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Although the of the intervention on the paretic upper extremity 3 sessions per week effect of Botulium toxin A injection is different from person to per- during 4 weeks cheapest generic levitra professional uk erectile dysfunction in young adults. Material and Methods: Forty purchase 20mg levitra professional overnight delivery erectile dysfunction injection,26 and 17 chronic stage of stroke beta power buy discount levitra professional 20mg line erectile dysfunction milkshake, concentration and activation. The frst time injection was per- (C4) and Beta power (C3 and C4), concentration (F3, F4 and C3) formed at 1380 days after the onset of stroke, while the average in- and activation (C4) (p<0. Introduction/Background: Spasticity, defned as a velocity-depend- Domen2 ent increase in tonic stretch refexes, disturbs activities of daily living 1Sasayama Medical Center Hyogo College of Medicine, Depart- in patients with cerebrovascular disorders. We report a patient with subarachnoid 2 3 4 hemorrhage who underwent orthopedic selective spasticity control Ogino , M. Material and Methods: A 41-year- ment of General Medicine and Community Health Science, Sasay- old man suffered from subarachnoid hemorrhage (Hunt & Kosnik ama Hyogo, Japan, 2Sasayama Medical Center Hyogo College of grade 5) due to the rupture of an anterior communicating artery an- Medicine, Department of Rehabilitation, Sasayama Hyogo, Japan, eurysm. He underwent the craniotomy clipping and lumboperitoneal 3Nishinomiya Kyouritsu Rehabilitation Hospital, Department of shunt surgeries for the treatment of hydrocephalus, which he devel- Rehabilitation, Nishinomiya Hyogo, Japan, 4Hyogo College of oped later. He was discharged on the 239thday and returned home, but was admitted in our hospital for further rehabili- Introduction/Background: The evaluation of the spasticity is essential tation on the 256th day. However, there is no established quantitative evaluation of the lower limbs were very diffcult to treat and had limited the knee the spasticity currently. We recorded M-response, H-refex and T-refex ure score improved by 21 points at discharge, compared to that at by tibial nerve stimulation of the affected side before and 4 weeks admission. This is 1 1 1 because Tmax/Mmax refects achilles tendon refex clinically, which C. Introduction/Background: Approximately 20–43% of the post-stroke patients developed spasticity and motor defcit. All the assessment emphasis after acute brain injury is more on life preservation. Tradi- was done at baseline (pre-treatment), one week after treatment and tionally, contracture resulting from spasticity have been managed by at four weeks follow-up. Results: The intervention group showed signifcant improvement spasticity has also role in the pathophysiology of contracture, another in the upper limb motor function and the effect persisted up to one option to treat contracture is by giving local injection procedure such month after treatment. Other than that, there was no signifcant im- as chemical neurolysis using alcohol, phenol or Botolinum Toxin provement in the spasticity and motor evolved potential. High dose of Botulinum improved motor impairment of upper limb with no effect on spasticity. Clinical follow up was obtained at 2 limb amputations treated at Disabled Child Assistance Association weeks, 2 months and 6 month post intervention. Material and Methods: 39 patients answered the question- injection and undergone intensive rehabilitation involving stretching, naire, which included items related to general characteristics, am- functional gait training including ground walking and body weight putation, rehabilitation, activities of daily living, occupation, driv- supported gait training, patient has shown impressive improvement ing and pain in the stump. Beck Anxiety and Depression Inventory in both clinical assessment and outcome measures. Statistical nonparametric tests with equality of two outcome of patient from this case report suggests that Botulinum tox- proportions, confdence interval for mean of 95% e p-value <0. Chung1 Introduction/Background: Interruptions to amputee rehabilitation is 1University of Malaya, Department of Rehabilitation Medicine, a common occurrence. Meikle et al studied the frequency of inter- Kuala Lumpur, Malaysia ruptions in 254 patients admitted for rehabilitation and discovered interruptions in 30% of the patients. It is thought that walking on single limb with endothelial trauma (vascular injury), and the substantial incidence of the support of a walking aids will affect the peak plantar pressure autoantibodies to phospholipid in vascular surgery patients (hyperco- compared to bipedal walking. The purpose of this study is to fnd out agulability) places amputees at high risk. Although interruptions are if there is any difference in peak plantar pressure between normal common and result in longer lengths of stay, these interruptions do bipedal walking and walking on single limb with walking aids. Our case study supports published litera- barefoot on Footscan Pressure Plate using a 2-step protocol. Right ture that return to complete rehabilitation in this scenario can lead and left foot peak plantar pressure of their bipedal walking, walk- to successful prosthetic rehabilitation. Results: A 67-year-old male underwent left below knee test and post hoc analysis with Wilcoxon signed-rank tests were amputation on 21/10/2014. We re-established goals, and re-initiated in peak plantar pressure of right and left foot. When comparing right and left foot pressure, only Due to frequent fuctuation in stump volume regular follow-up is es- walking on single limb with crutches had a signifcant difference sential. There is a statistically signifcant positive correlation be- of Physical Medicine and Rehabilitation. Conclusion: The results have shown that single grades: a new population-specifc measure for lower limb amputees. If the result is to be extrapolated to the diabetic patient, it has to be done with caution. Stewart1 motion of the right knee was normal but the patient had pain during 1University of the Witwatersrand, Physiotherapy, Johannesburg, the examination. Magnetic resonance imaging of right knee showed the presence of hyperintense area and increased fat pad Background: It is important to outline the mapping and integration volume compatible with Hoffa’s disease at the lateral side of the of reviewed concepts and ideas to inform studies addressing ampu- knee (Figure 1). We administered diclofenac sodium 75 mg twice tee health in Johannesburg, in order to support the rationale, answer a day for ten days and he was advised for resting, elevation and the research questions, develop, implement, report and evaluate re- cold application. It can the researchers noticed that the current rehabilitation available fol- be diffcult to distinguish this clinical entity from other pathologies. This led to the postulation and expectation that an additional that have pain in the region of knee. Presence of this syndrome may and more supportive intervention is needed if one is to improve prevent prosthesis use. These included 766 problems specifc to developing countries and in particular South Africa. Haga1 problems were addressed in two forms namely, a randomised con- 1Graduate School of Medicine - The University of Tokyo, Depart- trolled trial and an epidemiological study. These problems included ment of Rehabilitation Medicine, Tokyo, Japan, 2The University of mobility, impairment, socioeconomic and psychological challenges. Their introduction is not troublesome, if the patients themselves have requests to use them or know their 768 usefulness. Therefore, it is sometimes diffcult to have young children utilize the prostheses. She then developed a Staph infection which progressed oelectric signals from residual limbs. Results: Several types of into toxic shock syndrome and then necrotizing fasciitis affecting all prostheses and devices were introduced to 12 patients; passive of her extremities causing her to require a bilateral below the knee hands with some function, body-powered prostheses, myoelec- amputation. She spent a total of 3 months in the hospital before be- tric hands, prosthetic hands with sports and recreational devices ing transferred to our Acute Inpatient Rehabilitation Unit where it (S&R), 3D printed robotic prosthesis the ‘Robohand’, three-fn- was noticed she had a locked knee. Material and Methods: A few gered functional hand the ‘Finch’ fabricated by 3D printer, and a different methods were attempted to release the patient’s locked motor-driven plastic toy train the ‘Plarail’ controlled by myoelec- knee.
There is evidence that legislation for smoke-free workplaces does protect non- smoking bar workers buy generic levitra professional canada erectile dysfunction age 21. In February 2006 order levitra professional no prescription erectile dysfunction treatments diabetes, the British Parliament voted for a total ban on smoking in public places safe 20mg levitra professional erectile dysfunction free samples. Many authorities have banned smoking in the workplace, public areas, prisons, and restaurants, except in designated areas. In July 2008, the German Constitutional Court upheld the case of small bars that held that because large bars had enough room to divide off areas for smokers the smaller establishments did not have this option, so throwing the German ban into disarray. Smoke-free workplaces protect against passive smoking and encourage smokers to quit or reduce consumption. Stubbs ea (2004) found that smokers and nurses in an English psychiatric hospital were more permissive toward smoking on wards than were non-smokers and psychiatrists. A short- 756 Requirements of a national tobacco control policy are shown in the box. Components of a national tobacco control policy2497 Increase price of and taxes on tobacco at rate above inflation Ban all advertising and sponsorship by tobacco industry Restrict smoking to designated areas (public places and work sites) Reduce passive tobacco exposure, including in utero Target people at-risk for starting to smoke “Proof of age” cards required when purchasing tobacco; retailers to be banned from selling tobacco (or worse, e. However, despite calls for weaker cigarettes, smokers may compensate for low nicotine yield by puffing more often and deeper, and by smoking more cigarettes. From January 2001 all cigarette packets in Canada carried health warnings that occupy 50% of the front of the pack, although attempts to ban sponsorship of public events by tobacco companies was watered down by the Quebec Court of Appeal in 2005. Changing to cigarettes with a lower tar yield may not reduce the chances of myocardial infarction if one continues to smoke. Young Irish children could until recently readily buy cigarettes from retail outlets and retailers are obliged to ensure that prospective customers are at least 18 years of age. Iran and Uruguay have total bans on smoking in public places, Syria following them in 2009. Some American insurance firms owned by tobacco companies have charged smokers almost double for term life insurance! Tobacco companies pressurised companies producing nicotine replacement products to tone down anti-smoking messages. Tobacco dependence is a chronic disorder requiring repeated attempts aimed at eventual abstinence. Practical counselling and social support are important ingredients in management, as are sustained-release bupropion hydrochloride (e. The present author agrees with Howell (2002) that smoking cessation products should be free to all who wish to stop smoking, not just to those who qualify for medical cards. Further research is needed to determine the efficacy of pharmacological interventions. Many adult smokers started by buying three cigarettes from shopkeepers whilst underage, a failure of the state to protect them. Methyl alcohol (methanol) Mortality from methanol2503 (wood alcohol) poisoning is about 20% because of a metabolic acidosis from toxic metabolites (formaldehyde and formic acid2504). Treatment strategies include gastric lavage, ethanol or fomepizole (competes for alcohol dehydrogenase so inhibiting formic acid production), folate, bicarbonate, and haemodialysis. Isopropyl alcohol (isopropanol, rubbing alcohol) This is found in a number of products, e. It is converted to acetone, which can be detected in breath (odour), blood and urine. It can cause euphoria, ataxia, dizziness, headache, nausea, vomiting, haematemesis, nystagmus, confusion, coma, hypotension, and respiratory depression. Most cases respond to supportive measures; gastric lavage and haemodialysis are options. Ethylene glycol This is found in antifreeze, windshield washer fluid, and radiator coolants. There can be tachycardia, hypertension, pulmonary oedema, metabolic acidosis, hypocalcaemia, myositis, coma, and convulsions. Severe poisoning is an indication for haemodialysis (which means ethanol or fomepizole dose should be increased) or haemodiafiltration. Absinthe This is a green, distilled, highly alcoholic, anise-flavoured spirit derived from herbs (e. Opinion varies on its psychoactivity but it has been blamed for such phenomena as delirium and hallucinations. Rizvi ea (2010) have reported a case of acute suicidality that emerged during absinthe consumption. Vincent Van Gogh (1853-1890) 2507 Epidemiology: Not everyone who drinks (ethyl) alcohol will develop significant problems from its use. For a discussion on whether and how to collaborate with the tobacco industry see Gray. Absinthe is sometimes known as Green Fairy due to its colour and is said to have been a favourite of Oscar Wilde. Also, it is a mistake to view alcohol dependence as an all or none phenomenon – it comes in all grades. Alcohol limits for drivers in the Republic of Ireland, 2009 (from December 1994) 2511 80 mgs/100 mls of blood 35 micrograms/100 mls of breath 2512 107 mgs/100 mls of urine Alcohol limits for drivers in the Republic of Ireland from September 2011 Road Traffic Bill 2009 passed by Dáil in June 2010 20 mgs/100 mls of blood for learner and professional drivers 50 mg/100 mls of blood for other drivers European blood alcohol limits for drivers, 2009 (mgs/100 mls of blood) 0. The proportion of a population drinking excessively is largely determined by the average consumption of 2513 that population. The latter is determined by price,(Kendell ea, 1983; Purshouse ea, 2010) licensing laws , and customs and moral beliefs. Islamic countries, especially Saudi Arabia, do not officially allow alcoholic consumption. People whose jobs carry a high risk of alcoholism include those who have ready assess to alcohol (chefs, barmen, brewery workers, kitchen porters - even some laboratory workers), those on expense accounts (salesmen, executives), seamen, printers, vagrants, printers, ex-convicts, doctors, and patients in general. In England, 38% of men and 23% of women drank more 2515 than the upper recommended levels for the heaviest drinking day of the week. A fifth of British adults drank in excess of double the safe limit on their heaviest day of the week in 2007. The social stigma associated with the presence of women in pubs has largely disappeared and they have more money to spend. Barriers that may reduce likelihood of women seeking help for substance abuse/dependence Social stigma Too busy with offspring or elder care Fear of loss of children Fear of drug-using partner Lack of child care services Lack of transport Poverty/lack of health insurance Perception that drug services are not geared toward women Heavy, regular drinking occurs at a later age in women than in men but there is a shorter length of time before women develop problems: this ‘telescoping’ effect in women has been described for other drugs as well as alcohol. Over 4% of British government revenue derived from alcohol taxes in the mid-1980s during which 750,000 people worked in the British drink trade. The total annual economic, health and social costs associated with alcohol misuse in England is somewhere between £20-30 bn. Rates of first admission per 1000,000 for England for both sexes rose from 4 in 1970 to 9 in 1986. Both problems were more prevalent among young adults, especially males aged 16-24 years.
Whilst the 1774 patient may be defining himself through his appearance (Veale levitra professional 20mg on line impotence cure, 2007) compliments about appearance have no ameliorating effect buy levitra professional 20 mg otc erectile dysfunction and diabetes leaflet. Most common areas of concern are the overall appearance buy levitra professional without a prescription erectile dysfunction raleigh nc, face, hair, nose, genitalia, legs, skin, and multiple areas. Some cases repeatedly check their appearance in mirrors whilst others avoid mirrors and cover up supposed defects with wigs or cosmetics. Cerebral blood flow studies suggest that these patients may have increased thalamic perfusion bilaterally as well as increased blood 1770 Espc. Surgical correction of alleged defects is generally ineffective for the underlying dysmorphophobia. Phillips ea, 2002) and pimozide added to fluoxetine was not more effective than placebo added to fluoxetine in a placebo- controlled study. Some cases, particularly children, may also pull hair from other people or from pet animals. It has been described in a variety 1780 of circumstances and in a number of different psychiatric disorders and I. Attempts may be made to cover up bald areas (wigs, hairstyles, colouring 1782 pencils, etc). N-acetylcysteine , an amino acid and glutamate modulator (perhaps increasing extracellular glutamate in the nucleus accumbens), was significantly more efficacious compared to placebo in an American study. Even if the patient is satisfied with the operation it is unlikely to alter the underlying disorder. Some patients are so ashamed and in fear of ridicule that they withdraw from social interaction. Mad, Bad and Sad: A History of Women and the Mind Doctors from 1800 to the Present. Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. Pulling Hair: Trichotillomania and its Treatment in Adults: A Guide for Clinicians. Pulling Hair: Trichotillomania and its Treatment in Children and Adolescents: : A Guide for Clinicians. Generalized Anxiety Disorder, Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder. Clark & Watson, 1999) opines three basic temperaments (positive or 1786 negative emotionality, and constraint ); Goldsmith ea (1987) listed four ways in which infants express temperament, i. Constraint (possibly subserved by serotonin) refers to the tendency to take the longterm view rather than simply reacting to emotions. According to the epigenesis approach, development occurs in successive, clearly defined stages. Each stage follows the previous one, and each must be negotiated successfully in order for development to proceed smoothly. Should a stage not be resolved, all subsequent stages reflect that failure in the guise of physical, cognitive, emotional or social maladjustment. In crisis points theory, on the other hand, each stage is characterised by a crisis point that must be successfully negotiated. Many factors interact in a complex way to produce our eventual personality: genes, experiences, culture, parents, other people, the environment, etc. Illness, disease or dysfunction does not arise in vacuo but in a person with a personality. Other factors are also important in modifying the clinical appearance of illness, e. The latter are prescribed by licensed professionals, the self, 1789 lay acquaintances, or illicitly. Also, in the context of environmental adversity, genetics become more important in the causation of ‘externalising disorders’ such as antisocial behaviour and substance use. The diagnosis is relatively unstable over time and many clinicians are either extremely reluctant to make it or view it as a working diagnosis. Learning problems and psychological difficulties are common in any population of epileptics. Hippocrates and temperament Temperament Body humour Characteristic Melancholic Black bile Pessimistic Sanguine Blood Over-optimistic Choleric Yellow bile Irritable Phlegmatic Phlegm Apathetic 1790 Trait theory is basically an attempt at taxonomy. Introversion-extraversion , body build types, and so on, are all based on the assumption that we, as people, occupy some point along some line(s) which are 1791 called trait(s). In 1936 Kretschmer described three personality types: pyknic, athletic and leptosomatic. In 1942 he rated personality on three dimensions: viscerotonia - relaxed, enjoys comfort; somatotonia - assertive, energetic; and cerebrotonia - very controlled, not inclined to overt action, expresses himself symbolically. These are all attempts at classifying people according to somatotype (body-build), a practice that had some grain of truth in extreme cases. Genes determine differences in reaction between individuals to the same environmental situation. Family environment (read ‘genetic’) is more important than wider (environmental) influences (e. There are three main traits (vide supra): E, extraversion – (ambiversion) – introversion; N, neuroticism – stability; and P, psychoticism – ego control. He is highly critical of modern psychiatric taxonomies, seeing that as politically compromised committee resolutions, and recommends the dimensional over the categorical approach to 1793 diagnosis. Cramer (1994) interprets Eysenck’s ‘neuroticism’ as reflecting emotional instability and his ‘psychoticism’ as meaning a lack of caring. Robert Cloninger (Cloninger, 1987, 2002) Dimensions preferable to categories (supported by Morey ea, 2007) Temperament is the emotional (limbic, hypothalamic) and character is the higher cognitive (mental self- government; thalamocortical, frontal cortex) aspects of personality respectively Four temperamental dimensions: harm avoidance (anxious v daring), novelty seeking (exploring/impulsive/irritable/aggressive v frugal/stoical), reward dependence (social sensitivity attachment v insensitive/aloof), and persistence (industrious/determined v underachiever) Character traits include self-directedness (purposeful/resourceful v aimless/helpless), cooperativeness (helpful/principled v hostile/opportunistic), and self-transcendence (inventive/insightful v unimaginative/undiscerning) People with personality disorders have immature characters and show low self-directedness and low- cooperativeness Cools and Ellenbroek (2002) detect some correspondence between Cloninger’s temperaments and the ancient Greek humors as well as with basic emotions (anger, fear, love, tenacity). It is possible that these insights owe more to the similar meanings of words from different languages than to any revelations about what makes people tick. Likewise, Schneider (1950) decried categorisation because he felt that personality, which he believed was genetically endowed, was too rich and complex to be described so narrowly. Community studies tend to support a dimensional approach, personality disorder being on a continuum with ‘normal’ personality. They point out the deficiencies of categories: overlap, heterogeneity within categories, vague boundaries with ‘normals’, and the fact that the ‘not otherwise specified’ category is the most heavily populated! Approaches centred on variables measure how they describe an individual patient whereas those centred on the patient look for closeness of (dimensional) match between a prototype and the patient. Trait-based dimensional approaches include many continuous variables on which all of us vary. Tyrer’s (2007) personality diathesis model suggests that personality disorder carries a vulnerability to an Axis I disorder that may or may not be manifest. He points out that personality disorder does not disappear when an Axis I condition erupts.
They wanted a highly scientific medicine purchase levitra professional no prescription erectile dysfunction drugs over the counter uk, based upon biological research and technology purchase levitra professional 20mg on-line impotence and diabetes 2. As most of the major foundations which grew up in the first half of this century were based upon the petro-chemical industry purchase 20 mg levitra professional mastercard impotence yoga poses, financial patronage for medicine primarily supported allopathic and pharmaceutical treatments. Other major foundations which subsidised, and therefore had some control over, American medicine throughout the twentieth century include the Ford Foundation (motor cars), the Kellogg Foundation (cereals), the Commonwealth Fund (created by Edward Harkness of Standard Oil), the Sloan Foundation (General Motors), and the Macy Foundation. In 1915 the Rockefeller Institute was set up, intent upon rivalling the Pasteur Institute in France and the Koch Institute in Berlin. Both of these institutes were completely given over to the study of scientific medicine. It had five divisions and a new strategy of concentrating effort on the life sciences. By the time of the Second World War, the Rockefeller business empire was co-operating with a large number of other pharmaceutical holding companies in a cartel arrangement which 17 was headed by Rockefeller and the massive German chemical combine I. Much of the money continued to be spent on the reductionist sciences like molecular biology. For over half a century the Rockefeller Foundation determined the direction and the content of medical research, without competition. Both before and after the Second World War, Rockefeller money washed around Europe, helping scientists to travel and hold conferences, 20 providing equipment and laboratories for major European institutes after the war. From the beginning, the support of scientific medical research by industry meant that the responsibility for disease was placed within the internal biological structure of the individual organism. In terms of illness, at least, the individual became separated from their environment and the industrial process, both of which were inevitably seen by the large industrial foundations as benign. This view stood in sharp contrast to the older holistic view of medicine, which always tried to see the person within the context of their immediate environment. As industry developed in the twentieth century and the philanthropic foundations began to exert even more pressure on medicine and its practice, this conflict was to surface repeatedly. Chapter Two The Beginning of the Health Fraud Movement Scientific matters can not possibly ever be decided upon in court. They can only be clarified by prolonged, faithful bona fide observations in friendly exchanges of opinion, never by litigation. It was set up in 1938 to protect the American public against false medical and health claims and harmful products. Since its inception, it has tended to defend the interests of the large 3 American food producing corporations, the pharmaceutical industry and medical orthodoxy. Before the Second World War, medicinal products did not have to be licensed in America. The New Deal, with its progressive if not socialistic intentions, heralded the beginning of a federal administration in a number of different domestic areas. They have been reformers with a left of centre view of economics and social administration. Their modern views on social administration were also inevitably in favour of progressive scientific development. In 1957, a Congressional investigation into drug pricing took place, it became known as the 6 Kefauver Hearings. Then in 1962, following the first news of the Thalidomide 7 horror,ff Congress passed amendments to the Food and Drug Act, which ordered the implementation of drug effectiveness requirements by 1964. Kefauver was principally concerned with monopolies and the way in which they distorted the market. In 1957, he chaired a series of hearings into prices in the large monopoly industries in America; these became known as the Kefauver Hearings. The hearings which looked at the drug companies went on from December 1959, until the passage of the Kefauver-Harris legislation in October 1962. Pregnant women taking the drug gave birth to malformed children with truncated or missing limbs and a high mortality rate. As was pointed out at the time, effectiveness could only really be determined by clinical and scientific trials and not by the subjective views of administrators, some of whom had vested interests. At the same time as legislating for the drug industry, and as if as a sop to pharmaceutical interests, the Food and Drug Administration moved against the manufacturers of vitamins and food supplements. The National Health Federation, a particularly energetic lobby, campaigned from 1962 until 1976 against this regulation of 9 vitamins and food supplements. Instead of shouldering this heavy responsibility, we find the agency engaged in bizarre and juvenile games of cops and robbers. When Gaylord Hauser, Paul Bragg, Edward McCollum and I, among others, preached the importance of natural whole grain bread — free of chemical preservatives — the dictocrats seemed to act as a gang to give us all the trouble possible. In their opinion we were quacks of the lowest order to suggest that it was harmful to eat devitalized, denatured, chemicalized, and highly preserved white bread. During the intermission I went into our supply room and found George Daughters holding my eight year old son on his lap and asking questions. Once these villainous straw men are set up all the unorthodox researchers, healers, health food distributors 16 and auto-therapists are identified with them. The assault upon alternative practitioners, which began in the early sixties and continued through the seventies, focused particularly upon vitamin supplements. Both vitamins and organic foods were seen as aspects of a preventative health programme and in this sense they represented a threat to purely symptomatically prescribed pharmaceutical remedies. The most frequently used argument was that certain vitamins were dangerous if taken in too high a dose. This was to be an amendment to the Federal Food, Drug and Cosmetic Act: it guaranteed that people could buy vitamins of any potency without a prescription from a doctor. Rockefeller interests, in the form of the First Boston and Chase Manhattan Bank, have 18 always exerted considerable influence over the New York Times. The article began: Thousands of food faddists, 142 Congressmen and a health lobby, which the Federal Government says has linked to quackery, are backing an obscure bill that would allow Americans to obtain as many vitamins as they want. Yet the Food and Drug Administration, the American Medical Association and experts in pharmacology insist that massive doses of vitamins A and D can be harmful and indeed life threatening in extreme cases. Pending 19 regulations would limit how much of a vitamin a person could buy without a prescription. Her crime was not that she sold the yeast but that she also gave out a leaflet which made health claims for the product. In 1963, it conducted a prosecution against Dr Stevan Durovic who had produced Krebiozen, a non-toxic substance found to be useful in the treatment of cancer patients. By June 1969, they had used this power to ban at least six books on alternative health. Miller of the National Health Federation claimed that there were three more bans threatened.