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WHO Essential Medicines vs Essential Medicines for Children

WHO Essential Medicines vs Essential Medicines for Children


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Per the WHO (World Health Organization), there are a list of "Essential Medicines" such as those listed on their Wikipedia page.

  1. Is there a database link for this directly other than Wikipedia?
  2. What is the difference between the "Children" list and the regular list. Is one a complete superset of the other? I noticed the "Children's" list is much larger.

I would like to make an open JSON database of some sort regarding a more easily accessible and organized way of accessing this data in a Postgres database or something. What do you know like this that exists?

https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines_for_Children


Mupirocin vs Neosporin – Comparison of Ointments For Wound Infection

The topical use of antimicrobial agents may be especially helpful to overcome the deleterious effects of bacteria in specific circumstances. Here is a comparison of Mupirocin and Neosporin, two medicines used to prevent minor wound infections:

Mupirocin

Mupirocin ointment is a unique topical agent that was developed for use in the treatment of superficial skin infections. It belongs to a family of drugs called topical antibiotics.

It can found under the brand names of Bactroban or Centany. The US Food and Drug Administration originally approved it in 1987.

Neosporin

It is a combination of neomycin, bacitracin, and polymyxin B. It was originally produced by Citron Pharma and first approved by the US FDA in 1971. In the present day, it is sold by Johnson & Johnson.


Aromatherapy is the practice of using essential oils for therapeutic benefit. Aromatherapy has been used for centuries. When inhaled, the scent molecules in essential oils travel from the olfactory nerves directly to the brain and especially impact the amygdala, the emotional center of the brain.

Essential oils can also be absorbed by the skin. A massage therapist might add a drop or two of wintergreen to oil to help relax tight muscles during a rubdown. A skincare company may add lavender to bath salts to create a soothing soak.


Precautions when choosing herbal supplements

Herbal supplements can interact with conventional medicines or have strong effects. Do not self-diagnose. Talk to your doctor before taking herbal supplements.

Educate yourself. Learn as much as you can about the herbs you are taking by consulting your doctor and contacting herbal supplement manufacturers for information.

If you use herbal supplements, follow label instructions carefully and use the prescribed dosage only. Never exceed the recommended dosage, and seek out information about who should not take the supplement.

Work with a professional. Seek out the services of a trained and licensed herbalist or naturopathic doctor who has extensive training in this area.

Watch for side effects. If symptoms, such as nausea, dizziness, headache, or upset stomach, occur, reduce the dosage or stop taking the herbal supplement.

Be alert for allergic reactions. A severe allergic reaction can cause trouble breathing. If such a problem occurs, call 911 or the emergency number in your area for help.

Research the company whose herbs you are taking. All herbal supplements are not created equal, and it is best to choose a reputable manufacturer's brand. Ask yourself:

Is the manufacturer involved in researching its own herbal products or simply relying on the research efforts of others?

Does the product make outlandish or hard-to-prove claims?

Does the product label give information about the standardized formula, side effects, ingredients, directions, and precautions?

Is label information clear and easy to read?

Is there a toll-free telephone number, an address, or a website address listed so consumers can find out more information about the product?


Contents

Prehistoric times Edit

Plants, including many now used as culinary herbs and spices, have been used as medicines, not necessarily effectively, from prehistoric times. Spices have been used partly to counter food spoilage bacteria, especially in hot climates, [5] [6] and especially in meat dishes which spoil more readily. [7] Angiosperms (flowering plants) were the original source of most plant medicines. [8] Human settlements are often surrounded by weeds used as herbal medicines, such as nettle, dandelion and chickweed. [9] [10] Humans were not alone in using herbs as medicines: some animals such as non-human primates, monarch butterflies and sheep ingest medicinal plants when they are ill. [11] Plant samples from prehistoric burial sites are among the lines of evidence that Paleolithic peoples had knowledge of herbal medicine. For instance, a 60 000-year-old Neanderthal burial site, "Shanidar IV", in northern Iraq has yielded large amounts of pollen from eight plant species, seven of which are used now as herbal remedies. [12] A mushroom was found in the personal effects of Ötzi the Iceman, whose body was frozen in the Ötztal Alps for more than 5,000 years. The mushroom was probably used against whipworm. [13]

Ancient times Edit

In ancient Sumeria, hundreds of medicinal plants including myrrh and opium are listed on clay tablets. The ancient Egyptian Ebers Papyrus lists over 800 plant medicines such as aloe, cannabis, castor bean, garlic, juniper, and mandrake. [14] From ancient times to the present, Ayurvedic medicine as documented in the Atharva Veda, the Rig Veda and the Sushruta Samhita has used hundreds of pharmacologically active herbs and spices such as turmeric, which contains curcumin. [15] [16] The Chinese pharmacopoeia, the Shennong Ben Cao Jing records plant medicines such as chaulmoogra for leprosy, ephedra, and hemp. [17] This was expanded in the Tang Dynasty Yaoxing Lun. [18] In the fourth century BC, Aristotle's pupil Theophrastus wrote the first systematic botany text, Historia plantarum. [19] In around 60 AD, the Greek physician Pedanius Dioscorides, working for the Roman army, documented over 1000 recipes for medicines using over 600 medicinal plants in De materia medica. The book remained the authoritative reference on herbalism for over 1500 years, into the seventeenth century. [4]

Middle Ages Edit

In the Early Middle Ages, Benedictine monasteries preserved medical knowledge in Europe, translating and copying classical texts and maintaining herb gardens. [20] [21] Hildegard of Bingen wrote Causae et Curae ("Causes and Cures") on medicine. [22] In the Islamic Golden Age, scholars translated many classical Greek texts including Dioscorides into Arabic, adding their own commentaries. [23] Herbalism flourished in the Islamic world, particularly in Baghdad and in Al-Andalus. Among many works on medicinal plants, Abulcasis (936–1013) of Cordoba wrote The Book of Simples, and Ibn al-Baitar (1197–1248) recorded hundreds of medicinal herbs such as Aconitum, nux vomica, and tamarind in his Corpus of Simples. [24] Avicenna included many plants in his 1025 The Canon of Medicine. [25] Abu-Rayhan Biruni, [26] Ibn Zuhr, [27] Peter of Spain, and John of St Amand wrote further pharmacopoeias. [28]

Early Modern Edit

The Early Modern period saw the flourishing of illustrated herbals across Europe, starting with the 1526 Grete Herball. John Gerard wrote his famous The Herball or General History of Plants in 1597, based on Rembert Dodoens, and Nicholas Culpeper published his The English Physician Enlarged. [29] Many new plant medicines arrived in Europe as products of Early Modern exploration and the resulting Columbian Exchange, in which livestock, crops and technologies were transferred between the Old World and the Americas in the 15th and 16th centuries. Medicinal herbs arriving in the Americas included garlic, ginger, and turmeric coffee, tobacco and coca travelled in the other direction. [30] [31] In Mexico, the sixteenth century Badianus Manuscript described medicinal plants available in Central America. [32]

19th and 20th centuries Edit

The place of plants in medicine was radically altered in the 19th century by the application of chemical analysis. Alkaloids were isolated from a succession of medicinal plants, starting with morphine from the poppy in 1806, and soon followed by ipecacuanha and strychnos in 1817, quinine from the cinchona tree, and then many others. As chemistry progressed, additional classes of pharmacologically active substances were discovered in medicinal plants. [33] [34] Commercial extraction of purified alkaloids including morphine from medicinal plants began at Merck in 1826. Synthesis of a substance first discovered in a medicinal plant began with salicylic acid in 1853. [34] Around the end of the 19th century, the mood of pharmacy turned against medicinal plants, as enzymes often modified the active ingredients when whole plants were dried, and alkaloids and glycosides purified from plant material started to be preferred. [33] Drug discovery from plants continued to be important through the 20th century and into the 21st, with important anti-cancer drugs from yew and Madagascar periwinkle. [34]

Medicinal plants are used with the intention of maintaining health, to be administered for a specific condition, or both, whether in modern medicine or in traditional medicine. [2] [35] The Food and Agriculture Organization estimated in 2002 that over 50,000 medicinal plants are used across the world. [36] The Royal Botanic Gardens, Kew more conservatively estimated in 2016 that 17,810 plant species have a medicinal use, out of some 30,000 plants for which a use of any kind is documented. [37]

In modern medicine, around a quarter [a] of the drugs prescribed to patients are derived from medicinal plants, and they are rigorously tested. [35] [38] In other systems of medicine, medicinal plants may constitute the majority of what are often informal attempted treatments, not tested scientifically. [39] The World Health Organization estimates, without reliable data, that some 80 percent of the world's population depends mainly on traditional medicine (including but not limited to plants) perhaps some two billion people are largely reliant on medicinal plants. [35] [38] The use of plant-based materials including herbal or natural health products with supposed health benefits, is increasing in developed countries. [40] This brings attendant risks of toxicity and other effects on human health, despite the safe image of herbal remedies. [40] Herbal medicines have been in use since long before modern medicine existed there was and often still is little or no knowledge of the pharmacological basis of their actions, if any, or of their safety. The World Health Organization formulated a policy on traditional medicine in 1991, and since then has published guidelines for them, with a series of monographs on widely used herbal medicines. [41] [42]

Medicinal plants may provide three main kinds of benefit: health benefits to the people who consume them as medicines financial benefits to people who harvest, process, and distribute them for sale and society-wide benefits, such as job opportunities, taxation income, and a healthier labour force. [35] However, development of plants or extracts having potential medicinal uses is blunted by weak scientific evidence, poor practices in the process of drug development, and insufficient financing. [2]

All plants produce chemical compounds which give them an evolutionary advantage, such as defending against herbivores or, in the example of salicylic acid, as a hormone in plant defenses. [43] [44] These phytochemicals have potential for use as drugs, and the content and known pharmacological activity of these substances in medicinal plants is the scientific basis for their use in modern medicine, if scientifically confirmed. [2] For instance, daffodils (Narcissus) contain nine groups of alkaloids including galantamine, licensed for use against Alzheimer's disease. The alkaloids are bitter-tasting and toxic, and concentrated in the parts of the plant such as the stem most likely to be eaten by herbivores they may also protect against parasites. [45] [46] [47]

Modern knowledge of medicinal plants is being systematised in the Medicinal Plant Transcriptomics Database, which by 2011 provided a sequence reference for the transcriptome of some thirty species. [48] The major classes of pharmacologically active phytochemicals are described below, with examples of medicinal plants that contain them. [8] [42] [49] [50] [51]

Alkaloids Edit

Alkaloids are bitter-tasting chemicals, very widespread in nature, and often toxic, found in many medicinal plants. [52] There are several classes with different modes of action as drugs, both recreational and pharmaceutical. Medicines of different classes include atropine, scopolamine, and hyoscyamine (all from nightshade), [53] the traditional medicine berberine (from plants such as Berberis and Mahonia), [b] caffeine (Coffea), cocaine (Coca), ephedrine (Ephedra), morphine (opium poppy), nicotine (tobacco), [c] reserpine (Rauvolfia serpentina), quinidine and quinine (Cinchona), vincamine (Vinca minor), and vincristine (Catharanthus roseus). [51] [56]

The opium poppy Papaver somniferum is the source of the alkaloids morphine and codeine. [51]

The alkaloid nicotine from tobacco binds directly to the body's Nicotinic acetylcholine receptors, accounting for its pharmacological effects. [57]

Glycosides Edit

Anthraquinone glycosides are found in medicinal plants such as rhubarb, cascara, and Alexandrian senna. [58] [59] Plant-based laxatives made from such plants include senna, [60] rhubarb [61] and Aloe. [51]

The cardiac glycosides are powerful drugs from medicinal plants including foxglove and lily of the valley. They include digoxin and digitoxin which support the beating of the heart, and act as diuretics. [43]

The foxglove, Digitalis purpurea, contains digoxin, a cardiac glycoside. The plant was used on heart conditions long before the glycoside was identified. [43] [62]

Polyphenols Edit

Polyphenols of several classes are widespread in plants, having diverse roles in defenses against plant diseases and predators. [43] They include hormone-mimicking phytoestrogens and astringent tannins. [51] [63] Plants containing phytoestrogens have been administered for centuries for gynecological disorders, such as fertility, menstrual, and menopausal problems. [64] Among these plants are Pueraria mirifica, [65] kudzu, [66] angelica, [67] fennel, and anise. [68]

Many polyphenolic extracts, such as from grape seeds, olives or maritime pine bark, are sold as dietary supplements and cosmetics without proof or legal health claims for beneficial health effects. [69] In Ayurveda, the astringent rind of the pomegranate, containing polyphenols called punicalagins, is used as a medicine. [70]

Angelica, containing phytoestrogens, has long been used for gynaecological disorders.

Polyphenols include phytoestrogens (top and middle), mimics of animal estrogen (bottom). [71]

Terpenes Edit

Terpenes and terpenoids of many kinds are found in a variety of medicinal plants, [72] and in resinous plants such as the conifers. They are strongly aromatic and serve to repel herbivores. Their scent makes them useful in essential oils, whether for perfumes such as rose and lavender, or for aromatherapy. [51] [73] [74] Some have medicinal uses: for example, thymol is an antiseptic and was once used as a vermifuge (anti-worm medicine). [75]

Thymol is one of many terpenes found in plants. [75]

Cultivation Edit

Medicinal plants demand intensive management. Different species each require their own distinct conditions of cultivation. The World Health Organization recommends the use of rotation to minimise problems with pests and plant diseases. Cultivation may be traditional or may make use of conservation agriculture practices to maintain organic matter in the soil and to conserve water, for example with no-till farming systems. [76] In many medicinal and aromatic plants, plant characteristics vary widely with soil type and cropping strategy, so care is required to obtain satisfactory yields. [77]

Preparation Edit

Medicinal plants are often tough and fibrous, requiring some form of preparation to make them convenient to administer. According to the Institute for Traditional Medicine, common methods for the preparation of herbal medicines include decoction, powdering, and extraction with alcohol, in each case yielding a mixture of substances. Decoction involves crushing and then boiling the plant material in water to produce a liquid extract that can be taken orally or applied topically. [78] Powdering involves drying the plant material and then crushing it to yield a powder that can be compressed into tablets. Alcohol extraction involves soaking the plant material in cold wine or distilled spirit to form a tincture. [79]

Traditional poultices were made by boiling medicinal plants, wrapping them in a cloth, and applying the resulting parcel externally to the affected part of the body. [80]

When modern medicine has identified a drug in a medicinal plant, commercial quantities of the drug may either be synthesised or extracted from plant material, yielding a pure chemical. [34] Extraction can be practical when the compound in question is complex. [81]

Usage Edit

Plant medicines are in wide use around the world. [82] In most of the developing world, especially in rural areas, local traditional medicine, including herbalism, is the only source of health care for people, while in the developed world, alternative medicine including use of dietary supplements is marketed aggressively using the claims of traditional medicine. As of 2015, most products made from medicinal plants had not been tested for their safety and efficacy, and products that were marketed in developed economies and provided in the undeveloped world by traditional healers were of uneven quality, sometimes containing dangerous contaminants. [83] Traditional Chinese medicine makes use of a wide variety of plants, among other materials and techniques. [84] Researchers from Kew Gardens found 104 species used for diabetes in Central America, of which seven had been identified in at least three separate studies. [85] [86] The Yanomami of the Brazilian Amazon, assisted by researchers, have described 101 plant species used for traditional medicines. [87] [88]

Drugs derived from plants including opiates, cocaine and cannabis have both medical and recreational uses. Different countries have at various times made use of illegal drugs, partly on the basis of the risks involved in taking psychoactive drugs. [89]

Effectiveness Edit

Plant medicines have often not been tested systematically, but have come into use informally over the centuries. By 2007, clinical trials had demonstrated potentially useful activity in nearly 16% of herbal medicines there was limited in vitro or in vivo evidence for roughly half the medicines there was only phytochemical evidence for around 20% 0.5% were allergenic or toxic and some 12% had basically never been studied scientifically. [42] Cancer Research UK caution that there is no reliable evidence for the effectiveness of herbal remedies for cancer. [90]

A 2012 phylogenetic study built a family tree down to genus level using 20,000 species to compare the medicinal plants of three regions, Nepal, New Zealand and the South African Cape. It discovered that the species used traditionally to treat the same types of condition belonged to the same groups of plants in all three regions, giving a "strong phylogenetic signal". [91] Since many plants that yield pharmaceutical drugs belong to just these groups, and the groups were independently used in three different world regions, the results were taken to mean 1) that these plant groups do have potential for medicinal efficacy, 2) that undefined pharmacological activity is associated with use in traditional medicine, and 3) that the use of a phylogenetic groups for medicines in one region may predict their use in the other regions. [91]

Regulation Edit

The World Health Organization (WHO) has been coordinating a network called the International Regulatory Cooperation for Herbal Medicines to try to improve the quality of medical products made from medicinal plants and the claims made for them. [92] In 2015, only around 20% of countries had well-functioning regulatory agencies, while 30% had none, and around half had limited regulatory capacity. [83] In India, where Ayurveda has been practised for centuries, herbal remedies are the responsibility of a government department, AYUSH, under the Ministry of Health & Family Welfare. [93]

WHO has set out a strategy for traditional medicines [94] with four objectives: to integrate them as policy into national healthcare systems to provide knowledge and guidance on their safety, efficacy, and quality to increase their availability and affordability and to promote their rational, therapeutically sound usage. [94] WHO notes in the strategy that countries are experiencing seven challenges to such implementation, namely in developing and enforcing policy in integration in safety and quality, especially in assessment of products and qualification of practitioners in controlling advertising in research and development in education and training and in the sharing of information. [94]

Drug discovery Edit

The pharmaceutical industry has roots in the apothecary shops of Europe in the 1800s, where pharmacists provided local traditional medicines to customers, which included extracts like morphine, quinine, and strychnine. [95] Therapeutically important drugs like camptothecin (from Camptotheca acuminata, used in traditional Chinese medicine) and taxol (from the Pacific yew, Taxus brevifolia) were derived from medicinal plants. [96] [34] The Vinca alkaloids vincristine and vinblastine, used as anti-cancer drugs, were discovered in the 1950s from the Madagascar periwinkle, Catharanthus roseus. [97]

Hundreds of compounds have been identified using ethnobotany, investigating plants used by indigenous peoples for possible medical applications. [98] Some important phytochemicals, including curcumin, epigallocatechin gallate, genistein and resveratrol are pan-assay interference compounds, meaning that in vitro studies of their activity often provide unreliable data. As a result, phytochemicals have frequently proven unsuitable as lead compounds in drug discovery. [99] [100] In the United States over the period 1999 to 2012, despite several hundred applications for new drug status, only two botanical drug candidates had sufficient evidence of medicinal value to be approved by the Food and Drug Administration. [2]

The pharmaceutical industry has remained interested in mining traditional uses of medicinal plants in its drug discovery efforts. [34] Of the 1073 small-molecule drugs approved in the period 1981 to 2010, over half were either directly derived from or inspired by natural substances. [34] [101] Among cancer treatments, of 185 small-molecule drugs approved in the period from 1981 to 2019, 65% were derived from or inspired by natural substances. [102]

Safety Edit

Plant medicines can cause adverse effects and even death, whether by side-effects of their active substances, by adulteration or contamination, by overdose, or by inappropriate prescription. Many such effects are known, while others remain to be explored scientifically. There is no reason to presume that because a product comes from nature it must be safe: the existence of powerful natural poisons like atropine and nicotine shows this to be untrue. Further, the high standards applied to conventional medicines do not always apply to plant medicines, and dose can vary widely depending on the growth conditions of plants: older plants may be much more toxic than young ones, for instance. [104] [105] [106] [107] [108] [109]

Pharmacologically active plant extracts can interact with conventional drugs, both because they may provide an increased dose of similar compounds, and because some phytochemicals interfere with the body's systems that metabolise drugs in the liver including the cytochrome P450 system, making the drugs last longer in the body and have a more powerful cumulative effect. [110] Plant medicines can be dangerous during pregnancy. [111] Since plants may contain many different substances, plant extracts may have complex effects on the human body. [5]

Quality, advertising, and labelling Edit

Herbal medicine and dietary supplement products have been criticized as not having sufficient standards or scientific evidence to confirm their contents, safety, and presumed efficacy. [112] [113] [114] [115] A 2013 study found that one-third of herbal products sampled contained no trace of the herb listed on the label, and other products were adulterated with unlisted fillers including potential allergens. [116] [117]

Where medicinal plants are harvested from the wild rather than cultivated, they are subject to both general and specific threats. General threats include climate change and habitat loss to development and agriculture. A specific threat is over-collection to meet rising demand for medicines. [118] A case in point was the pressure on wild populations of the Pacific yew soon after news of taxol's effectiveness became public. [34] The threat from over-collection could be addressed by cultivation of some medicinal plants, or by a system of certification to make wild harvesting sustainable. [118] A report in 2020 by the Royal Botanic Gardens, Kew identifies 723 medicinal plants as being at risk of extinction, caused partly by over-collection. [119] [102]


Contents

Medicine ( UK: / ˈ m ɛ d s ɪ n / ( listen ) , US: / ˈ m ɛ d ɪ s ɪ n / ( listen ) ) is the science and practice of the diagnosis, prognosis, treatment, and prevention of disease. [4] [5] The word "medicine" is derived from Latin medicus, meaning "a physician". [6] [7]

Medical availability and clinical practice varies across the world due to regional differences in culture and technology. Modern scientific medicine is highly developed in the Western world, while in developing countries such as parts of Africa or Asia, the population may rely more heavily on traditional medicine with limited evidence and efficacy and no required formal training for practitioners. [8]

In the developed world, evidence-based medicine is not universally used in clinical practice for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm. [9]

In modern clinical practice, physicians and physician assistants personally assess patients in order to diagnose, prognose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed by a medical interview [10] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination for signs and interviewing for symptoms, the doctor may order medical tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions. [11] Follow-ups may be shorter but follow the same general procedure, and specialists follow a similar process. The diagnosis and treatment may take only a few minutes or a few weeks depending upon the complexity of the issue.

The components of the medical interview [10] and encounter are:

  • Chief complaint (CC): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'chief concern' or 'presenting complaint'.
  • History of present illness (HPI): the chronological order of events of symptoms and further clarification of each symptom. Distinguishable from history of previous illness, often called past medical history (PMH). Medical history comprises HPI and PMH.
  • Current activity: occupation, hobbies, what the patient actually does. (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines or remedies. Allergies are also recorded.
  • Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases or vaccinations, history of known allergies.
  • Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol). (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
  • Review of systems (ROS) or systems inquiry: a set of additional questions to ask, which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc.), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc.).

The physical examination is the examination of the patient for medical signs of disease, which are objective and observable, in contrast to symptoms that are volunteered by the patient and not necessarily objectively observable. [12] The healthcare provider uses sight, hearing, touch, and sometimes smell (e.g., in infection, uremia, diabetic ketoacidosis). Four actions are the basis of physical examination: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen), generally in that order although auscultation occurs prior to percussion and palpation for abdominal assessments. [13]

The clinical examination involves the study of: [14]

  • Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, and hemoglobin oxygen saturation[15]
  • General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
  • Head, eye, ear, nose, and throat (HEENT) [16] (heart and blood vessels) (large airways and lungs) [17] and rectum
  • Genitalia (and pregnancy if the patient is or could be pregnant) (including spine and extremities) (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves) (orientation, mental state, mood, evidence of abnormal perception or thought).

It is to likely focus on areas of interest highlighted in the medical history and may not include everything listed above.

The treatment plan may include ordering additional medical laboratory tests and medical imaging studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised. Depending upon the health insurance plan and the managed care system, various forms of "utilization review", such as prior authorization of tests, may place barriers on accessing expensive services. [18]

The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.

On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.

Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations, such as churches. The characteristics of any given health care system have significant impact on the way medical care is provided.

From ancient times, Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals and the Catholic Church today remains the largest non-government provider of medical services in the world. [19] Advanced industrial countries (with the exception of the United States) [20] [21] and many developing countries provide medical services through a system of universal health care that aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities, most commonly by a combination of all three.

Most tribal societies provide no guarantee of healthcare for the population as a whole. In such societies, healthcare is available to those that can afford to pay for it or have self-insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.

Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality, and pricing greatly affects the choice by patients/consumers and, therefore, the incentives of medical professionals. While the US healthcare system has come under fire for lack of openness, [22] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.

Delivery Edit

Provision of medical care is classified into primary, secondary, and tertiary care categories. [23]

Primary care medical services are provided by physicians, physician assistants, nurse practitioners, or other health professionals who have first contact with a patient seeking medical treatment or care. [24] These occur in physician offices, clinics, nursing homes, schools, home visits, and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.

Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. [25] Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, Emergency departments, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.

Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.

Modern medical care also depends on information – still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.

In low-income countries, modern healthcare is often too expensive for the average person. International healthcare policy researchers have advocated that "user fees" be removed in these areas to ensure access, although even after removal, significant costs and barriers remain. [26]

Separation of prescribing and dispensing is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug. In the Western world there are centuries of tradition for separating pharmacists from physicians. In Asian countries, it is traditional for physicians to also provide drugs. [27]

The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while considered by some a separate discipline from medicine, is a medical field.

A patient admitted to the hospital is usually under the care of a specific team based on their main presenting problem, e.g., the cardiology team, who then may interact with other specialties, e.g., surgical, radiology, to help diagnose or treat the main problem or any subsequent complications/developments.

Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.

The main branches of medicine are:

  • Basic sciences of medicine this is what every physician is educated in, and some return to in biomedical research , where different medical specialties are mixed to function in certain occasions.

Basic sciences Edit

  • Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
  • Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
  • Biomechanics is the study of the structure and function of biological systems by means of the methods of Mechanics.
  • Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
  • Biophysics is an interdisciplinary science that uses the methods of physics and physical chemistry to study biological systems.
  • Cytology is the microscopic study of individual cells.
  • Embryology is the study of the early development of organisms.
  • Endocrinology is the study of hormones and their effect throughout the body of animals.
  • Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
  • Genetics is the study of genes, and their role in biological inheritance.
  • Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry.
  • Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
  • Medical physics is the study of the applications of physics principles in medicine.
  • Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
  • Molecular biology is the study of molecular underpinnings of the process of replication, transcription and translation of the genetic material.
  • Neuroscience includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord. Some related clinical specialties include neurology, neurosurgery and psychiatry.
  • Nutrition science (theoretical focus) and dietetics (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases.
  • Pathology as a science is the study of disease—the causes, course, progression and resolution thereof.
  • Pharmacology is the study of drugs and their actions.
  • Gynecology is the study of female reproductive system.
  • Photobiology is the study of the interactions between non-ionizing radiation and living organisms.
  • Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
  • Radiobiology is the study of the interactions between ionizing radiation and living organisms.
  • Toxicology is the study of hazardous effects of drugs and poisons.

Specialties Edit

In the broadest meaning of "medicine", there are many different specialties. In the UK, most specialities have their own body or college, which has its own entrance examination. These are collectively known as the Royal Colleges, although not all currently use the term "Royal". The development of a speciality is often driven by new technology (such as the development of effective anaesthetics) or ways of working (such as emergency departments) the new specialty leads to the formation of a unifying body of doctors and the prestige of administering their own examination.

Within medical circles, specialities usually fit into one of two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most of its subspecialties require preliminary training in Internal Medicine. In the UK, this was traditionally evidenced by passing the examination for the Membership of the Royal College of Physicians (MRCP) or the equivalent college in Scotland or Ireland. "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in General Surgery, which in the UK leads to membership of the Royal College of Surgeons of England (MRCS). At present, some specialties of medicine do not fit easily into either of these categories, such as radiology, pathology, or anesthesia. Most of these have branched from one or other of the two camps above for example anaesthesia developed first as a faculty of the Royal College of Surgeons (for which MRCS/FRCS would have been required) before becoming the Royal College of Anaesthetists and membership of the college is attained by sitting for the examination of the Fellowship of the Royal College of Anesthetists (FRCA).

Surgical specialty Edit

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas (for example, a perforated ear drum). Surgeons must also manage pre-operative, post-operative, and potential surgical candidates on the hospital wards. Surgery has many sub-specialties, including general surgery, [28] ophthalmic surgery, [29] cardiovascular surgery, colorectal surgery, [30] neurosurgery, [31] oral and maxillofacial surgery, [32] oncologic surgery, [33] orthopedic surgery, [34] otolaryngology, [35] plastic surgery, [36] podiatric surgery, transplant surgery, trauma surgery, [37] urology, [38] vascular surgery, [39] and pediatric surgery [40] . In some centers, anesthesiology is part of the division of surgery (for historical and logistical reasons), although it is not a surgical discipline. Other medical specialties may employ surgical procedures, such as ophthalmology and dermatology, but are not considered surgical sub-specialties per se.

Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time-consuming.

Internal medicine specialty Edit

Internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. [41] According to some sources, an emphasis on internal structures is implied. [42] In North America, specialists in internal medicine are commonly called "internists." Elsewhere, especially in Commonwealth nations, such specialists are often called physicians. [43] These terms, internist or physician (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.

Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized such general physicians would see any complex nonsurgical problem this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys. [44]

In the Commonwealth of Nations and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of primary care.

There are many subspecialities (or subdisciplines) of internal medicine:

  • Angiology/Vascular Medicine
  • Bariatrics
  • Cardiology
  • Critical care medicine
  • Endocrinology
  • Gastroenterology
  • Geriatrics
  • Hematology
  • Hepatology
  • Infectious disease
  • Nephrology
  • Neurology
  • Oncology
  • Pediatrics
  • Pulmonology/Pneumology/Respirology/chest medicine
  • Rheumatology
  • Sports Medicine

Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on medical education and physician for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one- to three-year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the US. This difference does not apply in the UK where all doctors are now required by law to work less than 48 hours per week on average.

Diagnostic specialties Edit

  • Clinical laboratory sciences are the clinical diagnostic services that apply laboratory techniques to diagnosis and management of patients. In the United States, these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services. Subspecialties include transfusion medicine, cellular pathology, clinical chemistry, hematology, clinical microbiology and clinical immunology.
  • Pathology as a medical specialty is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology.
  • Diagnostic radiology is concerned with imaging of the body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonancetomography. Interventional radiologists can access areas in the body under imaging for an intervention or diagnostic sampling.
  • Nuclear medicine is concerned with studying human organ systems by administering radiolabelled substances (radiopharmaceuticals) to the body, which can then be imaged outside the body by a gamma camera or a PET scanner. Each radiopharmaceutical consists of two parts: a tracer that is specific for the function under study (e.g., neurotransmitter pathway, metabolic pathway, blood flow, or other), and a radionuclide (usually either a gamma-emitter or a positron emitter). There is a degree of overlap between nuclear medicine and radiology, as evidenced by the emergence of combined devices such as the PET/CT scanner.
  • Clinical neurophysiology is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include electroencephalography, electromyography, evoked potential, nerve conduction study and polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.

Other major specialties Edit

The following are some major medical specialties that do not directly fit into any of the above-mentioned groups:

  • Anesthesiology (also known as anaesthetics): concerned with the perioperative management of the surgical patient. The anesthesiologist's role during surgery is to prevent derangement in the vital organs' (i.e. brain, heart, kidneys) functions and postoperative pain. Outside of the operating room, the anesthesiology physician also serves the same function in the labor and delivery ward, and some are specialized in critical medicine.
  • Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
  • Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
  • Family medicine, family practice, general practice or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family physicians often provide services across a broad range of settings including office based practices, emergency department coverage, inpatient care, and nursing home care.
  • Obstetrics and gynecology (often abbreviated as OB/GYN (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
  • Medical genetics is concerned with the diagnosis and management of hereditary disorders.
  • Neurology is concerned with diseases of the nervous system. In the UK, neurology is a subspecialty of general medicine.
  • Ophthalmology is exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
  • Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
  • Pharmaceutical medicine is the medical scientific discipline concerned with the discovery, development, evaluation, registration, monitoring and medical aspects of marketing of medicines for the benefit of patients and public health.
  • Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
  • Podiatric medicine is the study of, diagnosis, and medical & surgical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
  • Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related fields include psychotherapy and clinical psychology.
  • Preventive medicine is the branch of medicine concerned with preventing disease.
    • Community health or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.

    Interdisciplinary fields Edit

    Some interdisciplinary sub-specialties of medicine include:

    • Aerospace medicine deals with medical problems related to flying and space travel.
    • Addiction medicine deals with the treatment of addiction.
    • Medical ethics deals with ethical and moral principles that apply values and judgments to the practice of medicine.
    • Biomedical Engineering is a field dealing with the application of engineering principles to medical practice.
    • Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
    • Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
    • Disaster medicine deals with medical aspects of emergency preparedness, disaster mitigation and management.
    • Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
    • Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
    • Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death, type of weapon used to inflict trauma, reconstruction of the facial features using remains of deceased (skull) thus aiding identification.
    • Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
    • Hospice and Palliative Medicine is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
    • Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the United States and Canada. The term Most Responsible Physician (MRP) or attending physician is also used interchangeably to describe this role.
    • Laser medicine involves the use of lasers in the diagnostics or treatment of various conditions.
    • Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
    • Health informatics is a relatively recent field that deal with the application of computers and information technology to medicine.
    • Nosology is the classification of diseases for various purposes.
    • Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.
    • Occupational medicine is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
    • Pain management (also called pain medicine, or algiatry) is the medical discipline concerned with the relief of pain.
    • Pharmacogenomics is a form of individualized medicine.
    • Podiatric medicine is the study of, diagnosis, and medical treatment of disorders of the foot, ankle, lower limb, hip and lower back.
    • Sexual medicine is concerned with diagnosing, assessing and treating all disorders related to sexuality.
    • Sports medicine deals with the treatment and prevention and rehabilitation of sports/exercise injuries such as muscle spasms, muscle tears, injuries to ligaments (ligament tears or ruptures) and their repair in athletes, amateur and professional.
    • Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health. [45]
    • Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
    • Tropical medicine deals with the prevention and treatment of tropical diseases. It is studied separately in temperate climates where those diseases are quite unfamiliar to medical practitioners and their local clinical needs.
    • Urgent care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency department. veterinarians apply similar techniques as physicians to the care of animals.
    • Wilderness medicine entails the practice of medicine in the wild, where conventional medical facilities may not be available.
    • Many other health science fields, e.g. dietetics

    Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or internship, or residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research. In Canada and the United States of America, a Doctor of Medicine degree, often abbreviated M.D., or a Doctor of Osteopathic Medicine degree, often abbreviated as D.O. and unique to the United States, must be completed in and delivered from a recognized university.

    Since knowledge, techniques, and medical technology continue to evolve at a rapid rate, many regulatory authorities require continuing medical education. Medical practitioners upgrade their knowledge in various ways, including medical journals, seminars, conferences, and online programs. A database of objectives covering medical knowledge, as suggested by national societies across the United States, can be searched at http://data.medobjectives.marian.edu/. [46]

    In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health.

    In the European Union, the profession of doctor of medicine is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for doctor of medicine in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC.

    Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.

    Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Six of the values that commonly apply to medical ethics discussions are:

      – the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.) – a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.) – concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). – "first, do no harm" (primum non-nocere). – the patient (and the person treating the patient) have the right to be treated with dignity. and honesty – the concept of informed consent has increased in importance since the historical events of the Doctors' Trial of the Nuremberg trials, Tuskegee syphilis experiment, and others.

    Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts. When moral values are in conflict, the result may be an ethical dilemma or crisis. Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient, family, or larger non-medical community. Conflicts can also arise between health care providers, or among family members. For example, some argue that the principles of autonomy and beneficence clash when patients refuse blood transfusions, considering them life-saving and truth-telling was not emphasized to a large extent before the HIV era.

    Ancient world Edit

    Prehistoric medicine incorporated plants (herbalism), animal parts, and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits) shamanism (the vesting of an individual with mystic powers) and divination (magically obtaining the truth). The field of medical anthropology examines the ways in which culture and society are organized around or impacted by issues of health, health care and related issues.

    In Egypt, Imhotep (3rd millennium BCE) is the first physician in history known by name. The oldest Egyptian medical text is the Kahun Gynaecological Papyrus from around 2000 BCE, which describes gynaecological diseases. The Edwin Smith Papyrus dating back to 1600 BCE is an early work on surgery, while the Ebers Papyrus dating back to 1500 BCE is akin to a textbook on medicine. [47]

    In China, archaeological evidence of medicine in Chinese dates back to the Bronze Age Shang Dynasty, based on seeds for herbalism and tools presumed to have been used for surgery. [48] The Huangdi Neijing, the progenitor of Chinese medicine, is a medical text written beginning in the 2nd century BCE and compiled in the 3rd century. [49]

    In India, the surgeon Sushruta described numerous surgical operations, including the earliest forms of plastic surgery. [50] [ dubious – discuss ] [51] Earliest records of dedicated hospitals come from Mihintale in Sri Lanka where evidence of dedicated medicinal treatment facilities for patients are found. [52] [53]

    In Greece, the Greek physician Hippocrates, the "father of modern medicine", [54] [55] laid the foundation for a rational approach to medicine. Hippocrates introduced the Hippocratic Oath for physicians, which is still relevant and in use today, and was the first to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence". [56] [57] The Greek physician Galen was also one of the greatest surgeons of the ancient world and performed many audacious operations, including brain and eye surgeries. After the fall of the Western Roman Empire and the onset of the Early Middle Ages, the Greek tradition of medicine went into decline in Western Europe, although it continued uninterrupted in the Eastern Roman (Byzantine) Empire.

    Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals. The Hebrew contribution to the development of modern medicine started in the Byzantine Era, with the physician Asaph the Jew. [58]

    Middle Ages Edit

    The concept of hospital as institution to offer medical care and possibility of a cure for the patients due to the ideals of Christian charity, rather than just merely a place to die, appeared in the Byzantine Empire. [59]

    Although the concept of uroscopy was known to Galen, he did not see the importance of using it to localize the disease. It was under the Byzantines with physicians such of Theophilus Protospatharius that they realized the potential in uroscopy to determine disease in a time when no microscope or stethoscope existed. That practice eventually spread to the rest of Europe. [60]

    After 750 CE, the Muslim world had the works of Hippocrates, Galen and Sushruta translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include the Persian polymath, Avicenna, who, along with Imhotep and Hippocrates, has also been called the "father of medicine". [61] He wrote The Canon of Medicine which became a standard medical text at many medieval European universities, [62] considered one of the most famous books in the history of medicine. [63] Others include Abulcasis, [64] Avenzoar, [65] Ibn al-Nafis, [66] and Averroes. [67] Persian physician Rhazes [68] was one of the first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine. [69] Some volumes of Rhazes's work Al-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. [70] Additionally, he has been described as a doctor's doctor, [71] the father of pediatrics, [72] [73] and a pioneer of ophthalmology. For example, he was the first to recognize the reaction of the eye's pupil to light. [73] The Persian Bimaristan hospitals were an early example of public hospitals. [74] [75]

    In Europe, Charlemagne decreed that a hospital should be attached to each cathedral and monastery and the historian Geoffrey Blainey likened the activities of the Catholic Church in health care during the Middle Ages to an early version of a welfare state: "It conducted hospitals for the old and orphanages for the young hospices for the sick of all ages places for the lepers and hostels or inns where pilgrims could buy a cheap bed and meal". It supplied food to the population during famine and distributed food to the poor. This welfare system the church funded through collecting taxes on a large scale and possessing large farmlands and estates. The Benedictine order was noted for setting up hospitals and infirmaries in their monasteries, growing medical herbs and becoming the chief medical care givers of their districts, as at the great Abbey of Cluny. The Church also established a network of cathedral schools and universities where medicine was studied. The Schola Medica Salernitana in Salerno, looking to the learning of Greek and Arab physicians, grew to be the finest medical school in Medieval Europe. [76]

    However, the fourteenth and fifteenth century Black Death devastated both the Middle East and Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Middle East. [77] In the early modern period, important early figures in medicine and anatomy emerged in Europe, including Gabriele Falloppio and William Harvey.

    The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general – see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Vesalius improved upon or disproved some of the theories from the past. The main tomes used both by medicine students and expert physicians were Materia Medica and Pharmacopoeia.

    Andreas Vesalius was the author of De humani corporis fabrica, an important book on human anatomy. [78] Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology. [79] Independently from Ibn al-Nafis, Michael Servetus rediscovered the pulmonary circulation, but this discovery did not reach the public because it was written down for the first time in the "Manuscript of Paris" [80] in 1546, and later published in the theological work for which he paid with his life in 1553. Later this was described by Renaldus Columbus and Andrea Cesalpino. Herman Boerhaave is sometimes referred to as a "father of physiology" due to his exemplary teaching in Leiden and textbook 'Institutiones medicae' (1708). Pierre Fauchard has been called "the father of modern dentistry". [81]

    Modern Edit

    Veterinary medicine was, for the first time, truly separated from human medicine in 1761, when the French veterinarian Claude Bourgelat founded the world's first veterinary school in Lyon, France. Before this, medical doctors treated both humans and other animals.

    Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Edward Jenner's discovery of the smallpox vaccine at the end of the 18th century (inspired by the method of inoculation earlier practiced in Asia), Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900.

    The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austria, doctors Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner and Otto Loewi made notable contributions. In the United Kingdom, Alexander Fleming, Joseph Lister, Francis Crick and Florence Nightingale are considered important. Spanish doctor Santiago Ramón y Cajal is considered the father of modern neuroscience.

    As science and technology developed, medicine became more reliant upon medications. Throughout history and in Europe right until the late 18th century, not only animal and plant products were used as medicine, but also human body parts and fluids. [82] Pharmacology developed in part from herbalism and some drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, [83] taxol, hyoscine, etc.). [84] Vaccines were discovered by Edward Jenner and Louis Pasteur.

    The first antibiotic was arsphenamine (Salvarsan) discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. The first major class of antibiotics was the sulfa drugs, derived by German chemists originally from azo dyes.

    Pharmacology has become increasingly sophisticated modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics and human evolution is having increasingly significant influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology, evolution, and genetics are influencing medical technology, practice and decision-making.

    Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by modern global information science, which allows as much of the available evidence as possible to be collected and analyzed according to standard protocols that are then disseminated to healthcare providers. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect. [85]

    Evidence-based medicine, prevention of medical error (and other "iatrogenesis"), and avoidance of unnecessary health care are a priority in modern medical systems. These topics generate significant political and public policy attention, particularly in the United States where healthcare is regarded as excessively costly but population health metrics lag similar nations. [86]

    Globally, many developing countries lack access to care and access to medicines. [87] As of 2015, most wealthy developed countries provide health care to all citizens, with a few exceptions such as the United States where lack of health insurance coverage may limit access. [88]

    The World Health Organization (WHO) defines traditional medicine as "the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness." [89] Practices known as traditional medicines include Ayurveda, Siddha medicine, Unani, ancient Iranian medicine, Irani, Islamic medicine, traditional Chinese medicine, traditional Korean medicine, acupuncture, Muti, Ifá, and traditional African medicine. [90]

    The WHO stated that "inappropriate use of traditional medicines or practices can have negative or dangerous effects" and that "further research is needed to ascertain the efficacy and safety" of several of the practices and medicinal plants used by traditional medicine systems. [89] As example, Indian Medical Association regard traditional medicine practices, such as Ayurveda and Siddha medicine, as quackery. [91] [92] [93] Practitioners of traditional medicine are not authorized to practice medicine in India unless trained at a qualified medical institution, registered with the government, and listed as registered physicians annually in The Gazette of India. [91] [92] Identifying practitioners of traditional medicine, the Supreme Court of India stated in 2018 that "unqualified, untrained quacks are posing a great risk to the entire society and playing with the lives of people without having the requisite training and education in the science from approved institutions". [91]

    Evidence on the effectiveness of the alternative medicine practice of acupuncture is "variable and inconsistent" for any condition, [94] but is generally safe when done by an appropriately trained practitioner. [95]

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      – Form of non-scientific healing – Wikimedia list article – Wikipedia list article – Wikipedia list article – Wikipedia list article – System of moral principles of the practice of medicine – part of the US health system's reimbursement process – Legal cause of action when health professionals deviate from standards of practice harming a patient – Promotion of fraudulent or ignorant medical practices – Medicine based on traditional beliefs
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    Promoting rational use of medicines

    Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.

    A major global problem

    Irrational use of medicines is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards. Examples of irrational use of medicines include: use of too many medicines per patient ("poly-pharmacy") inappropriate use of antimicrobials, often in inadequate dosage, for non-bacterial infections over-use of injections when oral formulations would be more appropriate failure to prescribe in accordance with clinical guidelines inappropriate self-medication, often of prescription-only medicines non-adherence to dosing regimes.

    WHO advocates 12 key interventions to promote more rational use:

    • Establishment of a multidisciplinary national body to coordinate policies on medicine use
    • Use of clinical guidelines
    • Development and use of national essential medicines list
    • Establishment of drug and therapeutics committees in districts and hospitals
    • Inclusion of problem-based pharmacotherapy training in undergraduate curricula
    • Continuing in-service medical education as a licensure requirement
    • Supervision, audit and feedback
    • Use of independent information on medicines
    • Public education about medicines
    • Avoidance of perverse financial incentives
    • Use of appropriate and enforced regulation
    • Sufficient government expenditure to ensure availability of medicines and staff.

    Ensure therapeutically sound and cost-effective use of medicines by health professionals and consumers.

    Improving the use of medicines by health workers and the general public is crucial both to reducing morbidity and mortality from communicable and non-communicable diseases, and to containing drug expenditure.

    Ideally, therapeutically sound and cost-effective use of medicines by health professionals and consumers is achieved at all levels of the health system, and in both the public and the private sectors. A sound rational drug use programme in any country has three elements:

    • Rational use of medicines strategy and monitoring -- advocating rational medicines use, identifying and promoting successful strategies, and securing responsible medicines promotion.
    • Rational use of medicines by health professionals -- working with countries to develop and update their treatment guidelines, national essential medicines lists and formularies, and supporting training programmes on rational use of medicines.
    • Rational use of medicines by consumers -- supporting the creation of effective systems of medicines information, and empowering consumers to take responsible decisions regarding their treatment.

    The above elements were developed in close collaboration with the regional and country offices. They are formulated in such a way as to reflect the main responsibilities of a national essential medicines programme.

    Rational medicine use strategy and monitoring : Support countries in implementing and monitoring a national strategy to promote rational use of medicines by health professionals and consumers.

    Rational medicine use by health professionals: Develop national standard treatment guidelines, essential medicine lists, educational programmes and other effective mechanisms to promote rational medicine use by health professionals.

    Rational medicine use by consumers : Establishing effective medicines information systems to provide independent and unbiased medicine information &ndash including on traditional medicine &ndash to the general public and to improve medicine use by consumers.


    Contents

    Classical history Edit

    In the written record, the study of herbs dates back 5,000 years to the ancient Sumerians, who described well-established medicinal uses for plants. In Ancient Egyptian medicine, the Ebers papyrus from c. 1552 BC records a list of folk remedies and magical medical practices. [3] The Old Testament also mentions herb use and cultivation in regards to Kashrut.

    Many herbs and minerals used in Ayurveda were described by ancient Indian herbalists such as Charaka and Sushruta during the 1st millennium BC. [4] The first Chinese herbal book was the Shennong Bencao Jing, compiled during the Han Dynasty but dating back to a much earlier date, which was later augmented as the Yaoxing Lun (Treatise on the Nature of Medicinal Herbs) during the Tang Dynasty. Early recognised Greek compilers of existing and current herbal knowledge include Pythagoras and his followers, Hippocrates, Aristotle, Theophrastus, Dioscorides and Galen.

    Roman sources included Pliny the Elder's Natural History and Celsus's De Medicina. [5] Pedanius Dioscorides drew on and corrected earlier authors for his De Materia Medica, adding much new material the work was translated into several languages, and Turkish, Arabic and Hebrew names were added to it over the centuries. [6] Latin manuscripts of De Materia Medica were combined with a Latin herbal by Apuleius Platonicus (Herbarium Apuleii Platonici) and were incorporated into the Anglo-Saxon codex Cotton Vitellius C.III. These early Greek and Roman compilations became the backbone of European medical theory and were translated by the Persian Avicenna (Ibn Sīnā, 980–1037), the Persian Rhazes (Rāzi, 865–925) and the Jewish Maimonides. [5]

    Some fossils have been used in traditional medicine since antiquity. [7]

    Medieval and later Edit

    Arabic indigenous medicine developed from the conflict between the magic-based medicine of the Bedouins and the Arabic translations of the Hellenic and Ayurvedic medical traditions. [8] Spanish medicine was influenced by the Arabs from 711 to 1492. [9] Islamic physicians and Muslim botanists such as al-Dinawari [10] and Ibn al-Baitar [11] significantly expanded on the earlier knowledge of materia medica. The most famous Persian medical treatise was Avicenna's The Canon of Medicine, which was an early pharmacopoeia and introduced clinical trials. [12] [13] [14] The Canon was translated into Latin in the 12th century and remained a medical authority in Europe until the 17th century. The Unani system of traditional medicine is also based on the Canon. [15]

    Translations of the early Roman-Greek compilations were made into German by Hieronymus Bock whose herbal, published in 1546, was called Kreuter Buch. The book was translated into Dutch as Pemptades by Rembert Dodoens (1517–1585), and from Dutch into English by Carolus Clusius, (1526–1609), published by Henry Lyte in 1578 as A Nievve Herball. This became John Gerard's (1545–1612) Herball or General Historie of Plantes. [5] [6] Each new work was a compilation of existing texts with new additions.

    Women's folk knowledge existed in undocumented parallel with these texts. [5] Forty-four drugs, diluents, flavouring agents and emollients mentioned by Dioscorides are still listed in the official pharmacopoeias of Europe. [6] The Puritans took Gerard's work to the United States where it influenced American Indigenous medicine. [5]

    Francisco Hernández, physician to Philip II of Spain spent the years 1571–1577 gathering information in Mexico and then wrote Rerum Medicarum Novae Hispaniae Thesaurus, many versions of which have been published including one by Francisco Ximénez. Both Hernandez and Ximenez fitted Aztec ethnomedicinal information into the European concepts of disease such as "warm", "cold", and "moist", but it is not clear that the Aztecs used these categories. [16] Juan de Esteyneffer's Florilegio medicinal de todas las enfermedas compiled European texts and added 35 Mexican plants.

    Martín de la Cruz wrote an herbal in Nahuatl which was translated into Latin by Juan Badiano as Libellus de Medicinalibus Indorum Herbis or Codex Barberini, Latin 241 and given to King Carlos V of Spain in 1552. [17] It was apparently written in haste [18] and influenced by the European occupation of the previous 30 years. Fray Bernardino de Sahagún's used ethnographic methods to compile his codices that then became the Historia General de las Cosas de Nueva España, published in 1793. [17] Castore Durante published his Herbario Nuovo in 1585 describing medicinal plants from Europe and the East and West Indies. It was translated into German in 1609 and Italian editions were published for the next century.

    Colonial America Edit

    In 17th and 18th-century America, traditional folk healers, frequently women, used herbal remedies, cupping and leeching. [19] Native American traditional herbal medicine introduced cures for malaria, dysentery, scurvy, non-venereal syphilis, and goiter problems. [20] Many of these herbal and folk remedies continued on through the 19th and into the 20th century, [21] with some plant medicines forming the basis for modern pharmacology. [22]

    Modern usage Edit

    The prevalence of folk medicine in certain areas of the world varies according to cultural norms. [23] Some modern medicine is based on plant phytochemicals that had been used in folk medicine. [24] Researchers state that many of the alternative treatments are "statistically indistinguishable from placebo treatments". [25]

    Indigenous medicine is generally transmitted orally through a community, family and individuals until "collected". Within a given culture, elements of indigenous medicine knowledge may be diffusely known by many, or may be gathered and applied by those in a specific role of healer such as a shaman or midwife. [26] Three factors legitimize the role of the healer – their own beliefs, the success of their actions and the beliefs of the community. [27] When the claims of indigenous medicine become rejected by a culture, generally three types of adherents still use it – those born and socialized in it who become permanent believers, temporary believers who turn to it in crisis times, and those who only believe in specific aspects, not in all of it. [28] [ verification needed ]

    Traditional medicine may sometimes be considered as distinct from folk medicine, and the considered to include formalized aspects of folk medicine. Under this definition folk medicine are longstanding remedies passed on and practiced by lay people. Folk medicine consists of the healing practices and ideas of body physiology and health preservation known to some in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience. [29]

    Folk medicine Edit

    Many countries have practices described as folk medicine which may coexist with formalized, science-based, and institutionalized systems of medical practice represented by conventional medicine. [30] Examples of folk medicine traditions are traditional Chinese medicine, traditional Korean medicine, Arabic indigenous medicine, Uyghur traditional medicine, Japanese Kampō medicine, traditional Aboriginal bush medicine, Native Hawaiian Lāʻau lapaʻau, and Georgian folk medicine, among others. [31]

    Australian bush medicine Edit

    Generally, bush medicine used by Aboriginal and Torres Strait Islander people in Australia is made from plant materials, such as bark, leaves and seeds, although animal products may be used as well. [32] A major component of traditional medicine is herbal medicine, which is the use of natural plant substances to treat or prevent illness. [33]

    Native American medicine Edit

    American Native and Alaska Native medicine are traditional forms of healing that have been around for thousands of years.

    Nattuvaidyam Edit

    Nattuvaidyam was a set of indigenous medical practices that existed in India before the advent of allopathic or western medicine. [34] These practices had different set of principles and ideas of the body, health and disease. There were overlaps and borrowing of ideas, medicinal compounds used and techniques within these practices. [35] Some of these practices had written texts in vernacular languages like Malayalam, Tamil, Telugu, etc. while others were handed down orally through various mnemonic devices. Ayurveda was one kind of nattuvaidyam practised in south India. [36] The others were kalarichikitsa (related to bone setting and musculature), [37] marmachikitsa (vital spot massaging), ottamoolivaidyam (single dose medicine or single time medication), [38] chintamanivaidyam and so on. When the medical system was revamped in twentieth century India, many of the practices and techniques specific to some of these diverse nattuvaidyam was included in Ayurveda.

    Home remedies Edit

    A home remedy (sometimes also referred to as a granny cure) is a treatment to cure a disease or ailment that employs certain spices, herbs, vegetables, or other common items. Home remedies may or may not have medicinal properties that treat or cure the disease or ailment in question, as they are typically passed along by laypersons (which has been facilitated in recent years by the Internet). Many are merely used as a result of tradition or habit or because they are effective in inducing the placebo effect. [39]

    One of the more popular examples of a home remedy is the use of chicken soup to treat respiratory infections such as a cold or mild flu. Other examples of home remedies include duct tape to help with setting broken bones and duct tape or superglue to treat plantar warts and Kogel mogel to treat sore throat. In earlier times, mothers were entrusted with all but serious remedies. Historic cookbooks are frequently full of remedies for dyspepsia, fevers, and female complaints. [40] Components of the aloe vera plant are used to treat skin disorders. [41] Many European liqueurs or digestifs were originally sold as medicinal remedies. In Chinese folk medicine, medicinal congees (long-cooked rice soups with herbs), foods, and soups are part of treatment practices. [42]

    Safety concerns Edit

    Although 130 countries have regulations on folk medicines, there are risks associated with the use of them (i.e. zoonosis, mainly as some traditional medicines still use animal-based substances [43] [44] ). It is often assumed that because supposed medicines are natural that they are safe, but numerous precautions are associated with using herbal remedies. [45]

    Use of endangered species Edit

    Endangered animals, such as the slow loris, are sometimes killed to make traditional medicines. [46]

    Shark fins have also been used in traditional medicine, and although their effectiveness has not been proven, it is hurting shark populations and their ecosystem. [47]

    The illegal ivory trade can partially be traced back to buyers of traditional Chinese medicine. Demand for ivory is a huge factor in the poaching of endangered species such as rhinos and elephants. [48]


    Habilitative Services and Devices

    The EHB benchmark plans displayed may not include coverage of habilitative services and devices. Pursuant to 45 CFR 156.110(f), the State may determine which services are included in the habilitative services and devices category if the base-benchmark plan does not include such coverage. If the State does not supplement the missing habilitative services and devices category, issuers should cover habilitative services and devices as defined in 45 CFR 156.115(a)(5)(i).


    Essential Oils

    Essential oils, which are obtained through mechanical pressing or distillation, are concentrated plant extracts that retain the natural smell and flavor of their source. As an example, about 220 pounds of lavender flowers are needed to produce a pound of lavender oil.

    Each essential oil has a unique composition of chemicals, and this variation affects the smell, absorption, and effects on the body. The chemical composition of an essential oil may vary within the same plant species, or from plant to plant.

    Synthetic oils are not considered true essential oils.

    Have researchers studied essential oils?

    Previous studies have shown that lavender and tea tree oil may act as endocrine disrupting chemicals (EDCs), which are natural or man-made compounds that mimic or oppose the actions of hormones produced in the human body. Also, clinical research found a possible link between the topical use of essential oils and the onset of male gynecomastia, or the development of breast tissue, in prepubescent boys. Since lavender and tea tree oil are composed of hundreds of chemicals, NIEHS scientists wanted to find out which of these chemicals displayed hormonal activity that could potentially lead to prepubertal gynecomastia.

    What is NIEHS Doing?

    NIEHS Lavender Oil and Tea Tree Oil Study

    How did NIEHS researchers conduct the study?

    The scientists applied pure essential lavender oil, tea tree oil, or eight of their chemical components to human cell lines in test tubes, known as in vitro experiments. They found that the compounds displayed a range of hormonal activities, which may stimulate prepubertal gynecomastia in boys.

    Which essential oils and components were tested in the NIEHS study?

    The researchers tested pure essential lavender and tea tree oils, as well as four chemicals commonly found in both: eucalyptol, 4-terpinenol, dipentene/limonene, and alpha-terpineol. These compounds were selected because the International Standard Organization mandated that they be included in both lavender and tea tree oils. The NIEHS research team also studied linalyl acetate and linalool, which are specific to lavender oil, and alpha-terpinene and gamma-terpinene, which are specific to tea tree oil.

    Do other essential oils contain these chemicals?

    According to an analysis of the chemical components of 93 essential oils, the eight chemicals selected in the NIEHS study appeared in most, as indicated in the list below. Each of the eight chemicals is followed by the number of oils in which it appeared.

    • dipentene/limonene &ndash 90
    • alpha-terpineol &ndash 87
    • linalool &ndash 82
    • 4-terpinenol &ndash 80
    • eucalyptol &ndash 79
    • gamma-terpinene &ndash 79
    • alpha-terpinene &ndash 77
    • linalyl acetate &ndash 62

    What age range are boys at risk for gynecomastia?

    Male gynecomastia is a common clinical symptom observed during infancy, adolescence, and older age. Some physicians theorize that periods of major hormonal change may lead to the condition. However, prepubertal gynecomastia is relatively rare due to lower circulating hormone levels. Some scientists suspect that boys in this range may be more susceptible to hormonal changes and disrupting chemicals, which may lead to gynecomastia.

    Is direct skin exposure the main link to male gynecomastia or can smelling or inhaling essential oils, as in aromatherapy, be linked, too?

    The clinical cases have only described using essential oils on skin or topical exposure and not aromatherapy. In the NIEHS study, the team described whether topical exposure to the chemicals led to hormonal activity. Further studies are needed to determine if the same can be said about aromatherapy.

    Are girls or women affected by lavender and tea tree oils?

    No clinical cases describing abnormal breast growth in prepubescent girls or women have been reported. However, because breast growth is a natural process for pubescent girls, it is more difficult to determine whether pure essential lavender oil or tea tree oil have the same effect in females as males.

    Are there differences between diluted essential oils and pure essential oils?

    NIEHS researchers created different dilutions of the two types of pure essential oils and the eight selected chemical components and tested their activity. They found as the dilution increased, the EDC activity of the oils and chemicals decreased.

    Should the public discontinue the use of essential oils? Why or why not?

    Using essential oils is up to the individual. The researchers want the public to be aware of the findings, since some essential oils and their components display hormonal activity and could be potential EDCs.


    Watch the video: Συγκινητικό:Η μιλά για το πως θεραπεύτηκε από τις κρίσεις πανικού. (September 2022).


Comments:

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