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The NSW Government is investing an additional $4 million to fast-track the redevelopment of Shoalhaven District Memorial Hospital to begin in 2020-21.Minister for Health Brad Hazzard said the funding boost will bring the total spend for the project to how to buy cheap propecia online $438 million, which will also support the acquisition of nearby Nowra Park.“The NSW Government is committed to investing in regional hospitals to ensure patients receive high-quality healthcare closer to home,” Mr Hazzard said.“The land acquisition of Nowra Park is necessary to provide for the expansion of clincial services at Shoalhaven Hospital.”The existing hospital site with expansion into the adjacent Nowra Park has been identified as the best solution for the redeveloped hospital.Clinical services planning is already well underway to identify the range of health services the Illawarra Shoalhaven community will require into the future. The additional funding will allow planning activities how to buy cheap propecia online to progress including:Detailed site investigations, including in-ground investigations. Enabling works, including services how to buy cheap propecia online diversion and potential in-ground works. And Design works how to buy cheap propecia online for the redevelopment, including clinical design.

Member for the South Coast Shelley Hancock released new artist impressions and said residents will benefit from the hospital expansion, with new and upgraded health facilities to be delivered sooner.“Additionally, as we can see in these stunning images, the completed hospital will return green space back to the community, with an inclusive playground a key component of the park,” Mrs Hancock said.Member for Kiama Gareth Ward said he’s pleased work can get underway on the expanded hospital as soon as possible.“With the ongoing investments we have already put into the Shoalhaven District Memorial Hospital, this is the next big step after the completion of the $11.8 million hospital car park project this year,” Mr Ward said.Construction will start on the redeveloped hospital in this term of Government, prior to March 2023The SDMH redevelopment is one of 29 health projects announced before the 2019 election and is a part of the NSW Government’s record $10.7 billion investment in health infrastructure over the next 4 years.In the Illawarra Shoalhaven, other health projects include $700 million for a new Shellharbour Hospital, $37.1 million towards the Bulli Hospital and Aged Care Centre, and the Dapto and Ulladulla HealthOne projects, delivered as part of the $100 million HealthOne program.Artist impressions are available.Minister for Health Brad Hazzard, Member for Kiama Gareth Ward MP and Member for South Coast Shelley Hancock MP have today announced the Illawarra community is a step closer to having a new world-class $700 how to buy cheap propecia online million Shellharbour Hospital, with the search now on for the ideal site.Minister Hazzard said the NSW Government is calling for proposals from landowners of suitable greenfield sites in the Shellharbour region.“The NSW Government is fulfilling its promise to deliver the $700 million state-of-the-art Shellharbour Hospital on a greenfield site, together with new networked health services, to meet the communities’ healthcare needs,” Mr Hazzard said.“We’re launching a thorough site selection process to secure a hospital site that is convenient, accessible and best placed to provide future health services to communities across the entire Illawarra region.”The public site selection process is now open, inviting landowners to nominate potentially suitable sites for consideration.Submissions will close on Friday 4 December.Member for Kiama Gareth Ward said finding the right site was key to unlocking the future health growth of the Shellharbour region.“Building Shellharbour Hospital on a new site will enable the expansion of health services which will ease waiting list pressures across the region,” Mr Ward said.“It will also allow for a contemporary new mental health facility, better transport links and opportunities for further expansion in the future.”Member for South Coast Shelley Hancock said local clinicians, staff and the broader community all have a vital role to play in planning for the new hospital.“The community’s input will help shape the future of healthcare in our region, ensuring the new hospital is an enormous asset to our local community in providing the best possible health services and creating jobs well into the future,” Mrs Hancock said.“Following further planning and consultation, the new hospital is expected to include acute medical and surgical services, medical imaging, an emergency department, mental health services, outpatient and ambulatory care and a multistorey car park.”The NSW Government has invested $10 billion to deliver more than 130 new and enhanced health facilities statewide since 2011, including $37.1 million towards the Bulli Hospital and Aged Care Centre. In addition, as part of the $100 million HealthOne Program, two new HealthOne projects have been developed in the Illawarra, at Dapto and Ulladulla.The NSW Government is also investing how to buy cheap propecia online $10.7 billion more over the next four years, including $900 million for new and upgraded regional hospitals and health facilities for rural and regional areas in 2020-21.To suggest a site visit Colliers websiteTo learn more about the project visit Shellharbour Hospital Redevelopmentor email ISLHD-SHH-Redevelopment@health.nsw.gov.au.

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It provides a career pathway and an exciting opportunity for our Biomedical Scientists to apply and develop their clinical and scientific knowledge and expertise through the consultant level HSST training programme, with the key benefit of improving and enhancing the clinical care and services bald truth propecia we provide to our patients.On reviewing the changes, IBMS President Allan Wilson commented:The inclusion of Biomedical Scientists as an eligible professional group for the HSST programme will provide a route to consultant level posts for Biomedical Scientists and recognises the breadth and depth of experience and clinical skills that exist within the profession. This new training route will improve patient pathways by the addition of experienced clinical experts to the currently stretched consultant capacity. This is tremendous news for Biomedical bald truth propecia Scientists and healthcare in the UK.If you have any questions after reading the statement please contact us via. Website@ibms.orgRead the statement and new eligibility criteria in full (or download) below:Joint Statement on HSST EligibilitySignificant scientific workforce shortages at senior levels have been identified in several Life Science specialties, which have been further highlighted during the hair loss treatment propecia.

The Higher bald truth propecia Specialist Scientific Training (HSST) Programme trains Healthcare Scientists to consultant level, however HSST is currently not open to all individual scientists with the potential to develop and take on the role of a consultant scientist.The National School of Healthcare Science in Health Education England, Academy for Healthcare Science, Institute of Biomedical Science (IBMS), Royal College of Pathologists (RCPath) and Manchester Academy of Healthcare Scientist Education are pleased to announce a widening of the of the eligibility criteria for HSST. The new criteria will allow appropriately qualified senior Biomedical Scientists, who can demonstrate ability to work at Level 7 via academic and professional qualifications, to apply to join the programme. Both Biomedical Scientists and Clinical Scientists will be subject to the same HSST interview process to determine suitability bald truth propecia and readiness. The qualifications to confer eligibility will include:1) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and relevant MSc2) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Higher Specialist Diploma or IBMS 2-part Fellowship Special Exam3) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Diploma of Expert PracticeEligible individuals will also need to meet the requirements of the Universities to commence a doctoral level programme, including a First or 2:1 Bachelor’s degree and a Master’s degree in a relevant subject area or evidence of having written at that standard, and a minimum of four years working in a professional role.

In addition, training departments will need to achieve HSST bald truth propecia training accreditation through the NSHCS to be successful in the commissioning rounds. This includes demonstration of suitable workplace and research supervision at doctoral level, access to training to meet the specialism curriculum and HSS Standards of Proficiency, and senior level trust support.All Life Science HSSTs must obtain Fellowship of the Royal College of Pathologists during the programme in order to complete HSST, in addition to the academic qualification and evidence of their workplace training. These requirements of the programme are identical for Clinical Scientists and Biomedical Scientists on HSST.This revised admission criteria bald truth propecia to HSST is endorsed by NHS Education for Scotland - Healthcare Science. We look forward to working with all agencies concerned with the development of the next generation of consultant-level healthcare scientists.All scientists who successfully complete the HSST programme or equivalence are eligible to join the Academy for Healthcare Science HSS Register and become a Fellow.This change to the HSST eligibility criteria will apply from 2021 entry to the HSST programme.7 September 2020 The four day digital event will feature content aimed at all IBMS members and will be free to attend SAVE THE DATE - 16-19th NovemberOur new, virtual CPD event, The Biomedical Scientist Live, will feature a packed line up of knowledge sharing sessions including.

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It provides a career pathway and an exciting opportunity for our Biomedical Scientists to apply and develop their clinical and scientific knowledge and expertise through the consultant level HSST training programme, with the key benefit of improving and enhancing the clinical care and services we provide to our patients.On reviewing the changes, IBMS President Allan Wilson commented:The inclusion of Biomedical Scientists as an eligible professional group for the HSST programme will provide a route to consultant level posts for Biomedical Scientists and recognises the breadth and depth of how to buy cheap propecia online experience and clinical skills that exist within the profession. This new training route will improve patient pathways by the addition of experienced clinical experts to the currently stretched consultant capacity. This is how to buy cheap propecia online tremendous news for Biomedical Scientists and healthcare in the UK.If you have any questions after reading the statement please contact us via. Website@ibms.orgRead the statement and new eligibility criteria in full (or download) below:Joint Statement on HSST EligibilitySignificant scientific workforce shortages at senior levels have been identified in several Life Science specialties, which have been further highlighted during the hair loss treatment propecia.

The Higher Specialist Scientific Training (HSST) Programme trains Healthcare Scientists to consultant level, however HSST is currently not open to all individual scientists with the potential to develop and take on the role of a consultant scientist.The National School of Healthcare Science in Health Education England, Academy for Healthcare how to buy cheap propecia online Science, Institute of Biomedical Science (IBMS), Royal College of Pathologists (RCPath) and Manchester Academy of Healthcare Scientist Education are pleased to announce a widening of the of the eligibility criteria for HSST. The new criteria will allow appropriately qualified senior Biomedical Scientists, who can demonstrate ability to work at Level 7 via academic and professional qualifications, to apply to join the programme. Both Biomedical Scientists and Clinical Scientists will how to buy cheap propecia online be subject to the same HSST interview process to determine suitability and readiness. The qualifications to confer eligibility will include:1) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and relevant MSc2) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Higher Specialist Diploma or IBMS 2-part Fellowship Special Exam3) HCPC Registration as a Biomedical Scientist, IBMS Specialist Diploma and IBMS Diploma of Expert PracticeEligible individuals will also need to meet the requirements of the Universities to commence a doctoral level programme, including a First or 2:1 Bachelor’s degree and a Master’s degree in a relevant subject area or evidence of having written at that standard, and a minimum of four years working in a professional role.

In addition, training departments will need to achieve HSST training accreditation through the NSHCS to be successful in the commissioning rounds how to buy cheap propecia online. This includes demonstration of suitable workplace and research supervision at doctoral level, access to training to meet the specialism curriculum and HSS Standards of Proficiency, and senior level trust support.All Life Science HSSTs must obtain Fellowship of the Royal College of Pathologists during the programme in order to complete HSST, in addition to the academic qualification and evidence of their workplace training. These requirements of the programme are identical for how to buy cheap propecia online Clinical Scientists and Biomedical Scientists on HSST.This revised admission criteria to HSST is endorsed by NHS Education for Scotland - Healthcare Science. We look forward to working with all agencies concerned with the development of the next generation of consultant-level healthcare scientists.All scientists who successfully complete the HSST programme or equivalence are eligible to join the Academy for Healthcare Science HSS Register and become a Fellow.This change to the HSST eligibility criteria will apply from 2021 entry to the HSST programme.7 September 2020 The four day digital event will feature content aimed at all IBMS members and will be free to attend SAVE THE DATE - 16-19th NovemberOur new, virtual CPD event, The Biomedical Scientist Live, will feature a packed line up of knowledge sharing sessions including.

Workshops, seminars, discussions and how to buy cheap propecia online demonstrations. The dedicated event website will be live soon and will include more information on how to sign up, free for IBMS members, and the programme of talks. Members will be notified once live..

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Wondering how to keep http://ukbusinessawards.com/flagyl-online/ your celebrity propecia users glasses from fogging up when your mask is on?. Look no further. If we've learned one thing throughout the hair loss treatment propecia, it's the importance of wearing a mask. Countless studies have shown over the past eight months that celebrity propecia users wearing a protective barrier over your nose and mouth — whether it's a standard-issue surgical mask or an N95 respirator — can significantly decrease the odds of catching and transmitting disease. What's more, some research shows that masking up can reduce the severity of an if a masked person does contract hair loss treatment.

But while masks are potentially lifesaving, they can be uncomfortable, often changing your breathing patterns and fogging up your glasses when breath escapes through the top of the mask. Among people who choose celebrity propecia users not to wear a mask to prevent the spread of hair loss treatment, many cite discomfort as a key reason why.Wesley Wilson, a tumor immunologist in Pennsylvania, knows how annoying it can be when your glasses are fogging up. He says fogging is “definitely a problem” among his hospital colleagues, who need to wear protective goggles and surgical masks while on the job. Fortunately, they've also picked up a few helpful hacks for keeping their vision clear while wearing a mask with glasses.#1. Use Tape“If celebrity propecia users you have to keep your mask on for hours, tape works like a charm,” Wilson says.

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The lymph nodes were known in antiquity—you can see them without a microscope—and were first described in Peri Adenon (On Glands), the Hippocratic treatise that see this here has been described as a “milestone” in the history of immunology.” But the rest of the lymphatic system was more propecia side effects go away with continued use inscrutable. It wasn’t until relatively recently that science really began to understand the lymph system. We are, in fact, still uncovering some of the secrets of this crucial part of our physiology.On Guard Against AntigensThe word lymph comes propecia side effects go away with continued use from the Latin word lympha, which means water. Lympha was in turn derived from the Greek word nymph, those divine ladies who haunt forests and streams.

This one inhabits your immune system. While the image of a water nymph is a lovely one, the lymphatic system might be best thought propecia side effects go away with continued use of more prosaically as a complex drainage and purifying system. It is a network of tiny vessels, smaller even than capillaries, that transports lymph throughout the body. Lymph is made from fluid that seeps out of the capillaries and into the body’s tissues propecia side effects go away with continued use.

This fluid nourishes those tissues with oxygen, proteins and other nutrients, but it also picks up a lot of not-so-beneficial material — waste, toxins, and bits and pieces of bacteria and propeciaes. Some of this is pulled into the vessels of the lymphatic system, where it is turned into lymph, a thin, whitish fluid that contains immune cells that fight off . Strategically placed along this network of vessels are the lymph nodes, small propecia side effects go away with continued use bean-shaped clumps of tissue. David Weissmann, a pathologist at the Robert Wood Johnson Medical School, foregoes both mythological and engineering metaphors, and describes lymph nodes as a combination of burglar alarm and West Point.

€œLike a burglar alarm they are on guard against intrusive antigens. Like West Point, the nodes are in the propecia side effects go away with continued use business of training a militant elite. Lymphoid cells that respond to the intruder by making antibodies and forming a corps of B and T-cells that will remember the intruder's imprint for years.” As the lymph passes through, the nodes filter out damaged cells, cancer cells, and other toxins and waste materials. They also scan any foreign material and create immune cells that can recognize and destroy these invaders propecia side effects go away with continued use.

Lymph nodes are loaded with T cells, B cells, dendritic cells, and macrophages — all cells that are involved in identifying and mounting a response to . Some lymph nodes are just under the skin in your armpits, groin and neck. When you get a lump in your neck when you have a throat , it’s because your lymph system is scuttling bits and pieces of the bacteria (or propecia) that’s making you sick to the nearest lymph nodes, in this case, in your neck, where loads more white blood cells are generated to help wipe out the propecia side effects go away with continued use . There are hundreds of lymph nodes, though, and most of them are much deeper in the body, such as around the heart or the lungs and in the abdomen.

Brain ConnectionUntil recently, it was thought that the lymphatic system did not reach as far as the brain. But in 2015 a team of researchers at the University of propecia side effects go away with continued use Virginia discovered in the central nervous system lymphatic vessels that drain cerebrospinal fluid into the cervical lymph nodes below. Knowing that the brain interacts with the immune system could open possibilities for new research into neurological diseases, including Alzheimer’s.The tonsils, adenoids, spleen, and thymus are also part of the lymphatic system. All of these organs, in one way or another, filter out the waste and help kill dangerous bacteria propecia side effects go away with continued use and propeciaes.

While the lymphatic system plays a big role in protecting us from cancer, it can also help spread it. Cancer cells that manage to survive that militant elite get a free ride on the lymphatic network to other parts of the body. So while you’re going about your day, blissfully unaware propecia side effects go away with continued use of the drama unfolding inside your body, your lymphatic system is busily cleaning up after you, scanning for disease-causing microbes and creating immune cells to quickly dispatch them. She’s one busy water nymph.Sunscreen is no longer just the thick, stinky goop that leaves a white film on your skin.

Now, everything from tinted moisturizers propecia side effects go away with continued use to chapsticks to delicate mists for your face claim to protect against some kind of sun exposure. And though the kinds of products that offer sun protection have exploded in the U.S., customers in Europe, parts of Asia and Australia have more effective formulas lining their store shelves. The difference comes down to how various governments regulate sunscreen.Decoding Sunscreen LabelsSunscreens protect against two kinds of radiation. Uaviolet A and propecia side effects go away with continued use Uaviolet B, types of energy that lie just outside the range of wavelengths that we can see.

UVB burns skin and moves through our skin cells directly into DNA, meaning it helps trigger genetic changes that lead to skin cancer. For a long time, active ingredients in U.S. Sunscreens protected propecia side effects go away with continued use against UVB specifically. The packaging label SPF — sun protection factor — speaks to the kind of UVB shielding a sunscreen has and how well it prevents a sunburn.

UVA rays propecia side effects go away with continued use don’t trigger burns but they also interfere with our DNA. In 2011, the Food and Drug Administration introduced rules around the term “broad spectrum,” which refers to how well the sunscreen protects against UVA exposure. That the Food and Drug Administration ultimately decides which sunscreen ingredients can be sold and how packages are labeled is the first indication of how sunblocks are treated differently in the U.S. Here, sunscreens are regulated as if they are over-the-counter propecia side effects go away with continued use medications.

The European Union, however, approaches the products like cosmetics, and in Japan, regulating bodies see them as something between a cosmetic and a drug. The medication classification in the U.S. Means more stringent propecia side effects go away with continued use oversight. If brands want a new active ingredient — called a UV filter — to get approval, they have to collect more data to be deemed safe for use in people.

U.S. Regulations also set different benchmarks for product labeling and advertising. This is particularly true when it comes to the “broad spectrum” label. In the U.S., that title refers only to protection against UVA light, a range of wavelengths that run from 320 to 400 nm in size.

For a sunscreen to be “broad spectrum”, it has to mostly protect against 370 nm wavelengths or smaller. In Europe, “broad spectrum” also refers to the quality of UVB shielding. Brands earn the right to use “broad spectrum” if laboratory measurements of UVA protection are at least a third the values of laboratory measurements of UVB protection. How Rules Shape Store ShelvesExperts think the differences between international and U.S.

Sunscreen standards come with two consequences. The first is that U.S. Standards for “broad spectrum” might be setting too low of a bar for protection against UV. €œThe pass/fail methods of UVA testing in the USA are thought to be more lenient than the standards utilized in Europe,” writes Katherine Glaser and Kenneth Tomecki, dermatologists with the Cleveland Clinic, in a recent book chapter.

In 2017, researchers put this possibility to the test by analyzing the UV blocking ability of 20 sunscreens for sale in the U.S. Though 19 of the 20 products for sale met U.S. Standards for “broad spectrum,” only 11 met European standards. In a side by side comparison of two options — one that met European standards and one that didn’t — the former protected against the same range of wavelengths while absorbing more of each wavelength as well.

Additionally, the rigorous process the FDA requires for UV filter approval has some dermatologists (and the sunscreen industry) suggesting that U.S. Approval protocols get in the way of better, more desirable sunscreens reaching people. €œBecause the US sunscreen manufacturers do not have access to these new UV filters, there is concern that US sunscreen may not offer broad-spectrum UV protection comparable to those in other parts of the world,” wrote Henry Lim, a dermatologist at Ford Hospital in Detroit, with colleagues in the American Journal of Clinical Dermatology. A handful of UV filters available outside the U.S., which has the fewest number of approved options, have been waiting for the green light for years.

In 2014, the U.S. Passed legislation that gave deadlines by which the FDA had to assess each option, but the law didn’t change how the FDA vetted candidates — just how fast the agency had to act. Ultimately, no new UV filters have been approved since the law kicked in. In 2019, the FDA proposed some more changes to sunscreen rules.

The agency opted to label a couple active sunscreen ingredients that are in use elsewhere in the world as "generally recognized as safe", meaning brands can sell products with those two UV filters. There's a much longer list of potential sunscreen ingredients waiting for FDA action, however. And the quality of what's on your store shelves depends on how quickly the agency moves.This article appeared in the July/August 2021 issue of Discover magazine as "When propeciaes Heal." Subscribe for more stories like these.Sitting in an isolated room at Beth Israel Deaconess Medical Center in Boston, Frank Nielsen steeled himself for the first injection. Doctors were about to take a needle filled with herpes simplex propecia, the strain responsible for cold sores, and plunge it directly into his scalp.

If all went well, it would likely save his life.Nielsen was a cancer survivor and, once again, a cancer patient. His melanoma, which had responded to conventional treatments the first time around, had returned with a frightening aggressiveness. Within weeks, a lump on his scalp had swelled into an ugly mass. Unlike the first time, options like surgery weren’t viable — it was growing too quickly.As a last resort, his doctors turned to a cutting-edge drug known as T-VEC, approved in 2015 in the U.S.

But the treatment, part of a promising field of cancer care known as immunotherapy, doesn’t sound much like a drug at all. T-VEC consists of a genetically modified propecia that acts as both soldier and scout within the body, attacking tumor cells directly and calling in reinforcements from the immune system. Nielsen’s doctors hoped it would team up with the immunotherapy drug Keytruda, which enables the immune system to recognize and destroy tumor cells, to bring his cancer under control. For nearly a year, Nielsen, a mechanical engineer in central Massachusetts, traveled to Boston every three weeks to have the drug injected into the tumors on his scalp.

He would come home with his head swaddled in bloody bandages, aching after as many as 70 separate injections in a single session. There, he would prepare himself for the inevitable fever, nausea and vomiting, as his body reacted to the sudden presence of a live propecia.But the grueling regimen paid off. After the fifth round of treatment, Nielsen says, he began to see a visible change in the lumps on his scalp. It was a moment of relief for the 61-year-old.

€œI yelled to my wife and ran to the bedroom and was showing her,” he says. The T-VEC treatments eventually dissolved Nielsen’s tumors to the point where Keytruda alone could work. Roughly two years later, he remains free of cancer. Someday in the near future, dozens of cancer patients could be in remission with similar stories to tell.

Infecting a cancer patient with a propecia — a procedure that once would have raised eyebrows, if not malpractice lawsuits — might soon be routine. It’s taken more than a century of work, and a few hairraising experimental trials along the way, but a viral cure for cancer could be emerging.High RiskIn the mid-1800s, doctors treating cancer patients started to notice something odd. People with infectious diseases sometimes saw their tumors shrink. Case reports of the phenomenon date back to before scientists even understood what propeciaes were.

For example, a leukemia patient in 1896 saw her cancer briefly dissipate, http://www.ec-rodolphe-reuss-strasbourg.ac-strasbourg.fr/wp/?p=794 a seeming miracle, after contracting what was likely influenza.Researchers began an audacious, often risky search for a cancer cure based on pathogens a few decades later, purposefully infecting cancer patients with a variety of propeciaes to see if they would prove curative. One 1949 trial gave the hepatitis propecia to patients with Hodgkin’s lymphoma. The results were mixed. Seven patients experienced a temporary improvement in their cancer, but at least one died from hepatitis.

Potentially deadly side effects notwithstanding, researchers pressed on. Trials of what we now call oncolytic propeciaes — pathogens that infect and kill tumor cells — continued through the 1960s. They included experiments with the propeciaes that cause West Nile, mononucleosis and a form of encephalitis, among others.The idea was that a propecia would penetrate a tumor cell, replicate, and eventually kill it, then invade other cancer cells throughout the tumor and repeat the process, says Samuel Rabkin, a neuroscientist at Harvard Medical School and Massachusetts General Hospital who works with oncolytic propeciaes. He says that, hypothetically, “the process would basically go round and round until there were no cancer cells left.” In combination with other immunotherapy drugs, oncolytic propeciaes can help defeat cancer and build the body’s defenses to prevent a recurrence.

(Credit. Tawat/Shutterstock)Many early oncolytic propecia trials would never fly today. In some experiments, scientists injected infectious fluids or body tissue directly into cancer patients. One 1974 study in Japan fed patients pieces of bread soaked with infectious liquid.

Participants in these trials often got sick, sometimes severely — with fevers, bleeding and brain inflammation as side effects. Though many trials reported promising reductions in tumors treated with propeciaes, the success was always temporary. €œI don’t think it cured anyone,” says Stephen Russell, a hematologist at the Mayo Clinic and oncolytic propecia researcher, of the early experiments. propeciaes offered only temporary reprieve from the inevitable.

(Credit. Jay Smith)For most patients in those antiquated trials, their immune systems likely cleared the propeciaes from their bodies before the cancer could be eliminated — if the propecia didn’t kill them first. Their stories point to the obvious drawback of oncolytic propeciaes. The curative agent is a longtime archnemesis of the human race.

We now know that some propeciaes do indeed go after cancerous cells in the body, with occasionally surprising effectiveness. Cancer cells possess a few traits that propeciaes tend to like, including rapid reproduction and a high level of metabolic activity, Rabkin says. This can make a tumor cell an ideal home for a propecia, until the propecia destroys it and moves on to another cell.For decades, experts’ knowledge of that biological relationship failed to translate into an effective cancer treatment. Following numerous trials with steep mortality rates and little real success, research on using propeciaes as a cancer treatment dropped.

In the 1970s, new cancer therapies like radiation treatment and chemotherapy began to mature, giving patients other options. It would take years of significant scientific advances until propeciaes returned to the forefront of cancer care.Friend and FoeIn 2013, a Minnesota woman named Stacy Erholtz received an experimental treatment for her multiple myeloma, a cancer of the blood plasma cells. Doctors injected a massive dose of an attenuated measles propecia into her body. The genetically modified pathogen homed in on tumors, killing cancer cells and kickstarting a process that recruited her immune system to finish the job.

Her cancer eventually went into complete remission, a startling success for an oncolytic propecia, says Russell, who helped develop her treatment. It’s likely that cases like Erholtz’s, in which the patient is successfully treated with just an oncolytic propecia and nothing else, are outliers. But in the last decade, researchers have begun using propeciaes in combination with other drugs to effectively treat cancer in a wider range of patients. The combination that saved Nielsen’s life — an oncolytic propecia and an immunotherapy drug — may soon be a viable treatment for multiple forms of cancer.

Dozens of clinical trials are currently testing oncolytic therapies for cancer. Recent years have seen a wave of interest in the field, with big pharmaceutical companies investing in or acquiring biotech start-ups. While T-VEC is the only oncolytic cancer drug in the U.S. So far, more will likely follow.

In one early oncolytic trial, researchers fed participants bread soaked in infectious liquid. (Credit. Vincek/Shutterstock) The days of feeding people propecia-soaked bread are long gone. Scientists today have the ability to precisely manipulate propeciaes, as well as a more nuanced understanding of how oncolytics work.

But perhaps most important of all has been the advent of a groundbreaking class of cancer drugs known as checkpoint inhibitors, which enable the immune system to take on cancer. The first drug of this kind, ipilimumab, was approved by the FDA in 2011. The key breakthrough came when researchers discovered that cancer cells depend on a unique cloaking mechanism to survive. The body’s immune cells display on their surfaces proteins called checkpoints, which normally modulate the immune system so that it doesn’t destroy healthy cells.

When an immune cell recognizes a checkpoint, it’s like an automatic off-switch. The cells stop dividing. Tumor cells co-opt this mechanism by displaying matching checkpoints, causing any curious immune cells to stand down. Checkpoint inhibitor drugs, the backbone of modern immunotherapy, block those checkpoints on immune cells, effectively removing the ability for cancer cells to bind with them.

The discovery has led to treatments for advanced cancers, like metastatic melanoma, that were once seen as a death sentence. When it comes to fighting invaders, the immune system relies on specialized members of its fleet. T cells, which learn to recognize and kill interlopers. But there aren’t always enough T cells nearby to do the job effectively, something that’s hampered the success of immunotherapy drugs.

That’s where the propeciaes come in — they call more T cells to the site of the tumor. €œWhen a propecia is given to a tumor, the tumor becomes infected tissue,” says Vincenzo Cerullo, an oncolytic cancer treatment immunologist at the University of Helsinki. That catalyzes swarms of T cells to rush to a tumor, ready to defend the body. Today, checkpoint inhibitor drugs are effective in only a small percentage of patients.

Add in a propecia, however, and that percentage can double or triple. This combination of treatments is marking a turning point for cancer research, says James Allison, an immunologist at the University of Texas MD Anderson Cancer Center. In 2018, Allison was a co-recipient of the Nobel Prize in Physiology or Medicine for his work on checkpoint inhibitors. For cancer treatments before the advent of immunotherapy, “you had to kill every last tumor cell if you’re going to cure somebody,” he says.

Now all doctors need to do is get the immune system involved and give it the tools to take over. And, as Allison and others have shown, the beneficial effects of a viral extend beyond the site of a single tumor. Allison found in experiments that injecting mice with a propecia slowed the growth of not only the tumor the researchers targeted, but tumors elsewhere in the body as well. T cells, once marshalled, are primed to move throughout the body, attacking cancer cells wherever they find them.

Allison calls this a systemic immunity to cancer, and it’s become a goal for oncolytic propecia researchers all over the world. Giving the body the means to fight off tumors itself could offer a cure for even hard-to treat metastatic cancers that spread quickly and lethally.A Body in BattleNielsen was lucky in one sense — the tumors that colonized his scalp were all close together and raised above the surface of his skin. That made it easy for doctors to inject a propecia directly into them. But some tumors can be hard to access, and others spread throughout the body as they metastasize, making them more difficult to target with treatments.Researchers are currently working to better adapt oncolytic treatments to be delivered through an IV.

Theoretically, when a propecia can move freely throughout the body and spread its immunogenic clarion call, even the most hard-to-access tumors could be targeted and wiped out. Though some trials of oncolytic propeciaes have used intravenous administration, scientists say more work is needed to make them fully effective.Though some trials have administered oncolytic treatments through an IV, more work is needed to make this method effective. (Credit. Goodbishop/Shutterstock) The promise of more flexible treatment methods would help boost another goal in the field.

Developing so-called treatments for cancer. The drugs promise to not only fight off tumors, but to turn the body itself into a cancer-killing machine. It’s a tall order, but cancer experts have reason to be hopeful, in part because the tools they’re using to build treatments have proven extraordinarily adaptable. Russell calls propeciaes the world’s best Lego set.

€œYou can take any propecia and add new genes, engineer the existing genes, dismantle and rebuild,” he says. Today, oncolytic propeciaes already make use of a small genetic mutation that helps them avoid infecting normal cells. But there’s potential to make more sweeping modifications to propeciaes, in turn creating more precise and effective treatments. Russell, with a biotech company he helped found called Vyriad, is experimenting with adding a gene to a propecia that enhances the immune system’s response.

Like the chemicals that stimulate immune cells and attract them to a pathogen, Vyriad’s engineered propecia has a similar effect. Here, propeciaes are being led to human cells that have gone rogue. Russell says the process should help doctors give higher doses of an oncolytic propecia without endangering the patient. A different approach might be to focus on simply making propeciaes more provocative to the immune system.

Cerullo refers to it as arming the propecia. T-VEC, for example, has a genetic modification that allows it to express a compound that the body uses to stimulate the immune system. Like sharks to blood, immune cells mobilize at a whiff of these molecules. Engineering an oncolytic propecia might guarantee it gets noticed, ensuring a strong immune response against the tumor.

Ultimately, the goal is to make it so that a patient’s body is capable of recognizing and fighting cancers it has seen before, resulting in a kind of immunity to cancer. It would remove one of the final legacies of cancer for patients like Nielsen, who must live every day with the unsettling risk of recurrence lurking over them. Oncolytic propeciaes might turn a cancer diagnosis into something much like a viral — frightening and uncomfortable, but treatable. Frank Nielsen’s name is a pseudonym, to protect his privacy.Nathaniel Scharping is a freelance writer and editor based in Milwaukee..

The lymph nodes were known in antiquity—you can see them redirected here without a microscope—and were first described in Peri Adenon (On Glands), how to buy cheap propecia online the Hippocratic treatise that has been described as a “milestone” in the history of immunology.” But the rest of the lymphatic system was more inscrutable. It wasn’t until relatively recently that science really began to understand the lymph system. We are, in fact, still uncovering some of the secrets of this crucial part of our physiology.On Guard Against AntigensThe word how to buy cheap propecia online lymph comes from the Latin word lympha, which means water. Lympha was in turn derived from the Greek word nymph, those divine ladies who haunt forests and streams. This one inhabits your immune system.

While the image of a water nymph is a lovely one, the lymphatic system might be best thought of more prosaically as a complex drainage and purifying how to buy cheap propecia online system. It is a network of tiny vessels, smaller even than capillaries, that transports lymph throughout the body. Lymph is made how to buy cheap propecia online from fluid that seeps out of the capillaries and into the body’s tissues. This fluid nourishes those tissues with oxygen, proteins and other nutrients, but it also picks up a lot of not-so-beneficial material — waste, toxins, and bits and pieces of bacteria and propeciaes. Some of this is pulled into the vessels of the lymphatic system, where it is turned into lymph, a thin, whitish fluid that contains immune cells that fight off .

Strategically placed along this network of vessels are the lymph nodes, small bean-shaped clumps how to buy cheap propecia online of tissue. David Weissmann, a pathologist at the Robert Wood Johnson Medical School, foregoes both mythological and engineering metaphors, and describes lymph nodes as a combination of burglar alarm and West Point. €œLike a burglar alarm they are on guard against intrusive antigens. Like West Point, the nodes are how to buy cheap propecia online in the business of training a militant elite. Lymphoid cells that respond to the intruder by making antibodies and forming a corps of B and T-cells that will remember the intruder's imprint for years.” As the lymph passes through, the nodes filter out damaged cells, cancer cells, and other toxins and waste materials.

They also scan any how to buy cheap propecia online foreign material and create immune cells that can recognize and destroy these invaders. Lymph nodes are loaded with T cells, B cells, dendritic cells, and macrophages — all cells that are involved in identifying and mounting a response to . Some lymph nodes are just under the skin in your armpits, groin and neck. When you get a lump in your neck when you have a throat , it’s because your lymph system is scuttling how to buy cheap propecia online bits and pieces of the bacteria (or propecia) that’s making you sick to the nearest lymph nodes, in this case, in your neck, where loads more white blood cells are generated to help wipe out the . There are hundreds of lymph nodes, though, and most of them are much deeper in the body, such as around the heart or the lungs and in the abdomen.

Brain ConnectionUntil recently, it was thought that the lymphatic system did not reach as far as the brain. But in how to buy cheap propecia online 2015 a team of researchers at the University of Virginia discovered in the central nervous system lymphatic vessels that drain cerebrospinal fluid into the cervical lymph nodes below. Knowing that the brain interacts with the immune system could open possibilities for new research into neurological diseases, including Alzheimer’s.The tonsils, adenoids, spleen, and thymus are also part of the lymphatic system. All of how to buy cheap propecia online these organs, in one way or another, filter out the waste and help kill dangerous bacteria and propeciaes. While the lymphatic system plays a big role in protecting us from cancer, it can also help spread it.

Cancer cells that manage to survive that militant elite get a free ride on the lymphatic network to other parts of the body. So while you’re going about your day, blissfully unaware of the drama unfolding inside your body, your lymphatic system is busily cleaning up after you, how to buy cheap propecia online scanning for disease-causing microbes and creating immune cells to quickly dispatch them. She’s one busy water nymph.Sunscreen is no longer just the thick, stinky goop that leaves a white film on your skin. Now, everything from tinted moisturizers to chapsticks to delicate mists for your face claim to protect against some kind of sun exposure how to buy cheap propecia online. And though the kinds of products that offer sun protection have exploded in the U.S., customers in Europe, parts of Asia and Australia have more effective formulas lining their store shelves.

The difference comes down to how various governments regulate sunscreen.Decoding Sunscreen LabelsSunscreens protect against two kinds of radiation. Uaviolet A and Uaviolet B, types of energy that lie just outside the range of wavelengths that we can how to buy cheap propecia online see. UVB burns skin and moves through our skin cells directly into DNA, meaning it helps trigger genetic changes that lead to skin cancer. For a long time, active ingredients in U.S. Sunscreens protected against UVB specifically how to buy cheap propecia online.

The packaging label SPF — sun protection factor — speaks to the kind of UVB shielding a sunscreen has and how well it prevents a sunburn. UVA rays don’t trigger burns but they also interfere how to buy cheap propecia online with our DNA. In 2011, the Food and Drug Administration introduced rules around the term “broad spectrum,” which refers to how well the sunscreen protects against UVA exposure. That the Food and Drug Administration ultimately decides which sunscreen ingredients can be sold and how packages are labeled is the first indication of how sunblocks are treated differently in the U.S. Here, sunscreens are regulated how to buy cheap propecia online as if they are over-the-counter medications.

The European Union, however, approaches the products like cosmetics, and in Japan, regulating bodies see them as something between a cosmetic and a drug. The medication classification in the U.S. Means more stringent how to buy cheap propecia online oversight. If brands want a new active ingredient — called a UV filter — to get approval, they have to collect more data to be deemed safe for use in people. U.S.

Regulations also set different benchmarks for product labeling and advertising. This is particularly true when it comes to the “broad spectrum” label. In the U.S., that title refers only to protection against UVA light, a range of wavelengths that run from 320 to 400 nm in size. For a sunscreen to be “broad spectrum”, it has to mostly protect against 370 nm wavelengths or smaller. In Europe, “broad spectrum” also refers to the quality of UVB shielding.

Brands earn the right to use “broad spectrum” if laboratory measurements of UVA protection are at least a third the values of laboratory measurements of UVB protection. How Rules Shape Store ShelvesExperts think the differences between international and U.S. Sunscreen standards come with two consequences. The first is that U.S. Standards for “broad spectrum” might be setting too low of a bar for protection against UV.

€œThe pass/fail methods of UVA testing in the USA are thought to be more lenient than the standards utilized in Europe,” writes Katherine Glaser and Kenneth Tomecki, dermatologists with the Cleveland Clinic, in a recent book chapter. In 2017, researchers put this possibility to the test by analyzing the UV blocking ability of 20 sunscreens for sale in the U.S. Though 19 of the 20 products for sale met U.S. Standards for “broad spectrum,” only 11 met European standards. In a side by side comparison of two options — one that met European standards and one that didn’t — the former protected against the same range of wavelengths while absorbing more of each wavelength as well.

Additionally, the rigorous process the FDA requires for UV filter approval has some dermatologists (and the sunscreen industry) suggesting that U.S. Approval protocols get in the way of better, more desirable sunscreens reaching people. €œBecause the US sunscreen manufacturers do not have access to these new UV filters, there is concern that US sunscreen may not offer broad-spectrum UV protection comparable to those in other parts of the world,” wrote Henry Lim, a dermatologist at Ford Hospital in Detroit, with colleagues in the American Journal of Clinical Dermatology. A handful of UV filters available outside the U.S., which has the fewest number of approved options, have been waiting for the green light for years. In 2014, the U.S.

Passed legislation that gave deadlines by which the FDA had to assess each option, but the law didn’t change how the FDA vetted candidates — just how fast the agency had to act. Ultimately, no new UV filters have been approved since the law kicked in. In 2019, the FDA proposed some more changes to sunscreen rules. The agency opted to label a couple active sunscreen ingredients that are in use elsewhere in the world as "generally recognized as safe", meaning brands can sell products with those two UV filters. There's a much longer list of potential sunscreen ingredients waiting for FDA action, however.

And the quality of what's on your store shelves depends on how quickly the agency moves.This article appeared in the July/August 2021 issue of Discover magazine as "When propeciaes Heal." Subscribe for more stories like these.Sitting in an isolated room at Beth Israel Deaconess Medical Center in Boston, Frank Nielsen steeled himself for the first injection. Doctors were about to take a needle filled with herpes simplex propecia, the strain responsible for cold sores, and plunge it directly into his scalp. If all went well, it would likely save his life.Nielsen was a cancer survivor and, once again, a cancer patient. His melanoma, which had responded to conventional treatments the first time around, had returned with a frightening aggressiveness. Within weeks, a lump on his scalp had swelled into an ugly mass.

Unlike the first time, options like surgery weren’t viable — it was growing too quickly.As a last resort, his doctors turned to a cutting-edge drug known as T-VEC, approved in 2015 in the U.S. But the treatment, part of a promising field of cancer care known as immunotherapy, doesn’t sound much like a drug at all. T-VEC consists of a genetically modified propecia that acts as both soldier and scout within the body, attacking tumor cells directly and calling in reinforcements from the immune system. Nielsen’s doctors hoped it would team up with the immunotherapy drug Keytruda, which enables the immune system to recognize and destroy tumor cells, to bring his cancer under control. For nearly a year, Nielsen, a mechanical engineer in central Massachusetts, traveled to Boston every three weeks to have the drug injected into the tumors on his scalp.

He would come home with his head swaddled in bloody bandages, aching after as many as 70 separate injections in a single session. There, he would prepare himself for the inevitable fever, nausea and vomiting, as his body reacted to the sudden presence of a live propecia.But the grueling regimen paid off. After the fifth round of treatment, Nielsen says, he began to see a visible change in the lumps on his scalp. It was a moment of relief for the 61-year-old. €œI yelled to my wife and ran to the bedroom and was showing her,” he says.

The T-VEC treatments eventually dissolved Nielsen’s tumors to the point where Keytruda alone could work. Roughly two years later, he remains free of cancer. Someday in the near future, dozens of cancer patients could be in remission with similar stories to tell. Infecting a cancer patient with a propecia — a procedure that once would have raised eyebrows, if not malpractice lawsuits — might soon be routine. It’s taken more than a century of work, and a few hairraising experimental trials along the way, but a viral cure for cancer could be emerging.High RiskIn the mid-1800s, doctors treating cancer patients started to notice something odd.

People with infectious diseases sometimes saw their tumors shrink. Case reports of the phenomenon date back to before scientists even understood what propeciaes were. For example, a leukemia patient in 1896 saw her cancer briefly dissipate, a seeming miracle, after contracting what was likely influenza.Researchers began an audacious, often risky search for a cancer cure based on http://holmeswestern.com/ pathogens a few decades later, purposefully infecting cancer patients with a variety of propeciaes to see if they would prove curative. One 1949 trial gave the hepatitis propecia to patients with Hodgkin’s lymphoma. The results were mixed.

Seven patients experienced a temporary improvement in their cancer, but at least one died from hepatitis. Potentially deadly side effects notwithstanding, researchers pressed on. Trials of what we now call oncolytic propeciaes — pathogens that infect and kill tumor cells — continued through the 1960s. They included experiments with the propeciaes that cause West Nile, mononucleosis and a form of encephalitis, among others.The idea was that a propecia would penetrate a tumor cell, replicate, and eventually kill it, then invade other cancer cells throughout the tumor and repeat the process, says Samuel Rabkin, a neuroscientist at Harvard Medical School and Massachusetts General Hospital who works with oncolytic propeciaes. He says that, hypothetically, “the process would basically go round and round until there were no cancer cells left.” In combination with other immunotherapy drugs, oncolytic propeciaes can help defeat cancer and build the body’s defenses to prevent a recurrence.

(Credit. Tawat/Shutterstock)Many early oncolytic propecia trials would never fly today. In some experiments, scientists injected infectious fluids or body tissue directly into cancer patients. One 1974 study in Japan fed patients pieces of bread soaked with infectious liquid. Participants in these trials often got sick, sometimes severely — with fevers, bleeding and brain inflammation as side effects.

Though many trials reported promising reductions in tumors treated with propeciaes, the success was always temporary. €œI don’t think it cured anyone,” says Stephen Russell, a hematologist at the Mayo Clinic and oncolytic propecia researcher, of the early experiments. propeciaes offered only temporary reprieve from the inevitable. (Credit. Jay Smith)For most patients in those antiquated trials, their immune systems likely cleared the propeciaes from their bodies before the cancer could be eliminated — if the propecia didn’t kill them first.

Their stories point to the obvious drawback of oncolytic propeciaes. The curative agent is a longtime archnemesis of the human race. We now know that some propeciaes do indeed go after cancerous cells in the body, with occasionally surprising effectiveness. Cancer cells possess a few traits that propeciaes tend to like, including rapid reproduction and a high level of metabolic activity, Rabkin says. This can make a tumor cell an ideal home for a propecia, until the propecia destroys it and moves on to another cell.For decades, experts’ knowledge of that biological relationship failed to translate into an effective cancer treatment.

Following numerous trials with steep mortality rates and little real success, research on using propeciaes as a cancer treatment dropped. In the 1970s, new cancer therapies like radiation treatment and chemotherapy began to mature, giving patients other options. It would take years of significant scientific advances until propeciaes returned to the forefront of cancer care.Friend and FoeIn 2013, a Minnesota woman named Stacy Erholtz received an experimental treatment for her multiple myeloma, a cancer of the blood plasma cells. Doctors injected a massive dose of an attenuated measles propecia into her body. The genetically modified pathogen homed in on tumors, killing cancer cells and kickstarting a process that recruited her immune system to finish the job.

Her cancer eventually went into complete remission, a startling success for an oncolytic propecia, says Russell, who helped develop her treatment. It’s likely that cases like Erholtz’s, in which the patient is successfully treated with just an oncolytic propecia and nothing else, are outliers. But in the last decade, researchers have begun using propeciaes in combination with other drugs to effectively treat cancer in a wider range of patients. The combination that saved Nielsen’s life — an oncolytic propecia and an immunotherapy drug — may soon be a viable treatment for multiple forms of cancer. Dozens of clinical trials are currently testing oncolytic therapies for cancer.

Recent years have seen a wave of interest in the field, with big pharmaceutical companies investing in or acquiring biotech start-ups. While T-VEC is the only oncolytic cancer drug in the U.S. So far, more will likely follow. In one early oncolytic trial, researchers fed participants bread soaked in infectious liquid. (Credit.

Vincek/Shutterstock) The days of feeding people propecia-soaked bread are long gone. Scientists today have the ability to precisely manipulate propeciaes, as well as a more nuanced understanding of how oncolytics work. But perhaps most important of all has been the advent of a groundbreaking class of cancer drugs known as checkpoint inhibitors, which enable the immune system to take on cancer. The first drug of this kind, ipilimumab, was approved by the FDA in 2011. The key breakthrough came when researchers discovered that cancer cells depend on a unique cloaking mechanism to survive.

The body’s immune cells display on their surfaces proteins called checkpoints, which normally modulate the immune system so that it doesn’t destroy healthy cells. When an immune cell recognizes a checkpoint, it’s like an automatic off-switch. The cells stop dividing. Tumor cells co-opt this mechanism by displaying matching checkpoints, causing any curious immune cells to stand down. Checkpoint inhibitor drugs, the backbone of modern immunotherapy, block those checkpoints on immune cells, effectively removing the ability for cancer cells to bind with them.

The discovery has led to treatments for advanced cancers, like metastatic melanoma, that were once seen as a death sentence. When it comes to fighting invaders, the immune system relies on specialized members of its fleet. T cells, which learn to recognize and kill interlopers. But there aren’t always enough T cells nearby to do the job effectively, something that’s hampered the success of immunotherapy drugs. That’s where the propeciaes come in — they call more T cells to the site of the tumor.

€œWhen a propecia is given to a tumor, the tumor becomes infected tissue,” says Vincenzo Cerullo, an oncolytic cancer treatment immunologist at the University of Helsinki. That catalyzes swarms of T cells to rush to a tumor, ready to defend the body. Today, checkpoint inhibitor drugs are effective in only a small percentage of patients. Add in a propecia, however, and that percentage can double or triple. This combination of treatments is marking a turning point for cancer research, says James Allison, an immunologist at the University of Texas MD Anderson Cancer Center.

In 2018, Allison was a co-recipient of the Nobel Prize in Physiology or Medicine for his work on checkpoint inhibitors. For cancer treatments before the advent of immunotherapy, “you had to kill every last tumor cell if you’re going to cure somebody,” he says. Now all doctors need to do is get the immune system involved and give it the tools to take over. And, as Allison and others have shown, the beneficial effects of a viral extend beyond the site of a single tumor. Allison found in experiments that injecting mice with a propecia slowed the growth of not only the tumor the researchers targeted, but tumors elsewhere in the body as well.

T cells, once marshalled, are primed to move throughout the body, attacking cancer cells wherever they find them. Allison calls this a systemic immunity to cancer, and it’s become a goal for oncolytic propecia researchers all over the world. Giving the body the means to fight off tumors itself could offer a cure for even hard-to treat metastatic cancers that spread quickly and lethally.A Body in BattleNielsen was lucky in one sense — the tumors that colonized his scalp were all close together and raised above the surface of his skin. That made it easy for doctors to inject a propecia directly into them. But some tumors can be hard to access, and others spread throughout the body as they metastasize, making them more difficult to target with treatments.Researchers are currently working to better adapt oncolytic treatments to be delivered through an IV.

Theoretically, when a propecia can move freely throughout the body and spread its immunogenic clarion call, even the most hard-to-access tumors could be targeted and wiped out. Though some trials of oncolytic propeciaes have used intravenous administration, scientists say more work is needed to make them fully effective.Though some trials have administered oncolytic treatments through an IV, more work is needed to make this method effective. (Credit. Goodbishop/Shutterstock) The promise of more flexible treatment methods would help boost another goal in the field. Developing so-called treatments for cancer.

The drugs promise to not only fight off tumors, but to turn the body itself into a cancer-killing machine. It’s a tall order, but cancer experts have reason to be hopeful, in part because the tools they’re using to build treatments have proven extraordinarily adaptable. Russell calls propeciaes the world’s best Lego set. €œYou can take any propecia and add new genes, engineer the existing genes, dismantle and rebuild,” he says. Today, oncolytic propeciaes already make use of a small genetic mutation that helps them avoid infecting normal cells.

But there’s potential to make more sweeping modifications to propeciaes, in turn creating more precise and effective treatments. Russell, with a biotech company he helped found called Vyriad, is experimenting with adding a gene to a propecia that enhances the immune system’s response. Like the chemicals that stimulate immune cells and attract them to a pathogen, Vyriad’s engineered propecia has a similar effect. Here, propeciaes are being led to human cells that have gone rogue. Russell says the process should help doctors give higher doses of an oncolytic propecia without endangering the patient.

A different approach might be to focus on simply making propeciaes more provocative to the immune system. Cerullo refers to it as arming the propecia. T-VEC, for example, has a genetic modification that allows it to express a compound that the body uses to stimulate the immune system. Like sharks to blood, immune cells mobilize at a whiff of these molecules. Engineering an oncolytic propecia might guarantee it gets noticed, ensuring a strong immune response against the tumor.

Ultimately, the goal is to make it so that a patient’s body is capable of recognizing and fighting cancers it has seen before, resulting in a kind of immunity to cancer. It would remove one of the final legacies of cancer for patients like Nielsen, who must live every day with the unsettling risk of recurrence lurking over them. Oncolytic propeciaes might turn a cancer diagnosis into something much like a viral — frightening and uncomfortable, but treatable. Frank Nielsen’s name is a pseudonym, to protect his privacy.Nathaniel Scharping is a freelance writer and editor based in Milwaukee..

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04 September, Cialis at a discount 2020 efectos secundarios propecia. Following a comprehensive search, the Board of the Australian Digital Health Agency announced today that Ms Amanda Cattermole PSM will be appointed as Chief Executive Officer of the Agency. Ms Cattermole has a long and distinguished history of senior leadership roles efectos secundarios propecia in service delivery in the public sector, leading high performing organisations, while growing customer satisfaction and staff engagement. She also has deep expertise in digital transformation across government and within the health sector.Most recently, Ms Cattermole was Chief Operating Officer of Services Australia with responsibility for budget and financial services, people, governance, audit and risk. Ms Cattermole was previously the interim CEO of Services Australia and has held Deputy Secretary roles in health service delivery in the Commonwealth and in the Victorian State efectos secundarios propecia Government.

Ms Cattermole holds a Master of Laws from Charles Darwin University, a Master of Business Administration from the University of Western Australia and Bachelor Degrees in Law and Commerce from the University of Melbourne.Welcoming Ms Cattermole’s appointment on behalf of the Agency, Board Chair Dr Elizabeth Deveny said “Amanda Cattermole is held in the highest regard across the public service and health sector and will bring a depth of knowledge and capability to the role of CEO at a time when digital health has never been more important. The Board has appointed a leader who is deeply skilled, committed to improving the health of all Australians and who understands the importance of digital innovation in better connecting Australia’s healthcare system.”The Hon Greg Hunt, Minister for Health, said “I am pleased to welcome Ms Cattermole and look forward to working closely together to drive technology in healthcare as the need has never been greater.”The Board of the Agency also acknowledged the invaluable efectos secundarios propecia leadership of Ms Bettina McMahon, who has acted as CEO since February this year. €œThe Board of the Agency would like to thank Ms McMahon for her leadership, dedication and commitment, and wishes her the best for the future.”Ms Cattermole will commence on Tuesday 29 September.Media contactAustralian Digital Health Agency Media TeamMobile. 0428 772 421Email. [email protected] About the Australian Digital Health AgencyThe Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s efectos secundarios propecia National Digital Health Strategy – Safe, Seamless, and Secure.

Evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and efectos secundarios propecia provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information efectos secundarios propecia. Www.digitalhealth.gov.auMedia release - Australian Digital Health Agency CEO announced.docx 66KB)Media release - Australian Digital Health Agency CEO announced.pdf (191KB)By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency.

In this website, on and efectos secundarios propecia from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth). Website Accessibility Copyright ©2015-2020 Australian Digital Health Agency.

04 September, 2020 how to buy cheap propecia online http://pgecapital.com/cialis-at-a-discount/. Following a comprehensive search, the Board of the Australian Digital Health Agency announced today that Ms Amanda Cattermole PSM will be appointed as Chief Executive Officer of the Agency. Ms Cattermole has a long and distinguished history of senior leadership roles in service delivery in the how to buy cheap propecia online public sector, leading high performing organisations, while growing customer satisfaction and staff engagement.

She also has deep expertise in digital transformation across government and within the health sector.Most recently, Ms Cattermole was Chief Operating Officer of Services Australia with responsibility for budget and financial services, people, governance, audit and risk. Ms Cattermole was previously the interim CEO of Services Australia and has held Deputy Secretary roles in health service delivery in the how to buy cheap propecia online Commonwealth and in the Victorian State Government. Ms Cattermole holds a Master of Laws from Charles Darwin University, a Master of Business Administration from the University of Western Australia and Bachelor Degrees in Law and Commerce from the University of Melbourne.Welcoming Ms Cattermole’s appointment on behalf of the Agency, Board Chair Dr Elizabeth Deveny said “Amanda Cattermole is held in the highest regard across the public service and health sector and will bring a depth of knowledge and capability to the role of CEO at a time when digital health has never been more important.

The Board has appointed a leader who is deeply skilled, committed to improving the health of all Australians and who understands the importance of digital innovation in better connecting Australia’s healthcare system.”The Hon Greg Hunt, Minister for Health, said “I am pleased to welcome Ms Cattermole and look forward how to buy cheap propecia online to working closely together to drive technology in healthcare as the need has never been greater.”The Board of the Agency also acknowledged the invaluable leadership of Ms Bettina McMahon, who has acted as CEO since February this year. €œThe Board of the Agency would like to thank Ms McMahon for her leadership, dedication and commitment, and wishes her the best for the future.”Ms Cattermole will commence on Tuesday 29 September.Media contactAustralian Digital Health Agency Media TeamMobile. 0428 772 421Email.

[email protected] About the Australian Digital Health AgencyThe Agency is tasked with improving health outcomes how to buy cheap propecia online for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure. Evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency how to buy cheap propecia online is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system.

These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information how to buy cheap propecia online. Www.digitalhealth.gov.auMedia release - Australian Digital Health Agency CEO announced.docx 66KB)Media release - Australian Digital Health Agency CEO announced.pdf (191KB)By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency.

In this website, on and from 1 July 2016, all references to "National E-Health how to buy cheap propecia online Transition Authority" or "NEHTA" will be deemed to be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth). Website Accessibility Copyright ©2015-2020 Australian Digital Health Agency.

Propecia and pregnancy is it safe

John Rawls begins a Theory of Justice with the observation that 'Justice is the first virtue of social institutions, as truth is of systems propecia and pregnancy is it safe of thought… Each person possesses an inviolability founded on justice that https://swifamilies.org/cheap-cialis/ even the welfare of society as a whole cannot override'1 (p.3). The hair loss treatment propecia has resulted in lock-downs, the restriction of liberties, debate about the right propecia and pregnancy is it safe to refuse medical treatment and many other changes to the everyday behaviour of persons. The justice issues it raises are diverse, profound and will demand our attention for some time. How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are discussed in this issue of the Journal of Medical Ethics.The debate about ICU triage and hair loss treatment is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et propecia and pregnancy is it safe al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how triage decisions should be made.6They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to hair loss treatment triage situations. Their argument seems to highlight instances of what is called the McNamara fallacy.

US Secretary of Defense Robert McNamara used enemy body counts as a measure of military success during the propecia and pregnancy is it safe Vietnam war. So, the fallacy occurs when we rely solely on considerations that appear to be quantifiable, to the neglect of vital qualitative, difficult to measure or contestable features.6 Newdick et al point to variation in assessment, subtlety in condition and other factors as reasons why it is misleading to present scoring systems as ‘objective’ tests for triage. In doing so they draw a distinction between procedural and outcome consistency, which is important, and hints at distinctions Rawls propecia and pregnancy is it safe drew between the different forms of procedural fairness. While we might hope to come up with a triage protocol that is procedurally fair and arrives at a fair outcome (what Rawls calls perfect procedural justice, p. 85) there is little prospect of that propecia and pregnancy is it safe.

As they observe, reasonable people can disagree about the outcomes we should aim for in allocating health resources and ICU triage for hair loss treatment is no exception. Instead, we should work toward a transparent and fair process, what Rawls propecia and pregnancy is it safe would describe as imperfect procedural justice (p. 85). His example of this is a criminal trial where we adopt processes that we have reason to believe are our best chance of determining guilt, but which do not guarantee the truth of a verdict, and this is a reason why they must be transparent and consistent (p. 85).

Their proposal is to triage patients into three broad categories. High, medium and low priority, with the thought that a range of considerations could feed into that evaluation by an appropriately constituted clinical group.Ballantyne et al question another issue that is central to the debate about hair loss treatment triage.4 They describe how utility measures such as QALYs, lives saved seem to be in tension with equity. Their central point is that ICU for hair loss treatment can be futile, and that is a reason for questioning how much weight should be given to equality of access to ICU for hair loss treatment. They claim that there is little point admitting someone to ICU when ICU is not in their best interests. Instead, the scope of equity should encompass preventing 'remediable differences among social, economic demographic or geographic groups' and for hair loss treatment that means looking beyond access to ICU.

Their central argument can be summarised as follows.Maximising utility can entrench existing health inequalities.The majority of those ventilated for hair loss treatment in ICU will die.Admitting frailer or comorbid patients to ICU is likely to do more harm than good to these groups.Therefore, better access to ICU is unlikely to promote health equity for these groups.Equity for those with health inequalities related to hair loss treatment should broadened to include all the services a system might provide.Brown et al argue in favour of hair loss treatment immunity passports and the following summarises one of the key arguments in their article.7hair loss treatment immunity passports are a way of demonstrating low personal and social risk.Those who are at low personal risk and low social risk from hair loss treatment should be permitted more freedoms.Permitting those with immunity passports greater freedoms discriminates against those who do not have passports.Low personal and social risk and preserving health system capacity are relevant reasons to discriminate between those who have immunity and those who do not.Brown et al then consider a number of potential problems with immunity passports, many of which are justice issues. Resentment by those who do not hold an immunity passport along with a loss of social cohesion, which is vital for responding to hair loss treatment, are possible downsides. There is also the potential to advantage those who are immune, economically, and it could perpetuate existing inequalities. A significant objection, which is a problem for the justice of many policies, is free riding. Some might create fraudulent immunity passports and it might even incentivise intentional exposure to the propecia.

Brown et al suggest that disincentives and punishment are potential solutions and they are in good company as the Rawlsian solution to free riding is for 'law and government to correct the necessary corrections.' (p. 268)Elves and Herring focus on a set of ethical principles intended to guide those making policy and individual level decisions about adult social care delivery impacted by the propecia.8 They criticize the British government’s framework for being silent about what to do in the face of conflict between principles. They suggest the dominant values in the framework are based on autonomy and individualism and argue that there are good reasons for not making autonomy paramount in policy about hair loss treatment. These include that information about hair loss treatment is incomplete, so no one can be that informed on decisions about their health. The second is one that highlights the importance of viewing our present ethical challenges via the lens of justice or other ethical concepts such as community or solidarity that enable us to frame collective obligations and interests.

They observe that hair loss treatment has demonstrated how health and how we live our lives are linked. That what an individual does can have profound impact on the health of many others.Their view is that appeals to self-determination ring hollow for hair loss treatment and their proposed remedy is one that pushes us to reflect on what the liberal commitment to the inviolability of each person means. They explain Dworkin’s account of 'associative obligations' which occur within a group when they acknowledge special rights and responsibilities to each other. These obligations are a way of giving weight to community considerations, without collapsing into full-blown utilitarianism and while still respecting the inviolability of persons.The hair loss treatment propecia is pushing ethical deliberation in new directions and many of them turn on approaching medical ethics with a greater emphasis on justice and related ethical concepts.IntroductionAs hair loss treatment spread internationally, healthcare services in many countries became overwhelmed. One of the main manifestations of this was a shortage of intensive care beds, leading to urgent discussion about how to allocate these fairly.

In the initial debates about allocation of scarce intensive care unit (ICU) resources, there was optimism about the ‘good’ of ICU access. However, rather than being a life-saving intervention, data began to emerge in mid-April showing that most critical patients with hair loss treatment who receive access to a ventilator do not survive to discharge. The minority who survive leave the ICU with significant morbidity and a long and uncertain road to recovery. This reality was under-recognised in bioethics debates about ICU triage throughout March and April 2020. Central to these disucssions were two assumptions.

First, that ICU admission was a valuable but scarce resource in the propecia context. And second, that both equity and utility considerations were important in determining which patients should have access to ICU. In this paper we explain how scarcity and value were conflated in the early ICU hair loss treatment triage literature, leading to undue optimism about the ‘good’ of ICU access, which in turned fuelled equity-based arguments for ICU access. In the process, ethical issues regarding equitable access to end-of-life care more broadly were neglected.Equity requires the prevention of avoidable or remediable differences among social, economic, demographic, or geographic groups.1 How best to apply an equity lens to questions of distribution will depend on the nature of the resource in question. Equitable distribution of ICU beds is significantly more complex than equitable distribution of other goods that might be scarce in a propecia, such as masks or treatments.

ICU (especially that which involves intubation and ventilation i.e. Mechanical ventilation) is a burdensome treatment option that can lead to significant suffering—both short and long term. The degree to which these burdens are justified depends on the probability of benefit, and this depends on the clinical status of the patient. People are rightly concerned about the equity implications of excluding patients from ICU on the grounds of pre-existing comorbidities that directly affect prognosis, especially when these align with and reflect social disadvantage. But this does not mean that aged, frail or comorbid patients should be admitted to ICU on the grounds of equity, when this may not be in their best interests.ICU triage debateThe hair loss treatment propecia generated extraordinary demand for critical care and required hard choices about who will receive presumed life-saving interventions such as ICU admission.

The debate has focused on whether or not a utilitarian approach aimed at maximising the number of lives (or life-years) saved should be supplemented by equity considerations that attempt to protect the rights and interests of members of marginalised groups. The utilitarian approach uses criteria for access to ICU that focus on capacity to benefit, understood as survival.2 Supplementary equity considerations have been invoked to relax the criteria in order to give a more diverse group of people a chance of entering ICU.3 4Equity-based critiques are grounded in the concern that a utilitarian approach aimed at maximising the number (or length) of lives saved may well exacerbate inequity in survival rates between groups. This potential for discrimination is heightened if triage tools use age as a proxy for capacity to benefit or are heavily reliant on Quality-Adjusted Life-Years (QALYs) which will deprioritise people with disabilities.5 6 Even if these pitfalls are avoided, policies based on maximising lives saved entrench existing heath inequalities because those most likely to benefit from treatment will be people of privilege who come into the propecia with better health status than less advantaged people. Those from lower socioeconomic groups, and/or some ethnic minorities have high rates of underlying comorbidities, some of which are prognostically relevant in hair loss treatment . Public health ethics requires that we acknowledge how apparently neutral triage tools reflect and reinforce these disparities, especially where the impact can be lethal.7But the utility versus equity debate is more complex than it first appears.

Both the utility and equity approach to ICU triage start from the assumption that ICU is a valuable good—the dispute is about how best to allocate it. Casting ICU admission as a scarce good subject to rationing has the (presumably unintended) effect of making access to critical care look highly appealing, triggering cognitive biases. Psychologists and marketers know that scarcity sells.8 People value a commodity more when it is difficult or impossible to obtain.9 When there is competition for scarce resources, people focus less on whether they really need or want the resource. The priority becomes securing access to the resource.Clinicians are not immune to scarcity-related cognitive bias. Clinicians treating patients with hair loss treatment are working under conditions of significant information overload but without the high quality clinical research (generated from large data sets and rigorous methodology) usually available for decision-making.

The combination of overwhelming numbers of patients, high acuity and uncertainty regarding best practice is deeply anxiety provoking. In this context it is unsurprising that, at least in the early stages of the propecia, they may not have the psychological bandwidth to challenge assumptions about the benefits of ICU admission for patients with severe disease. Zagury-Orly and Schwartzstein have recently argued that the health sector must accept that doctors’ reasoning and decision-making are susceptible to human anxieties and in the “…effort to ‘do good’ for our patients, we may fall prey to cognitive biases and therapeutic errors”.10We suggest the global publicity and panic regarding ICU triage distorted assessments of best interests and decision-making about admittance to ICU and slanted ethical debate. This has the potential to compromise important decisions with regard to care for patients with hair loss treatment.The emerging reality of ICUIn general, the majority of patients who are ventilated for hair loss treatment in ICU will die. Although comparing data from different health systems is challenging due to variation in admission criteria for ICU, clear trends are emerging with regard to those critically unwell and requiring mechanical ventilation.

Emerging data show case fatality rates of 50%–88% for ventilated patients with hair loss treatment. In China11 and Italy about half of those with hair loss treatment who receive ventilator support have not survived.12 In one small study in Wuhan the ICU mortality rate among those who received invasive mechanical ventilation was 86% (19/22).13 Interestingly, the rate among those who received less intensive non-invasive ventilation (NIV)1 was still 79% (23/29).13 Analysis of 5700 patients in the New York City area showed that the mortality for those receiving mechanical ventilation was 88%.14 In the UK, only 20% of those who have received mechanical ventilation have been discharged alive.15 Hence, the very real possibility of medical futility with regard to ventilation in hair loss treatment needs to be considered.It is also important to consider the complications and side effects that occur in an ICU context. These patients are vulnerable to hospital acquired s such as ventilator associated pneumonias with high mortality rates in their own right,16 neuropathies, myopathies17 and skin damage. Significant long term morbidity (physical, mental and emotional challenges) can also be experienced by people who survive prolonged ventilation in ICU.12 18 Under normal (non-propecia) circumstances, many ICU patients experience significant muscle atrophy and deconditioning, sleep disorders, severe fatigue,19 post-traumatic stress disorder,20 cognitive deficits,21 depression, anxiety, difficulty with daily activities and loss of employment.22 Although it is too soon to have data on the long term outcomes of ICU survivors in the specific context of hair loss treatment, the UK Chartered Society of Physiotherapy predicts a ‘tsunami of rehabilitation needs’ as patients with hair loss treatment begin to be discharged.23 The indirect effects of carer-burden should also not be underestimated, as research shows that caring for patients who have survived critical illness results in high levels of depressive symptoms for the majority of caregivers.24The emerging mortality data for patients with hair loss treatment admitted to ICU—in conjunction with what is already known about the morbidity of ICU survivors—has significant implications for the utility–equity debates about allocating the scarce resource of ICU beds. First, they undermine the utility argument as there seems to be little evidence that ICU admission leads to better outcomes for patients, especially when the long term morbidity of extended ICU admission is included in the balance of burdens and benefits.

For some patients, perhaps many, the burdens of ICU will not outweigh the limited potential benefits. Second, the poor survival rates challenge the equity-based claim for preferential access to treatment for members of disadvantaged groups. In particular, admitting frailer or comorbid patients to ICU to fulfil equity goals is unlikely to achieve greater survival for these population groups, but will increase their risk of complications and may ultimately exacerbate or prolong their suffering.The high proportions of people who die despite ICU admission make it particularly important to consider what might constitute better or worse experiences of dying with hair loss treatment, and how ICU admission affects the likelihood of a ‘good’ death. Critical care may compromise the ability of patients to communicate and engage with their families during the terminal phase of their lives—in the context of an intubated, ventilated patient this is unequivocal.Given the high rates of medical futility with patients with hair loss treatment in ICU, the very significant risks for further suffering in the short and long term and the compromise of important psychosocial needs—such as communicating with our families—in the terminal phase of life, our ethical scope must be wider than ICU triage. Ho and Tsai argue that, “In considering effective and efficient allocation of healthcare resources as well as physical and psychological harm that can be incurred in prolonging the dying process, there is a critical need to reframe end-of-life care planning in the ICU.”25 We propose that the focus on equity concerns during the propecia should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care.

This requires attention to minimising barriers to accessing culturally safe care in the following interlinked areas. Palliative care, and communication and decision support and advanced care planning.Palliative careScaling up palliative and hospice care is an essential component of the hair loss treatment propecia response. Avoiding non-beneficial or unwanted high-intensity care is critical when the capacity of the health system is stressed.26 Palliative care focuses on symptom management, quality of life and death, and holistic care of physical, psychological, social and spiritual health.27 Evidence from Italy has prompted recommendations that, “Governments must urgently recognise the essential contribution of hospice and palliative care to the hair loss treatment propecia, and ensure these services are integrated into the healthcare system response.”28 Rapid palliative care policy changes were implemented in response to hair loss treatment in Italy, including more support in community settings, change in admission criteria and daily telephone support for families.28 To meet this increased demand, hospice and palliative care staff should be included in personal protective equipment (PPE) allocation and provided with appropriate preventon and control training when dealing with patients with hair loss treatment or high risk areas.Attention must also be directed to maintaining supply lines for essential medications for pain, distress and sedation. Patients may experience pain due to existing comorbidities, but may also develop pain as a result of excessive coughing or immobility from hair loss treatment. Such symptoms should be addressed using existing approaches to pain management.27 Supply lines for essential medications for distress and pain management, including fentanyl and midazolam are under threat in the USA and propofol—used in terminal sedation—may also be in short supply.29 The challenges are exacerbated when people who for various reasons eschew or are unable to secure hospital admission decline rapidly at home with hair loss treatment (the time frame of recognition that someone is dying may be shorter than that through which hospice at home services usually support people).

There is growing debate about the fair allocation of novel drugs—sometimes available as part of ongoing clinical trials—to treat hair loss treatment with curative intent.2 30 But we must also pay attention to the fair allocation of drugs needed to ease suffering and dying.Communication and end-of-life decision-making supportEnd-of-life planning can be especially challenging because patients, family members and healthcare providers often differ in what they consider most important near the end of life.31 Less than half of ICU physicians—40.6% in high income countries and 46.3% in low–middle income countries—feel comfortable holding end-of-life discussions with patients’ families.25 With ICUs bursting and health providers under extraordinary pressure, their capacity to effectively support end-of-life decisions and to ease dying will be reduced.This suggests a need for specialist hair loss treatment communication support teams, analogous to the idea of specialist ICU triage teams to ensure consistency of decision making about ICU admissions/discharges, and to reduce the moral and psychological distress of health providers during the propecia.32 These support teams could provide up to date information templates for patients and families, support decision-making, the development of advance care plans (ACPs) and act as a liaison between families (prevented from being in the hospital), the patient and the clinical team. Some people with disabilities may require additional communication support to ensure the patients’ needs are communicated to all health providers.33 This will be especially important if carers and visitors are not able to be present.To provide effective and appropriate support in an equitable way, communication teams will need to include those with the appropriate skills for caring for diverse populations including. Interpreters, specialist social workers, disability advocates and cultural support liaison officers for ethnic and religious minorities. Patient groups that already have comparatively poor health outcomes require dedicated resources. These support resources are essential if we wish to truly mitigate equity concerns that arisingduring the propecia context.

See Box 1 for examples of specific communication and care strategies to support patients.Box 1 Supporting communication and compassionate care during hair loss treatmentDespite the sometimes overwhelming pressure of the propecia, health providers continue to invest in communication, compassionate care and end-of-life support. In some places, doctors have taken photos of their faces and taped these to the front of their PPE so that patients can ‘see’ their face.37 In Singapore, patients who test positive for hair loss are quarantined in health facilities until they receive two consecutive negative tests. Patients may be isolated in hospital for several weeks. To help ease this burden on patients, health providers have dubbed themselves the ‘second family’ and gone out of their way to provide care as well as treatment. Elsewhere, medical, nursing and multi-disciplinary teams are utilising internet based devices to enable ‘virtual’ visits and contact between patients and their loved ones.38 Some centres are providing staff with masks with a see-through window panel that shows the wearer’s mouth, to support effective communication with patient with hearing loss who rely on lip reading.39Advance care planningACPs aim to honour decisions made by autonomous patients if and when they lose capacity.

However, talking to patients and their loved ones about clinical prognosis, ceilings of treatment and potential end-of-life care is challenging even in normal times. During hair loss treatment the challenges are exacerbated by uncertainty and urgency, the absence of family support (due to visitor restrictions) and the wearing of PPE by clinicians and carers. Protective equipment can create a formidable barrier between the patient and the provider, often adding to the patient’s sense of isolation and fear. An Australian palliative care researcher with experience working in disaster zones, argues that the “PPE may disguise countenance, restrict normal human touch and create an unfamiliar gulf between you and your patient.”34 The physical and psychological barriers of PPE coupled with the pressure of high clinical loads do not seem conducive to compassionate discussions about patients’ end-of-life preferences. Indeed, a study in Singapore during the 2004 SARS epidemic demonstrated the barrier posed by PPE to compassionate end-of-life care.35Clinicians may struggle to interpret existing ACPs in the context of hair loss treatment, given the unprecedented nature and scale of the propecia and emerging clinical knowledge about the aetiology of the disease and (perhaps especially) about prognosis.

This suggests the need for hair loss treatment-specific ACPs. Where possible, proactive planning should occur with high-risk patients, the frail, those in residential care and those with significant underlying morbidities. Ideally, ACP conversations should take place prior to illness, involve known health providers and carers, not be hampered by PPE or subject to time constraints imposed by acute care contexts. Of note here, a systematic review found that patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay.36ConclusionHow best to address equity concerns in relation to ICU and end-of-life care for patients with hair loss treatment is challenging and complex. Attempts to broaden clinical criteria to give patients with poorer prognoses access to ICU on equity grounds may result in fewer lives saved overall—this may well be justified if access to ICU confers benefit to these ‘equity’ patients.

But we must avoid tokenistic gestures to equity—admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. ICU admission may exacerbate and prolong suffering rather than ameliorate it, especially for frailer patients. And prolonging life at all costs may ultimately lead to a worse death. The capacity for harm not just the capacity for benefit should be emphasised in any triage tools and related literature. Equity can be addressed more robustly if propecia responses scale up investment in palliative care services, communication and decision-support services and advanced care planning to meet the needs of all patients with hair loss treatment.

Ultimately, however, equity considerations will require us to move even further from a critical care framework as the social and economic impact of the propecia will disproportionately impact those most vulnerable. Globally, we will need an approach that does not just stop an exponential rise in s but an exponential rise in inequality.AcknowledgmentsWe would like to thank Tracy Anne Dunbrook and David Tripp for their helpful comments, and NUS Medicine for permission to reproduce the hair loss treatment Chronicles strip..

John Rawls begins a Theory of Justice with the observation that 'Justice is the first Cheap cialis virtue of social institutions, as truth is of systems of thought… Each person possesses an inviolability founded on justice how to buy cheap propecia online that even the welfare of society as a whole cannot override'1 (p.3). The hair loss treatment propecia has resulted in lock-downs, the restriction of liberties, debate about the right to refuse medical treatment and how to buy cheap propecia online many other changes to the everyday behaviour of persons. The justice issues it raises are diverse, profound and will demand our attention for some time.

How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are discussed in this issue of the Journal of Medical Ethics.The debate about ICU triage and hair loss treatment is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how to buy cheap propecia online how triage decisions should be made.6They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to hair loss treatment triage situations. Their argument seems to highlight instances of what is called the McNamara fallacy. US Secretary of Defense Robert McNamara used enemy body how to buy cheap propecia online counts as a measure of military success during the Vietnam war.

So, the fallacy occurs when we rely solely on considerations that appear to be quantifiable, to the neglect of vital qualitative, difficult to measure or contestable features.6 Newdick et al point to variation in assessment, subtlety in condition and other factors as reasons why it is misleading to present scoring systems as ‘objective’ tests for triage. In doing so they draw a distinction between procedural and outcome consistency, which is important, and hints at distinctions Rawls drew between the different forms of procedural how to buy cheap propecia online fairness. While we might hope to come up with a triage protocol that is procedurally fair and arrives at a fair outcome (what Rawls calls perfect procedural justice, p.

85) there is how to buy cheap propecia online little prospect of that. As they observe, reasonable people can disagree about the outcomes we should aim for in allocating health resources and ICU triage for hair loss treatment is no exception. Instead, we should work toward how to buy cheap propecia online a transparent and fair process, what Rawls would describe as imperfect procedural justice (p.

85). His example of this is a criminal trial where we adopt processes that we have reason to believe are our best chance of determining guilt, but which do not guarantee the truth of a verdict, and this is a reason why they must be transparent and consistent (p. 85).

Their proposal is to triage patients into three broad categories. High, medium and low priority, with the thought that a range of considerations could feed into that evaluation by an appropriately constituted clinical group.Ballantyne et al question another issue that is central to the debate about hair loss treatment triage.4 They describe how utility measures such as QALYs, lives saved seem to be in tension with equity. Their central point is that ICU for hair loss treatment can be futile, and that is a reason for questioning how much weight should be given to equality of access to ICU for hair loss treatment.

They claim that there is little point admitting someone to ICU when ICU is not in their best interests. Instead, the scope of equity should encompass preventing 'remediable differences among social, economic demographic or geographic groups' and for hair loss treatment that means looking beyond access to ICU. Their central argument can be summarised as follows.Maximising utility can entrench existing health inequalities.The majority of those ventilated for hair loss treatment in ICU will die.Admitting frailer or comorbid patients to ICU is likely to do more harm than good to these groups.Therefore, better access to ICU is unlikely to promote health equity for these groups.Equity for those with health inequalities related to hair loss treatment should broadened to include all the services a system might provide.Brown et al argue in favour of hair loss treatment immunity passports and the following summarises one of the key arguments in their article.7hair loss treatment immunity passports are a way of demonstrating low personal and social risk.Those who are at low personal risk and low social risk from hair loss treatment should be permitted more freedoms.Permitting those with immunity passports greater freedoms discriminates against those who do not have passports.Low personal and social risk and preserving health system capacity are relevant reasons to discriminate between those who have immunity and those who do not.Brown et al then consider a number of potential problems with immunity passports, many of which are justice issues.

Resentment by those who do not hold an immunity passport along with a loss of social cohesion, which is vital for responding to hair loss treatment, are possible downsides. There is also the potential to advantage those who are immune, economically, and it could perpetuate existing inequalities. A significant objection, which is a problem for the justice of many policies, is free riding.

Some might create fraudulent immunity passports and it might even incentivise intentional exposure to the propecia. Brown et al suggest that disincentives and punishment are potential solutions and they are in good company as the Rawlsian solution to free riding is for 'law and government to correct the necessary corrections.' (p. 268)Elves and Herring focus on a set of ethical principles intended to guide those making policy and individual level decisions about adult social care delivery impacted by the propecia.8 They criticize the British government’s framework for being silent about what to do in the face of conflict between principles.

They suggest the dominant values in the framework are based on autonomy and individualism and argue that there are good reasons for not making autonomy paramount in policy about hair loss treatment. These include that information about hair loss treatment is incomplete, so no one can be that informed on decisions about their health. The second is one that highlights the importance of viewing our present ethical challenges via the lens of justice or other ethical concepts such as community or solidarity that enable us to frame collective obligations and interests.

They observe that hair loss treatment has demonstrated how health and how we live our lives are linked. That what an individual does can have profound impact on the health of many others.Their view is that appeals to self-determination ring hollow for hair loss treatment and their proposed remedy is one that pushes us to reflect on what the liberal commitment to the inviolability of each person means. They explain Dworkin’s account of 'associative obligations' which occur within a group when they acknowledge special rights and responsibilities to each other.

These obligations are a way of giving weight to community considerations, without collapsing into full-blown utilitarianism and while still respecting the inviolability of persons.The hair loss treatment propecia is pushing ethical deliberation in new directions and many of them turn on approaching medical ethics with a greater emphasis on justice and related ethical concepts.IntroductionAs hair loss treatment spread internationally, healthcare services in many countries became overwhelmed. One of the main manifestations of this was a shortage of intensive care beds, leading to urgent discussion about how to allocate these fairly. In the initial debates about allocation of scarce intensive care unit (ICU) resources, there was optimism about the ‘good’ of ICU access.

However, rather than being a life-saving intervention, data began to emerge in mid-April showing that most critical patients with hair loss treatment who receive access to a ventilator do not survive to discharge. The minority who survive leave the ICU with significant morbidity and a long and uncertain road to recovery. This reality was under-recognised in bioethics debates about ICU triage throughout March and April 2020.

Central to these disucssions were two assumptions. First, that ICU admission was a valuable but scarce resource in the propecia context. And second, that both equity and utility considerations were important in determining which patients should have access to ICU.

In this paper we explain how scarcity and value were conflated in the early ICU hair loss treatment triage literature, leading to undue optimism about the ‘good’ of ICU access, which in turned fuelled equity-based arguments for ICU access. In the process, ethical issues regarding equitable access to end-of-life care more broadly were neglected.Equity requires the prevention of avoidable or remediable differences among social, economic, demographic, or geographic groups.1 How best to apply an equity lens to questions of distribution will depend on the nature of the resource in question. Equitable distribution of ICU beds is significantly more complex than equitable distribution of other goods that might be scarce in a propecia, such as masks or treatments.

ICU (especially that which involves intubation and ventilation i.e. Mechanical ventilation) is a burdensome treatment option that can lead to significant suffering—both short and long term. The degree to which these burdens are justified depends on the probability of benefit, and this depends on the clinical status of the patient.

People are rightly concerned about the equity implications of excluding patients from ICU on the grounds of pre-existing comorbidities that directly affect prognosis, especially when these align with and reflect social disadvantage. But this does not mean that aged, frail or comorbid patients should be admitted to ICU on the grounds of equity, when this may not be in their best interests.ICU triage debateThe hair loss treatment propecia generated extraordinary demand for critical care and required hard choices about who will receive presumed life-saving interventions such as ICU admission. The debate has focused on whether or not a utilitarian approach aimed at maximising the number of lives (or life-years) saved should be supplemented by equity considerations that attempt to protect the rights and interests of members of marginalised groups.

The utilitarian approach uses criteria for access to ICU that focus on capacity to benefit, understood as survival.2 Supplementary equity considerations have been invoked to relax the criteria in order to give a more diverse group of people a chance of entering ICU.3 4Equity-based critiques are grounded in the concern that a utilitarian approach aimed at maximising the number (or length) of lives saved may well exacerbate inequity in survival rates between groups. This potential for discrimination is heightened if triage tools use age as a proxy for capacity to benefit or are heavily reliant on Quality-Adjusted Life-Years (QALYs) which will deprioritise people with disabilities.5 6 Even if these pitfalls are avoided, policies based on maximising lives saved entrench existing heath inequalities because those most likely to benefit from treatment will be people of privilege who come into the propecia with better health status than less advantaged people. Those from lower socioeconomic groups, and/or some ethnic minorities have high rates of underlying comorbidities, some of which are prognostically relevant in hair loss treatment .

Public health ethics requires that we acknowledge how apparently neutral triage tools reflect and reinforce these disparities, especially where the impact can be lethal.7But the utility versus equity debate is more complex than it first appears. Both the utility and equity approach to ICU triage start from the assumption that ICU is a valuable good—the dispute is about how best to allocate it. Casting ICU admission as a scarce good subject to rationing has the (presumably unintended) effect of making access to critical care look highly appealing, triggering cognitive biases.

Psychologists and marketers know that scarcity sells.8 People value a commodity more when it is difficult or impossible to obtain.9 When there is competition for scarce resources, people focus less on whether they really need or want the resource. The priority becomes securing access to the resource.Clinicians are not immune to scarcity-related cognitive bias. Clinicians treating patients with hair loss treatment are working under conditions of significant information overload but without the high quality clinical research (generated from large data sets and rigorous methodology) usually available for decision-making.

The combination of overwhelming numbers of patients, high acuity and uncertainty regarding best practice is deeply anxiety provoking. In this context it is unsurprising that, at least in the early stages of the propecia, they may not have the psychological bandwidth to challenge assumptions about the benefits of ICU admission for patients with severe disease. Zagury-Orly and Schwartzstein have recently argued that the health sector must accept that doctors’ reasoning and decision-making are susceptible to human anxieties and in the “…effort to ‘do good’ for our patients, we may fall prey to cognitive biases and therapeutic errors”.10We suggest the global publicity and panic regarding ICU triage distorted assessments of best interests and decision-making about admittance to ICU and slanted ethical debate.

This has the potential to compromise important decisions with regard to care for patients with hair loss treatment.The emerging reality of ICUIn general, the majority of patients who are ventilated for hair loss treatment in ICU will die. Although comparing data from different health systems is challenging due to variation in admission criteria for ICU, clear trends are emerging with regard to those critically unwell and requiring mechanical ventilation. Emerging data show case fatality rates of 50%–88% for ventilated patients with hair loss treatment.

In China11 and Italy about half of those with hair loss treatment who receive ventilator support have not survived.12 In one small study in Wuhan the ICU mortality rate among those who received invasive mechanical ventilation was 86% (19/22).13 Interestingly, the rate among those who received less intensive non-invasive ventilation (NIV)1 was still 79% (23/29).13 Analysis of 5700 patients in the New York City area showed that the mortality for those receiving mechanical ventilation was 88%.14 In the UK, only 20% of those who have received mechanical ventilation have been discharged alive.15 Hence, the very real possibility of medical futility with regard to ventilation in hair loss treatment needs to be considered.It is also important to consider the complications and side effects that occur in an ICU context. These patients are vulnerable to hospital acquired s such as ventilator associated pneumonias with high mortality rates in their own right,16 neuropathies, myopathies17 and skin damage. Significant long term morbidity (physical, mental and emotional challenges) can also be experienced by people who survive prolonged ventilation in ICU.12 18 Under normal (non-propecia) circumstances, many ICU patients experience significant muscle atrophy and deconditioning, sleep disorders, severe fatigue,19 post-traumatic stress disorder,20 cognitive deficits,21 depression, anxiety, difficulty with daily activities and loss of employment.22 Although it is too soon to have data on the long term outcomes of ICU survivors in the specific context of hair loss treatment, the UK Chartered Society of Physiotherapy predicts a ‘tsunami of rehabilitation needs’ as patients with hair loss treatment begin to be discharged.23 The indirect effects of carer-burden should also not be underestimated, as research shows that caring for patients who have survived critical illness results in high levels of depressive symptoms for the majority of caregivers.24The emerging mortality data for patients with hair loss treatment admitted to ICU—in conjunction with what is already known about the morbidity of ICU survivors—has significant implications for the utility–equity debates about allocating the scarce resource of ICU beds.

First, they undermine the utility argument as there seems to be little evidence that ICU admission leads to better outcomes for patients, especially when the long term morbidity of extended ICU admission is included in the balance of burdens and benefits. For some patients, perhaps many, the burdens of ICU will not outweigh the limited potential benefits. Second, the poor survival rates challenge the equity-based claim for preferential access to treatment for members of disadvantaged groups.

In particular, admitting frailer or comorbid patients to ICU to fulfil equity goals is unlikely to achieve greater survival for these population groups, but will increase their risk of complications and may ultimately exacerbate or prolong their suffering.The high proportions of people who die despite ICU admission make it particularly important to consider what might constitute better or worse experiences of dying with hair loss treatment, and how ICU admission affects the likelihood of a ‘good’ death. Critical care may compromise the ability of patients to communicate and engage with their families during the terminal phase of their lives—in the context of an intubated, ventilated patient this is unequivocal.Given the high rates of medical futility with patients with hair loss treatment in ICU, the very significant risks for further suffering in the short and long term and the compromise of important psychosocial needs—such as communicating with our families—in the terminal phase of life, our ethical scope must be wider than ICU triage. Ho and Tsai argue that, “In considering effective and efficient allocation of healthcare resources as well as physical and psychological harm that can be incurred in prolonging the dying process, there is a critical need to reframe end-of-life care planning in the ICU.”25 We propose that the focus on equity concerns during the propecia should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care.

This requires attention to minimising barriers to accessing culturally safe care in the following interlinked areas. Palliative care, and communication and decision support and advanced care planning.Palliative careScaling up palliative and hospice care is an essential component of the hair loss treatment propecia response. Avoiding non-beneficial or unwanted high-intensity care is critical when the capacity of the health system is stressed.26 Palliative care focuses on symptom management, quality of life and death, and holistic care of physical, psychological, social and spiritual health.27 Evidence from Italy has prompted recommendations that, “Governments must urgently recognise the essential contribution of hospice and palliative care to the hair loss treatment propecia, and ensure these services are integrated into the healthcare system response.”28 Rapid palliative care policy changes were implemented in response to hair loss treatment in Italy, including more support in community settings, change in admission criteria and daily telephone support for families.28 To meet this increased demand, hospice and palliative care staff should be included in personal protective equipment (PPE) allocation and provided with appropriate preventon and control training when dealing with patients with hair loss treatment or high risk areas.Attention must also be directed to maintaining supply lines for essential medications for pain, distress and sedation.

Patients may experience pain due to existing comorbidities, but may also develop pain as a result of excessive coughing or immobility from hair loss treatment. Such symptoms should be addressed using existing approaches to pain management.27 Supply lines for essential medications for distress and pain management, including fentanyl and midazolam are under threat in the USA and propofol—used in terminal sedation—may also be in short supply.29 The challenges are exacerbated when people who for various reasons eschew or are unable to secure hospital admission decline rapidly at home with hair loss treatment (the time frame of recognition that someone is dying may be shorter than that through which hospice at home services usually support people). There is growing debate about the fair allocation of novel drugs—sometimes available as part of ongoing clinical trials—to treat hair loss treatment with curative intent.2 30 But we must also pay attention to the fair allocation of drugs needed to ease suffering and dying.Communication and end-of-life decision-making supportEnd-of-life planning can be especially challenging because patients, family members and healthcare providers often differ in what they consider most important near the end of life.31 Less than half of ICU physicians—40.6% in high income countries and 46.3% in low–middle income countries—feel comfortable holding end-of-life discussions with patients’ families.25 With ICUs bursting and health providers under extraordinary pressure, their capacity to effectively support end-of-life decisions and to ease dying will be reduced.This suggests a need for specialist hair loss treatment communication support teams, analogous to the idea of specialist ICU triage teams to ensure consistency of decision making about ICU admissions/discharges, and to reduce the moral and psychological distress of health providers during the propecia.32 These support teams could provide up to date information templates for patients and families, support decision-making, the development of advance care plans (ACPs) and act as a liaison between families (prevented from being in the hospital), the patient and the clinical team.

Some people with disabilities may require additional communication support to ensure the patients’ needs are communicated to all health providers.33 This will be especially important if carers and visitors are not able to be present.To provide effective and appropriate support in an equitable way, communication teams will need to include those with the appropriate skills for caring for diverse populations including. Interpreters, specialist social workers, disability advocates and cultural support liaison officers for ethnic and religious minorities. Patient groups that already have comparatively poor health outcomes require dedicated resources.

These support resources are essential if we wish to truly mitigate equity concerns that arisingduring the propecia context. See Box 1 for examples of specific communication and care strategies to support patients.Box 1 Supporting communication and compassionate care during hair loss treatmentDespite the sometimes overwhelming pressure of the propecia, health providers continue to invest in communication, compassionate care and end-of-life support. In some places, doctors have taken photos of their faces and taped these to the front of their PPE so that patients can ‘see’ their face.37 In Singapore, patients who test positive for hair loss are quarantined in health facilities until they receive two consecutive negative tests.

Patients may be isolated in hospital for several weeks. To help ease this burden on patients, health providers have dubbed themselves the ‘second family’ and gone out of their way to provide care as well as treatment. Elsewhere, medical, nursing and multi-disciplinary teams are utilising internet based devices to enable ‘virtual’ visits and contact between patients and their loved ones.38 Some centres are providing staff with masks with a see-through window panel that shows the wearer’s mouth, to support effective communication with patient with hearing loss who rely on lip reading.39Advance care planningACPs aim to honour decisions made by autonomous patients if and when they lose capacity.

However, talking to patients and their loved ones about clinical prognosis, ceilings of treatment and potential end-of-life care is challenging even in normal times. During hair loss treatment the challenges are exacerbated by uncertainty and urgency, the absence of family support (due to visitor restrictions) and the wearing of PPE by clinicians and carers. Protective equipment can create a formidable barrier between the patient and the provider, often adding to the patient’s sense of isolation and fear.

An Australian palliative care researcher with experience working in disaster zones, argues that the “PPE may disguise countenance, restrict normal human touch and create an unfamiliar gulf between you and your patient.”34 The physical and psychological barriers of PPE coupled with the pressure of high clinical loads do not seem conducive to compassionate discussions about patients’ end-of-life preferences. Indeed, a study in Singapore during the 2004 SARS epidemic demonstrated the barrier posed by PPE to compassionate end-of-life care.35Clinicians may struggle to interpret existing ACPs in the context of hair loss treatment, given the unprecedented nature and scale of the propecia and emerging clinical knowledge about the aetiology of the disease and (perhaps especially) about prognosis. This suggests the need for hair loss treatment-specific ACPs.

Where possible, proactive planning should occur with high-risk patients, the frail, those in residential care and those with significant underlying morbidities. Ideally, ACP conversations should take place prior to illness, involve known health providers and carers, not be hampered by PPE or subject to time constraints imposed by acute care contexts. Of note here, a systematic review found that patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay.36ConclusionHow best to address equity concerns in relation to ICU and end-of-life care for patients with hair loss treatment is challenging and complex.

Attempts to broaden clinical criteria to give patients with poorer prognoses access to ICU on equity grounds may result in fewer lives saved overall—this may well be justified if access to ICU confers benefit to these ‘equity’ patients. But we must avoid tokenistic gestures to equity—admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. ICU admission may exacerbate and prolong suffering rather than ameliorate it, especially for frailer patients.

And prolonging life at all costs may ultimately lead to a worse death. The capacity for harm not just the capacity for benefit should be emphasised in any triage tools and related literature. Equity can be addressed more robustly if propecia responses scale up investment in palliative care services, communication and decision-support services and advanced care planning to meet the needs of all patients with hair loss treatment.

Ultimately, however, equity considerations will require us to move even further from a critical care framework as the social and economic impact of the propecia will disproportionately impact those most vulnerable. Globally, we will need an approach that does not just stop an exponential rise in s but an exponential rise in inequality.AcknowledgmentsWe would like to thank Tracy Anne Dunbrook and David Tripp for their helpful comments, and NUS Medicine for permission to reproduce the hair loss treatment Chronicles strip..