The purple smoke and cooking soda costing $ 344 !/Omeprazole/sodium — generic Zegerid (Salix) zegerid OTC (Bayer) 20.40 mg packets for susp•; 20 mgn.l g. 40 mgn.l g capsE 20 g capsw 20—40 mg 344.70 16.10'

Proton pump inhibitors (PPIs) have become a mainstay of therapy not only in the practice of gastroenterology, but also for general medicine and even for the general public. Recently, proton pump inhibitors have been associated with a number of potential complications including impaired vitamin and mineral absorption, altered drug metabolism and increased risk for infections.

All five PPIs on the market are equally effective at equivalent doses; no trials have demonstrated an intrinsic therapeutic advantage 01 the newest PPI, Nexium, over other PPls at equivalent doses. The initial choice 01 agent should therelore depend on cost. In Canada, Ihe PPIs Pariet and Apo-OmeprazoleU represent a reduction in cost of approximately 40% over other PPI drugs. We have used as a comparator a DDD of 20 mg of rabeprazole (Pariet) which is priced almost exactly at the generic Price of omeprazole.

Excessive Medical Spending: Facing the Challenge

By Norman J. Temple, Andrew Thompson, Anwar Khan

 'All PPIs appear to be similarly effective and well tolerated for treatment of peptic ulcer disease and GERD. Most are available generically and over the counter for a fraction of the cost of Nexium or other expensive brand name products"

This was the conclusion  of The Medical letter  in it's June  22 2015 issue.

But still the  'purple pill" myth lingers among  physician and  patient  population and
  Astrazeneca made many millions even after 2015


Omeprazole/sodium — generic 20.40 mg packets for susp•;
Zegerid (Salix) 20 mgn.l g. 40 mgn.l g capsE  $ 344.70
zegerid OTC (Bayer) 20—40 mg 16.10'


 The  book color purple


Purple in Business
In using purple in business applications you need to understand the traits, qualities and mood of the color along with the psychological meaning. The messages the color sends to your customer base can have a major impact on your business success.

Purple suggests wealth and extravagance, fantasy and the world of dreams. It enhances spiritual pursuits and enlightenment.



Physiologically, it heightens people's sense of beauty and their reaction to more creative ideas.

It is often used to denote a high quality or superior product, such as Cadbury's chocolate or some women's cosmetics.

If you are in a service business, use some purple in your marketing to denote your premium service.

Positive Color Meanings in Business:

• unusual and individual, creative and inventive
• psychic and intuitive
• humanitarian, selfless and unlimited
• mystery, fantasy and the future

Negative Color Meanings in Business:

• immaturity
• impractical
• cynical and aloof, pompous and arrogant
• fraudulent and corrupt
• delusions of grandeur and the social climber

Table 1. Oral Proton Pump Inhibitors Drug Some Available Formulations Usual Adult Dosage1,2 Cost3 Dexlansoprazole – Dexilant (Takeda) 30, 60 mg DR caps 30-60 mg once/d $222.10 Esomeprazole magnesium – generic 20, 40 mg DR caps 20-40 mg once/d 204.50 Nexium (AstraZeneca) 20, 40 mg DR caps4 250.90 Nexium 24HR (OTC) (Pfi zer) 22.3 mg DR caps5 16.406 Lansoprazole – generic 15, 30 mg DR caps 15-30 mg once/d 64.60 Prevacid (Takeda) 333.70 Prevacid Solutab (Takeda) 15, 30 mg ODT 333.70 Prevacid 24HR (OTC)7 (Novartis) 15 mg DR caps 17.806 Omeprazole – generic 10, 20, 40 mg DR caps 20-40 mg once/d 16.30 Prilosec (AstraZeneca) 10, 20, 40 mg DR caps4 218.70 Prilosec OTC7 (AstraZeneca/P&G) 20 mg DR tabs 16.806 Omeprazole/sodium bicarbonate8 – generic 20, 40 mg packets for susp9 ; 20-40 mg once/d 344.70 Zegerid (Salix) 20 mg/1.1 g, 40 mg/1.1 g caps10 383.40 Zegerid OTC (Bayer) 20 mg/1.1 g caps10 16.106 Pantoprazole – generic 20, 40 mg DR tabs 40 mg once/d 6.40 Protonix (Pfi zer) 20, 40 mg DR tabs4 274.20 Rabeprazole – generic 20 mg DR tabs 20 mg once/d 52.40 Aciphex (Eisai) 419.70 Aciphex Sprinkle (Eisai) 5, 10 mg DR sprinkle caps11 699.80 DR = delayed-release; OTC = over the counter; ODT = orally disintegrating tablets 1. The lower end of the range is generally used for initial treatment of GERD. Higher or more frequent doses may be needed for patients with erosive esophagitis, peptic ulcer disease, hypersecretory conditions such as Zollinger-Ellison syndrome, or for treatment of Helicobacter pylori infection. 2. PPIs are generally taken 30-60 minutes before the fi rst meal of the day. Taking one before the evening meal or taking the drug twice daily may be more effective for nocturnal acid control. PPIs should generally be swallowed whole and should not be crushed or chewed. Omeprazole/sodium bicarbonate (Zegerid) should be taken on an empty stomach at least 1 hour before a meal. Dexlansoprazole (Dexilant) can be taken with or without food. 3. Approximate WAC for 30 days’ treatment with the lowest usual adult dosage. WAC = wholesaler acquisition cost or manufacturer’s published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. June 5, 2015. Reprinted with permission by First Databank, Inc. All rights reserved. ©2015. www.fdbhealth.com/policies/drug-pricing-policy. 4. Also available in delayed-release powder or granules for suspension. 5. Equivalent to 20 mg of esomeprazole. 6. Cost for 28 tablets or capsules. 7. Also available generically. 8. Immediate-release formulation that contains sodium bicarbonate as a buffer; it should be used with caution in patients on a low-sodium diet. 9. Each packet also contains 1680 mg of sodium bicarbonate. 10. Each capsule contains 1.1 g of sodium bicarbonate; therefore, two 20-mg caps are not equivalent to one 40-mg cap. 11. Contents of the capsule should be sprinkled on soft food or liquid and taken within 15 minutes

snitchiest technology/single digital ID card for every Indian.

  First was  PAN card
Then came Adhar card now this guy Amit shah wants a single digital ID card for every Indian.


"I got back to class and sat down again, Ms. Galvez warmly welcoming me back. I unpacked the school's standard-issue ma- chine and got back into classroom mode. The SchoolBooks were the snitchiest technology of them all, logging every keystroke, watching all the network traffic for suspicious keywords, counting every click, keeping track of every fleeting thought you put out over the net. We'd gotten them in my junior year, and it only took a couple months for the shininess to wear off. Once people figured out that these "free" laptops worked for the man—and showed a never-ending parade of obnoxious ads to boot—they suddenly started to feel very heavy and burdensome."

Little Brother

By Cory Doctorow

"Mr. XXX this is God, I want you to take a bath now and every day from now on!"

There was another patient that I personally did not know but heard a fascinating story about. This patient, as described to me by one of the psych resident doctors, was a schizophrenic Who frequently heard the voice of God talking to him. This is a common theme among schizophrenics, Who frequently have delusions and hallucinations With religious content. lt is one thing to say that God speaks to us (which most of us Christians believe strongly) and yet something completely different to say that you actually hear God's voice (considered a hallucination in psychiatry). This gentleman actually said he heard God's voice. But that wasn't the worst of it. He said that God had told him not to bathe or shower. Initially, this wasn't so much Of problem, but the longer that he was on the ward, the worse the smell got. This was a small unit With locked doors and windows and poor ventilation, so you can understand that it didn't take long before it was apparent that something had to be done. They couldn't just grab hirn, take his clothes off, and bathe him forcefully. Besides the danger of such behavior (to the patient as well as the staff) it just isn't legal. As the Story goes, the psych ward staff debated this problem for a while and came up With a unique and highly creative solution. The ward had an overhead public address system, so they got someone With a deep voice (we all assume that God has deep masculine voice, of course) Who announced over the PA, "Mr.   this is God, I want you to take a bath now and every day from now on!" Guess what? lt worked!

Why patients stop taking their medications?

most chronically mentally ill patients quit taking their medications every so often. 
The patients do this for several significant reasons. First, they don•t like the Side effects stRh as decreased sexual functioning (they become impotent in the case of males and have no sexual desire in the case of females). Also, the drugs decrease their energy, along With slowing down their mental processes. They tend to make them gain weight. Often, the patient decides that he or she is cured and no longer needs the medicines. No matter how often you tell them that they are not cured, they will keep going off of the medicines as soon as their symptoms of mental illness subside. This results in the slow return of their symptoms until they reach a crisis, return to the hospital, and get put back on their medicines. Even then they sometimes refuse to Start the medicine again. This was the case With this young man. 

The much maligned Jiankui He Chineses scientist Was he right ?

Last year, a scientist named Jiankui He scandalized the scientific world by using Crispr to edit CCR5 in human embryos, in an attempt to make children immune to HIV. The experiments crossed a plethora of ethical lines, in addition to not working that well. In response to the global outcry, China proposed new, stricter, regulations on gene-editing in humans.

But  now  almost everyone seems to be  on the Crispr bandwagon.

is it  sim[ply white people's racism and  Not made  here  syndrome  which leads such condemnations .

How much  of the  condemnation the  south korean scientist  and  his  cloning  experiments really deserved?

Is Your Medical Assistant Practicing Beyond His or Her Scope of Training?

The Medical Board receives numerous inquiries concerning the use of medical assistants in a physician's office. (By law, a medical assistant may not be employed for inpatient care in a licensed general acute care hospital.)

Medical assistants are unlicensed, and may only perform basic administrative, clerical and technical supportive services as permitted by law. An unlicensed person may not diagnose or treat or perform any task that is invasive or requires assessment. The responsibility for the appropriate use of unlicensed persons in health care delivery rests with the physician.

The classification of medical assistant is defined under the provisions of the Medical Practice Act (Business and Professions Code sections 2069-2071) as a person who may be unlicensed who performs basic administrative, clerical, and technical supportive services under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife.

Under the law, "technical supportive services" are simple, routine medical tasks and procedures that may be safely performed by a medical assistant who has limited training and who functions under the supervision of a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. "Supervision" is defined to require the licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife to be physically present in the treatment facility during the performance of those procedures.

Prior to performing technical supportive services, a medical assistant shall receive training by either (1) a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife or (2) an instructor in an approved school program to assure the medical assistant's competence in performing a service at the appropriate standard of care.

A medical assistant who has completed the minimum training prescribed by regulation may administer medication by intradermal, subcutaneous, or intramuscular injections, perform skin tests, and other technical supportive services upon the specific authorization and supervision of a licensed physician and surgeon, podiatrist, physician assistant, nurse practitioner, or nurse midwife.

"Specific authorization" means a specific written order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed on a patient, which shall be placed in the patient's medical record; or a standing order prepared by the supervising physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife authorizing the procedures to be performed, the duration of which shall be consistent with accepted medical practice. A notation of the standing order shall be placed in the patient's medical record.

Other technical supportive services which a medical assistant may perform have been established by regulation and include: applying and removing bandages and dressings, removing sutures, performing ear lavage, preparing patients for examinations, and shaving and disinfecting treatment sites. A medical assistant may also hand patients properly-labeled and pre-packaged prescriptions drugs (excluding controlled substances) that have been ordered by a licensed physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife. The properly-labeled and pre-packaged prescription drug must have the patient’s name affixed to the package, and the physician, podiatrist, physician assistant, nurse practitioner, or nurse midwife must verify it is the correct medication and dosage for that specific patient and provide the appropriate patient consultation regarding use of the drug prior to the medical assistant handing medication to a patient. The regulations governing medical assistants can be found in Title 16, California Code of Regulations, sections 1366-1366.4. Medical assistants who have completed the minimum training prescribed by regulation may draw blood.

Medical assistants are not allowed to perform such invasive procedures as:

• placing the needle or starting and disconnecting the infusion tube of an IV.
• administering medications or injections into the IV line.
• charting the pupillary responses.
• inserting a urine catheter.
• independently performing telephone triage.
• injecting collagen.
• using lasers to remove hair, wrinkles, scars, moles or other blemishes.
• administering chemotherapy.

Medical assistants may not interpret the results of skin tests, although they may measure and describe the test reaction and make a record in the patient's chart.

In summary, medical assistants are not licensed, and it is not legal to use them to replace highly trained, licensed professionals. The medical assistant is present to assist and perform basic supportive services in the physician's office.

Those duties must be appropriate with the medical assistant's required training.

medicine is not a profession that you can practice With a "cookbook" approach.

without realizing that the person is mentally ill. Unfortunately, that is a term that our society looks upon as something that is caused by someone being weak, spineless, cowardly, and worthless. Not true. There isn't anyone I know Who hasn't manifested some symptoms of mental illness in their lives and most overcome it. lt has been said With some truth that we are all "crazy" to some extent, it is just a question of degree.


paranoid delusions, I remember her saying several times that my grandmother was always trying to poison her food. For this reason, in most cases she would only eat food when she had personally observed the preparation and cooking of it. My grandmother was the caretaker of my great-grandmother in her last years and truly there wasn't much love lost between them. In reality, my grandmother easily conceded that she hated her mother due to the abuse she had suffered as a child. In spite of this, I never had any doubt that my grandmother didn't hate her enough to try to kill her. A humorous (though some would question that label)event occurred at one of our family gatherings one Saturday afternoon when I was a teenager. As usual at these functions, dishes 

very fast). In her progress toward her trailer, she walked past me. As she passed me, she stopped, grabbed me by my arm, and said in her normal barely audible voice, "Boy, don't eat anything on that table, those people will poison you!" I was intrigued about What had transpired between my uncle and her and, a short time later, I found out What he had said to her. He was telling the rest of the family about it and told them he had said to her, "Ma'am, that's an excellent choice of meat. That is the best armadillo meat on the face of the earth!" Then I understood her reaction since she would not eat anything except beef or pork and considered all Other meats vite. I have to explain that for years, the armadillo, an animal brought to Florida from Texas and accidentally released to proliferate greatly, was thought to be a worthless animal until someone tried eating them, only to find out that they are indeed good to eat in spite of their lack of appeal in appearance. The meat that my great-grandmother was serving herself was in fact roast beef, but With her paranoia, she fell for my uncle's joke. The next really interesting Story about a psychiatric patient occurred when I was in my first two years of medical school. In those years, we had very little interaction With patients since we were Learning basic sciences. But we had several Lectures by psychiatrists and psychologists about some of the things we might see in this realm of medicine. A told us a story about an ER patient seen in the hospital attached to the medical school. This occurred late at night (l have always been intrigued by the fact that 

The next really interesting story about a psychiatric patient occurred when I was in my first two years of medical school. In those years, we had very Little interaction With patients since we were learning basic sciences. But we had several Lectures by psychiatrists and psychologists about some of the things we might see in this realm of medicine. A told us a story about an ER patient seen in the hospital attached to the medical school. This occurred late at night (l have always been intrigued by the fact that these weird types of problems always seem to occur late at night or very early in the morning) and the psychiatrist was called because apparently an ambulance had brought in a patient found on the street Who appeared to be overdosed on drugs and largely unresponsive. However, as the Story went, White the ER staff were assessing the patient and trying to figure out how to treat him, (he was
(he was young man in his early twenties)the patient suddenly awoke out of his previous mental State, and began screaming wild obscenities and words without meaning to the ER staff. He tore the IV line out of his arm, jumped off of the gurney, and began grabbing anything he could get hold of and throwing it at the ER staff. He then began tearing apart anything in the room he could get his hands on. Realizing that discretion is indeed the better part of valor, the ER staff quickly evacuated the room, and shut and locked the door. This was the point when they called the aforementioned psychiatrist, inquiring as to What to do about this situation. I will mention here that psychiatrists have a unique perspective on the


human psyche and sometimes come up With strange but creative solutions for such problems. That certainly is What occurred here. The psychiatrist told the ER doctor to find the smallest, most frail- appearing female resident doctor and send her into the room. As the Story goes, the female resident edged her way into the room and stood With her back against the nearest wall, certainly terrified as to What might happen. As soon as he saw her, the patient crouched Iow and began advancing on her With his arms stretched out and hands shaped like claws, definitely a fearsome sight. He was also growling like an animal. As he got Close to her, she Said, "You know, you are scaring the out of me!" His reaction to this statement was apparently What the psychiatrist planned, because the patient immediately stopped his animalistic growling and approach to the resident. He calmly said to her, "I am?" He then calmed down and accept
and accepted the medical care that he so obviously needed. The psychiatrist finished his Lecture by explaining his rationale for this truly creative approach to a patient from hell. People on drugs Who are reacting violently like this do not have their higher brain centers functioning but are functioning With primitive brain centers that direct life-protecting activities. (One of my med school professors said this part of the brain controls only three activities, referred to as the three F's. The three F's are feeding, fighting, and fornicating.) Some people on psychoactive drugs (particularly drugs such as cocaine, I SD, PCP, and methamphetamines) react by basically shutting down the higher levels of the brain that give us the good sense to use those activities wisely, and using only that  primitive part of the brain, without any filtering by societal disciplines we have learned as we grow. When a doctor Who was not threatening in appearance or behavior was sent in, the patient was able to quell the fearful thoughts in his own mind. As you can see, medicine is not a profession that you can practice With a "cookbook" approach. My next significant experiences in the realm of psychiatry occurred when I was a third-year medical school student. My first psychiatric rotation was in the psychiatric ward of the local Veterans Administration (VA) hospital. This was a locked ward because many of the patients were a danger to society or to themselves and had to be locked up until they were no longer dangerous. Locking them up also gave them a sense of security since they had many fears (unrealistic fears, thus psychotic fears) about the world. lt sounds cruel and seems to go against the greatest benefit of our society, freedom to live our lives as we wish, but it was actually therapeutic for them. Within days of being locked up, many of their psychotic symptoms were lessened. Our psychiatry professor told us that this effect was not due to the powerful sedating medicines they received, but due to the sense of security they received in that locked environment. In fact, there was a long waiting list of people waiting to get a place in there. The patients in the VA psych unit Were by far the sickest mentally ill patients I have ever Seen. I have often theorized about Why that might be the case. Having been in the military, I have some insight about this. In the military, people are sometimes put in life-threatening situations that are too horrible for most people to contemplate and, while most soldiers or sailors get through these situations without prolonged after-effects, sorne are not able to maintain their mental health after these episodes. Truly, battle is probably the most stressful situation that anyone can endure. Some great philosopher once said, "War is hell." But I don't believe that is the only cause of mental illness among veterans. The Vietnam War, With all of its contradictions and lack of appropriate direction, led many people
into psychotic "breaks" away from reality. lt also led many young GIS into drug addiction and alcoholism. I know that for much of the time I was in the military, heavy drinking of alcohol was virtually a norm. lt was considered to be part of the hard swearing, hard drinking, smoking, womanizing behavior considered appropriate for the aggressive lifestyle that is military life. The armed services have begun to realize that in the modern world, GIS must use their higher brain centers and fight and live smarter than the warriors of old time-s. In people that have some predisposition to mental illness (Some figures say up to 9 percent Of the population) these behaviors combined With the stress of war send them over the edge. Most never recover completely. Additionally, the sexually transmitted diseases of inappropriate sexual behavior can lead to mental illness (syphilis in particular). awayto

One case that I was involved With concerned a man Who went away to Wortd War 11 at the age of eighteen or nineteen. He had grown up in an abusive home and had come from a long line of generations that were abusive to their children and spouses. He was very intelligent and had many talents, With Skills in music and many other areas. He went through basic training, which was pretty rudimentary at that point in history. The first military assignment for him was to land on Normandy Beach as one of the first wave of GIS invading Nazi-occupied France. This was probably the most deadly area of the most deadly battle of World War 11. Ninety-five percent of his unit was killed in those first few hours, though he survived without a scratch. Sometimes that in itself can give someone a tremendous sense of guilt for not having died With their Gl "brothers." He stated that he did not steep for the first two weeks after Landing on the French coast. Lack Of steep is a well- known trigger for psychotic behavior, and one of my psychiatry

professors said that most people that go forty-eight hours without steep Show signs Of psychotic behavior. Additionally, for the first two weeks after the invasion, I was told that they did not take prisoners. White it is true that the Geneva Convention dictates that if an enemy soldier surrenders, you must not harm hirn, the reality Of war is that sometimes the Geneva Convention is overlooked due to circumstances. The reality was that, in the heat of battle those first few weeks, they had no facilities or personnel to look after prisoners, so anyone that surrendered got shot anyway. That sort of behavior makes war very dehumanizing. About two weeks after the invasion, the Gl in this Story Said that they began taking prisoners into captivity and holding them. They had apparently captured some Germans and were herding them into a group in a French town. They had also not adequately searched the prisoners. One of the prisoners suddenly pulled out a pistol and began shooting at the American soldiers (the Germans also had their share of psychotic behavior). The patient in this Story pulled out his .45 caliber pistol (a big gun!) and began shooting at not only the Germans but the French and Americans, too. In the process, he shot and killed the German With his gun, but also a French woman. The fact that he was shooting at everyone is clear evidence of a paranoid psychotic break away from reality. He was subsequently subdued by Other Americans and shipped back to the U.S. I was told that he used no alcohol before the war, but afterward began daily consumption of large amounts of this drug (it is a drug!). I was told that before the war, he was kind, sensitive, and caring. Afterward, he was hardened and showed great cruelty to his family. He consistently showed paranoid behavior for the rest of his life and had chronic delusions that people were out to get him. He always carried a Loaded gun With him and threatened to kill people at times. He
had a family history of mental illness and it is apparent that he inherited some tendency toward this along With the alcoholism. Mentally ill patients also frequently "self-medicate" With alcohol to quell the "demons" within them.