventions- Day centre and day hospital attendance helps to mitigate social isolation. Treating hearing loss and visual impairment can help reduce sensory deprivation, which in itself can be an aetiological factor. Prognosis Late onset schizophrenia may have a better prognosis and response to treatment than early onset schizophrenia. Compliance with medication and good social support are among the predictors of good response. Schizoaffective disorder If both schizophrenic and affective symptoms develop simultaneously and are evenly balanced, the diagnosis of schizoaffective disorder should be made even if the schizophrenic symptoms by themselves would have justified the diagnosis of schizophrenia. Management is similar to that of schizophrenia; however the mood symptoms may need to be treated with antidepressants and/or mood stabilizer medication. Delusional disorder This disorder is characterized by the development of either a single delusion or a set of related delusions which are usually persistent and sometimes lifelong. The delusions are often persecutory, hypochondriacal, or grandiose but they may be concerned with litigation, jealousy, or express a conviction that the individual’s body is misshapen, or that others think he or she smells. The general criteria for schizophrenia are not fulfilled and the delusions are not typically schizophrenic. The condition should not be due to other medical or psychiatric disorder and depressive symptoms may be present at other times. Prognosis 970 In general, there is complete remission in 33-50%, noted improvement in 10% and persisting delusions in 33-50%. Acute onset is associated with better prognosis and presence of symptoms for more than six months is associated with poorer prognosis. There are few systematic studies that have examined the prevalence of alcohol abuse/dependence in people over the age of 65. A recent study (Blazer & Wu, 2011) examining the prevalence of alcohol abuse, dependence and subthreshold dependence among middle-aged and elderly persons in the United States found that about 6. Biological/medical treatments are most important in the acute setting, where detoxification may be required. In view of increased physical frailty and evidence for more severe alcohol withdrawals in older people (Brower ea, 1994), medical admission is advised for detoxification in older people. Fluid and electrolyte imbalances should be corrected and cognitive state should be monitored regularly in view of the risk of developing delirium. Care should be taken with benzodiazepine-assisted withdrawal in older people, in view of the elevated risk of over-sedation, confusion and falls. Orientation and clouding of sensorium Severity of alcohol withdrawal Mild: <10 Moderate: 10-20 Severe: 20+ Parenteral or oral thiamine should be given to prevent development of the Wernicke-Korsakoff syndrome. There is limited evidence available on the use of abstinence medications such as Disulfiram, Naltrexone and Acamprosate in older people, and they are probably best avoided in view of elevated risk of adverse effects. There is some evidence that older people may respond better to psychotherapy in same-age settings, i.
Changes in affect and activity levels can be observed and reported by people with mania and mild to even very severe intellectual disabilities and their carers cheap sildenafil online master card impotence signs. In Down’s syndrome cheap sildenafil 75 mg overnight delivery erectile dysfunction 21, mania is very uncommon among women purchase sildenafil australia erectile dysfunction vacuum pump india, whereas in the general population the male: female ratio is equal buy sildenafil pills in toronto erectile dysfunction drugs without side effects. Interestingly, those with Down’s syndrome less frequently have a positive family history. Similarly, cyclothymia (persistent mood swings not meeting severity criteria for affective disorders) has as yet received little attention in this population. High levels of anxiety are thought to be part of the behavioural psychiatric phenotype in William’s syndrome. Obsessive Compulsive Disorder Compulsive behaviours have reported frequencies of 3. Compulsions are significantly associated with stereotypies and self-injurious behaviour. Obsessions and compulsions can arise in a number of disorders other than obsessive–compulsive disorder, such as depression and pervasive developmental disorder. Some specific stereotyped movements have been associated with disorders such as Rett syndrome (hand-wringing movements in front of the body) and Smith–Magenis syndrome (body self-hugging, self-biting). Although obsessions and compulsions may need pharmacological treatment in individuals with Prader–Willi syndrome, the effectiveness of serotonin reuptake inhibitors in the treatment of stereotyped movements in Rett syndrome and Smith–Magenis syndrome is less established. The risk of posttraumatic stress disorder and adjustment disorder is therefore likely to be significantly increased. In the acute phase, management usually focuses in accessing services, ensuring safety of the patient and others and initiation of medication. After resolution of the acute phase, management is more likely to focus on maintaining good mental health, insight-related work and relapse prevention planning. Treatments should be tailored to the individual, and so take into account any co-existing medical conditions such as epilepsy, other drugs being taken and any other particular requirements. With the gradual closure of the long stay units and the focus in community care, the role of psychology has expanded enormously. Assessment and management of expressed emotion in families and professional carers can also be beneficial. Social and environmental risk factors relate to social barriers and dependence support from carers, and may include stigma and segregation, over- protection, lack of opportunities, neglect and abuse, limited social networks and poorly managed changes and losses. Respite care and rehabilitation for those with more chronic illnesses, including the use of day services, should be part of a comprehensive long-term person-centred management plan. Practical social interventions, tailored to the individual’s needs, are important in order to support both the patient and the support network. Treatment as for the general population is appropriate with the following cautions: Treatment with medication: start low, go slow and change one medication at a time, as there is higher frequency of idiosyncratic responses to psychotropic drugs. Where different medications are being used simultaneously, the reason for each needs to be explained. It is wise therefore to have a crisis plan mapped ahead of time in order to address safety and other issues at these times. For those with the most severe forms of depression and those with suicidal intent, hospital admission needs to be considered. Treatment with selective serotonin reuptake inhibitors may be beneficial in obsessive–compulsive disorder, as may various behavioural techniques. Social treatments can include interventions in the social network and helping people to find meaningful occupation and develop their skills. It can mean ensuring that people are treated with appropriate dignity and respect and are able to make choices in their lives. This is not only confined to just those areas of the brain responsible for cognitive and social functioning but also associated to a variety of physical impairments that can lead to additional health needs over and above those experienced by the general population. For example, depression and psychosis may predispose to poor compliance with medication, and chronic psychiatric illness is associated with poor physical health and morbidity. A third of adolescents with autism develop epilepsy, and it is associated with other syndromes such as Tuberose Sclerosis, Sturge- Weber syndrome and Rett’s syndrome. That is why a thorough full psychiatric and medical history and mental state is required. An informant is essential especially as witness to the seizures and a full description of seizure is required, i. Epilepsy is associated with increased prevalence of nearly all forms of psychiatric disorder. Possible mechanisms include greater social disadvantage, chronic potentially life threatening illness, accidents, head injuries, self-esteem issues, dependency on others. Some studies report that rates of psychosis are higher in those with milder disability and epilepsy, whereas depression rates are higher in those with severe disability. A complex relationship exists between poor impulse control, epilepsy and socio-cultural factors. Interestingly, ‘Forced Normalisation’ is an uncertain phenomenon but relatives/carers frequently report that patient is improved in mental health terms when fit control not so optimal. This can impact on physical health, psychological health and mortality, and in turn also could have an impact on the families and carers of these individuals. Most antiepileptic drugs have agitation or mental illness as an associated side effect, although carbamazepine, lamotrigine and 248 sodium valproate are also used as mood stabilisers. Finally, the treatment of epilepsy may also reduce cognitive ability (both drugs and surgery). They often report feeling isolated and wanting to have friends, though they may not have the skills necessary to form relationships. Frequently, due to the “one shot learning” style of memory, one unpleasant experience may lead to avoidance and a phobic reaction. They classically have repetitive behaviours and routines that they do usually for pleasure or to calm down their anxiety. The difficulty is deciding whether the level of distractibility or restlessness of the person is in keeping with their general level of functioning, or more severe than should be expected. In the later, stimulant medication could be considered in combination with behavioural programmes and bearing in mind the possibility of exacerbation of epilepsy and tics. That type of mood instability is linked to lack of self-awareness and emotional regulation and managed most successfully with psychological support. The most common prominent feature is the degree of sexual activity, which is associate with hypomania but very unusual in agitated depression. It is common that with anxiety and stress at times of crises develops into an acute and transient psychotic episode. This is defined as ‘culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to limit use of, or result in the person being denied access to, ordinary community facilities’. It can be caused by mental illness such as depression or psychotic disorders, or by environmental factors such as lack of sensory stimulation. Lesch-Nyhan syndrome and several neurotransmitters have also been implicated in its aetiology, e.
B ut to prove m y point I now predict th at in a m om ent th ere will be a n o th e r loud re p o rt sildenafil 100 mg with mastercard cough syrup causes erectile dysfunction. Among other things discount sildenafil 50 mg line tramadol causes erectile dysfunction, Nelya was apparently able to move objects around on a table without touching them order sildenafil 100mg on-line erectile dysfunction natural remedy. W hen doing so generic sildenafil 25 mg free shipping erectile dysfunction drugs for sale, her pulse rate escalated rapidly to nearly 200 beats per m inute; and she often lost three to six pounds when she worked. Leaving aside the obvious impli cations for weight control, her perform ance is remarkable. So rem arkable that some skeptics have pointed out that Nelya was given a jail sentence in 1964 for some unspecified crime. O strander and Schroeder claim it was for some unre lated petty offense, but the skeptics argue that it was for chicanery. Supporters, including Koestler, point out that Nelya is a high-spirited woman who is often a prankster in her work—a little like the brain surgeon who propositions the scrub nurse while gingerly separating brain tissues. But some critics have been unsparing, and an author of Koestler’s caliber should not uncritically accept secondhand accounts. T here have been enough events like those reported by O strander and Schroeder, many verified by dubious schol ars, to conclude that paranorm al events do occur. In The Medicine, Society, and Culture 163 Roots of Coincidence,41 Koestler tries to introduce “respectabil ity” to the parapsychological field. They also formulated a simple basic hypothesis: “If one individual has access to information not available to another, then under certain circumstances and with known sensory channels rigidly controlled, the second individual can demonstrate knowledge of this information at a higher level than that compatible with the alternative explanation of chance guessing. For their subjects they used 22 volunteer psychology students, who operated in pairs. The information to be communicated consisted of a set of 23 concepts which seemed likely to evoke a wide range of emotional reactions, and which could be sym bolized by simple line drawings (including, for example, home, sleep, sorrow, sunshine, and the Pill). The sender in each pair sat at a row of five display panels, one of which was illuminated for 25 seconds. The receiver faced a similar row of the five symbols, all illuminated, with a button below each. He used the appro priate button to signal the concept he thought had been “transmitted” by the sender. The sender had to concentrate on the illuminated symbol for 25 seconds, and then relax for 5 seconds while the receiver made a choice. Electrodes are attached to the scalp over the subject’s frontal 164 The Climate for Medicine cortex to transm it electrical brain activities through an amplifier to a machine. In front of the subject there is a button which, if pressed, causes an “interesting scene” to appear on a television screen. About one second before the subject presses the button an electrical charge occurs in a large area of the subject’s cortex. Intelligent subjects soon realize that what they “intend” “produces” the expected result before they have actually moved a finger. T o sustain the effect, it is essential that subjects “want” the event to occur, and concentrate on it occurring. W hen subjects’ attention wan ders, as for example with a m onotonous presentation, or if they concentrate on concentration, they receive no pictures. A num ber of them are chronicled by Andrija Puharich, a physician who has worked extensively with psychics and healers. Geller was able to identify which box contained a metal airplane at odds of one million to one. He also reproduced instantaneously and with great accuracy drawings done by others miles away. These include psychokinesis—bending metal objects, moving objects, stopping and starting watches—and materialization and dematerialization. But it is enjoying m ore acceptance than ever, in part because physics itself, the most sublime of the sciences, is moving in strange directions. Koestler stresses the convergence of theoretical physics and parapsychological phenom enon. In a chapter entitled “T he Perversity o f Physics,” he assesses the em erging body of theory and its trajectory into the mysterious. He quotes Sir A rthur Eddington: [I]n the world of physics we watch a shadow graph perfor mance of familiar life. The shadow of my elbow rests on the shadow table as the shadow-ink flows over the shadow paper;. Many scientists refuse to examine the shifting and flimsy base upon which they stand. For centuries man has used carefully constructed filters to deflect certain data that did not fit prevailing paradigm s. Inform ation has been ignored because it threatened the premises of the existing scientific enterprise, or because it was generated by suspect inves tigators. But given the steady accumulation of evidence of paranorm al phenom ena, the filters will have to be changed and the paradigm s altered—and this is as true o f medicine as it is of physics. For centuries we have assumed that we were a species apart, creatures of a different order and type, unrelated to other life forms. M odern medicine has built upon this premise by isolating patients for treatm ent, but worse, by isoladng patients from their environm ents. We live in a complex network of interactions—we are not a shielded, invulnerable species. If oriented so that base lines face magnetic north- south and east-west, a used razor blade placed within and along the axis east-west can be resharpened indefinitely. Nelya Mikhailova52 and Uri Geller have little in common except one thing: telepathic and psychokinetic capabilities. Mikhailova can move small objects short distances at will without touching them, although with great exertion. Even the most recalcitrant physician is coming to the real ization that acupuncture works. What is known repudiates the “specific” theory o f pain which is incorporated into W estern medical practice. All that is clear is that acupuncturists trigger pain-blocking mechanisms in the body through the isolation of points for the insertion and m anipulation of needles. However, on the as sum ption that trial and error would have been inefficient (and perhaps painful), it is possible that the body signals its vulnerabilities, that it can cause alterations in its energy field. The work o f Harold B urr o f the Yale School of Medicine and Cleve Backster has dem onstrated an “energy field” or aura that surrounds the body. In The Fields of Life: Our Links With the Universe,53 B urr reports fluctuations in the body’s energy field at ovulation, and abnormalities in the fields of women with cancer of the cervix. He has dem onstrated their receptivity to Medicine, Society, and Culture 167 stimuli m easured first with a polygraph and m ore recently with an electroencephalogram. But there is some evidence that its premises may be sound, however much it is inflated in practice. A handful o f recent studies reveal statistically significant correlations between “cosmic” events and hum an behavior. For example, in a study o f m ore than 500,000 births in New York hospitals between 1948 and 1957, there was a clear and unmistakable trend for m ore births to occur during a waxing rather than waning moon.