Polypharmacy

UnknownPopulation aging in first world countries is a growing concern for many reasons. One of those involves the issue of polypharmacy in the older adult.

Polypharmacy is defined as a patient using four or more medications concurrently and statistics show that 40% of senior adults living in their own homes are affected. Additionally, over 20% of adults with intellectual disabilities (Alzheimer’s and other dementia diagnoses) are exposed to polypharmacy prescribing practices.

A more accurate definition of polypharmacy is the use of more medications than areMH900321056 medically necessary, but that situation is more difficult to identify without discontinuing all medications one-at-a-time to discover which drug produces no ill effects when discontinued.

The potential for polypharmacy increases when patients are seen by multiple physicians for varying chronic illnesses. Often adequate communication among the prescribing physicians is lacking and this contributes to additional, and at times inappropriate, prescribing.

Specific concerns regarding polypharmacy include increased adverse drug reactions that can erode a patient’s quality of life, as well as a decrease in mobility and mental capacity. With polypharmacy, there is the potential for increased drug interactions that can exhibit as either enhanced or reduced therapeutic effects of the interacting drugs. Such situations where drugs literally fight with each other in the body may necessitate medication dosage adjustments to compensate for the interactions if the offending drug regimen must be continued.

Additional concerns include a phenomenon known as Prescription Cascade—a MH900321090term that refers to the side effects of a drug that are misdiagnosed as completely new medical issues and that result in further drug prescribing. The potential for additional side effects and/or drug interactions with the introduction of even more drugs can lead to FURTHER adverse drug reactions, and potentially even more drugs added to the equation.

One of the issues at hand is that patients are physiologically unique and can react somewhat differently to drug therapies. Therefore, physicians may not easily identify a new patient complaint as a drug side effect or a drug combination interaction.

There are a couple of specific actions a patient or a caregiver can do to prevent polypharmacy adverse events. The first is to make sure all physicians involved in drug prescribing for a patient communicate with each other via medical record copying and that all physicians involved have a complete list of current medications that a patient is taking.

A second very important step is to use only one pharmacy when filling prescriptionsUnknown-1 and ask the pharmacist to do a thorough drug interaction study of current medications. The drugs involved in the interaction study should include over-the-counter (OTC) medications and herbs since these too can contribute to adverse drug reactions and interactions. Some of the more commonly used OTC drugs include acetaminophen, ibuprofen and aspirin and these can contribute to adverse drug effects, especially in the elderly.

Thoughts? Comments? I’d love to hear them!

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LETHAL MEDICINE:

Clinical pharmacist Jon Masters seems to have it all. But still haunted by his days inPrint Special Forces, Jon’s life implodes when evidence found at a murder scene implicates him in an elaborate scheme to distribute a pharmaceutical quality street drug disguised as an experimental medication. With the help of a trusted army confidante, Jon reenters the world of covert ops and cyber intelligence, and he embarks on a global mission to save his reputation and regain control over his life as he uncovers a complex international conspiracy to redefine the nation’s recreational drug culture.

Available in Paperback and eBook Formats!

Amazon: http://www.amazon.com/dp/B013CG7AGU

Posted in A New Drug Abuse Threat, About James J. Murray, About Medications/Pharmacy, Blog Writers, Blogging, Defining Polypharmacy, Drug Error Prevention, Drug Errors in The Elderly, Drug Misadventures, James J. Murray Blog, Lethal Medicine-The Novel, Misuse of Drugs, New Blog, Pharmacist Directed Drug Interaction Studies in Community Pharmacies, Polypharmacy and the Aging Patient, Polypharmacy in First World Countries, Polypharmacy in the Elderly, Prescription Cascade Effect, Prescription Drug Safety, Prescription Drugs and the Aging Population, Prescription For Murder Blog, Prescription Trends, Preventing Drug Interactions in Polypharmacy, The Pharmacy Profession, The Practice of Pharmacy, Value of Consulting With Your Pharmacist | Tagged , , , , , , , , , , , , , , , , , , , | Leave a comment

TABUN – A Dramatic Murder Weapon!

Although first developed as a possible pesticide in Germany in 1936, tabun imagesquickly became known as an excellent chemical warfare agent and was made on an industrial scale by Germany during World War II. It was the first of the so-called G-Series nerve agents developed during that time.

Tabun is among the most toxic and rapidly acting of the known chemical warfare agents. Since tabun is much easier to make than other nerve agents, countries that develop nerve agent capability but lack advanced industrial facilities often start with tabun.

During the Iran-Iraq War, Iraq used nerve agents against Iranian ground forces and tabun was among the agents used. Today, international production is highly controlled, and the Chemical Weapons Convention of 1993 has outlawed the stockpiling of this chemical.

Tabun, by appearance, can be deceiving. Although an extremely lethalclear-liquid-pouring-beaker-slow-motion-43369446 chemical, it presents as a clear, colorless, and tasteless liquid with a faint fruity odor. Tabun readily mixes with water, so it could be used to poison water and water-based liquids. Since tabun contamination is possible on a small or a grand scale, it could be utilized for an intimate murder scene or be used by a thriller writer to create scenes of catastrophic destruction.

The toxic effects of tabun occur even if the contaminated liquid is not consumed. Merely having the chemical come into contract with skin can be deadly. Even with its distinctive faint fruity odor, that may not be noticeable enough to warm victims that tabun is present.

smoke-vapor_645x400Tabun transforms into a vapor when heated, and the vapor can easily be absorbed into clothing materials. When fabrics have been exposed to the vapor, the clothing releases the toxic vapors for hours after and can be deadly to anyone wearing the clothing.

If tabun is released into the air (either as a liquid spray or a vapor), exposure can be through skin contact, eye contact or by inhalation. An interesting fact is that tabun vapor is heavier than air, so it will create a greater hazard in low-lying areas by replacing the air.

The extent of poisoning caused by tabun depends on the amount and form of tabun to which the person was exposed. Symptoms can appear within a few seconds after exposure to tabun vapors and within a few minutes after exposure to the liquid form.

The symptoms of tabun exposure include nervousness/restlessness, pupil contraction, a runny nose, excessive salivation, and difficulty in breathing. The chemical’s toxic effects interfere with the normal operation of an enzyme that acts as the body’s “off switch” for glands and muscles. In effect, the body’s glands and muscles are constantly being stimulated after exposure to tabun. After a time, they tire and can no longer function.

Initial symptoms include a slow heartbeat, drooling, chest tightness and sweatingimages-1 with rapid progression to convulsions, total lung function shutdown, and loss of bladder and bowel control. Even a small drop of tabun on the skin can cause sweating and muscle twitching where the chemical touched the skin.

Recovery from tabun exposure is possible with treatment and life support measures. There are a couple of antidotes available (pralidoxime and deazapralidoxime), but they must be used quickly to be effective.

Tabun is an intriguing chemical, somewhat easy to make for a seasoned chemist, and can be a dramatic addition to a thriller or murder mystery plot.

Thoughts? Comments? I’d love to hear them!

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Aconite – A Two-Edged Sword!

Many botanical compounds have important medical uses, and some of modern medicine’s most important drugs were derived initially from plant sources.

narrow_therapeutic_index_ntiHowever, some of these botanical compounds have a very narrow dosage range between a therapeutic effect and toxicity. This tight range of beneficial action is alternately referred to as the Therapeutic Index or the Therapeutic Window.

This concept certainly applies to a very interesting botanical that has been used throughout the ages and is present today in many homeopathic preparations.

Aconite is the usual reference to aconitum, a plant genius thataconite_as resembles wild parsley or horseradish. There are 350 species of aconite that exist around the world, 170 in China alone. Many are found throughout Asia, Africa and Europe. More than 100 species are found in the temperate climates of both the United States and Canada.

Throughout the ages, aconite alternately has been referred to as monkshood, wolf’s bane, leopard’s bane, devil’s helmet and blue rocket.

In modern homeopathic medicine, aconite is used for general malaise, undefined weakness and to stimulate poor circulation. People with 2d38865b498b0a2a5ee034f4a057e6b4_nnumbness in the extremities or poor circulation (as in cold hands and feet) use aconite preparations to stimulate circulation, hence its colloquial reference name of “blue rocket” to the variety that produces beautiful deep blue flowers. In the same way, aconite preparations are used to alleviate joint pain, inflammation and certain skin diseases by stimulating blood circulation throughout the body.

The mechanism of action appears to be the increased production of nitric oxide in the human body. There has been considerable interest recently in nitric oxide supplementation for athletes involved in performance sports to increase their exercise intensity and endurance.

Since aconite is readily absorbed through the skin, topical aconite preparations (liniments, creams and lotions) are available that are used as “counterirritants”, products that stimulate local blood circulation and produce localized warmth to relieve joint pain and the leg pain from sciatica.

However, it should be noted that aconite is a highly poisonous plant and small amounts of the pure plant are highly toxic. So the above-mentioned preparations contain very small, very defined quantities of aconite.

As little as 2mg of pure aconite or one gram of the plant can cause640px-Aconitum_variegatum_110807f death! Even slight contact with the flowers can cause the fingers of one’s hand to become numb—a typical example of the therapeutic effect of aconite progressing to a toxic side effect with excessive exposure.

The therapeutic, as well as the lethal, compound in aconite is aconitine, a toxic alkaloid that generally accounts for about 1.5% of the dry weight of the plant.

Safe dosing of aconite tincture depends on meticulous processing of the plant using everything but the root, and pounding it into a pulp that can be pressed and mixed in alcohol to extract the aconitine alkaloid. Straining and diluting the resulting product will produce the desired homeopathic therapy, and a more concentrated tincture produces an interesting poison if you’re attempting to develop an unusual murder plot idea.

heart2battackSymptoms of aconite poisoning include nausea, vomiting, sweating, breathing difficulties and heart problems. Death usually results from paralysis of the respiratory system or cardiac arrest.

Although aconite can be lethal when applied to the skin, smaller doses are deadly when taken orally, and any oral dose beyond the therapeutic range will cause burning and tingling of the lips, tongue, mouth and throat. Numbness of the throat will follow, with difficulty in speaking, blurred vision and an interesting green-yellow vision distortion.

This last side effect would make for an interesting clue in a murder scene when deciding to use an aconite preparation to kill off a character in your murder mystery.

Thoughts? Comments? I’d love to hear them!

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Practicing Your Profession

For much of my life I was a practicing pharmacist. Each day I would draw on myMH900321056 professional experience and use every tidbit of education to make appropriate clinical decisions. Like so many other professionals, I was doing the work I was trained to do and loved every minute of it. I was also secure in the knowledge that I was very good at what I did and was making a difference in people’s lives.

So why did it rub me wrong when others would jokingly ask, “Practicing, huh? When do you think you’ll get it right?”

I laughed at the jokes but inwardly seethed. How could someone mock that by MH900150563which I defined myself? One day, though, I took a mental step back to analyze that old joke. Was I any different in how I managed my career than the physician to whom I trusted my health?  After all, he “practiced” medicine.  Absurdly, I wondered, “Does he practice on me, maybe to get it right later with another patient?”

One summer in my youth I practiced getting better at baseball. I was never very good, but that summer I managed to hit consistently two out of three pitches. Was my doctor getting it right two-thirds of the time? Was I one of the lucky two?

That kind of success rate in my pharmacy practice wouldn’t win me any fans. If I managed to get the right drug to the right person only two out of three times, all I’d gain would be stack of lawsuits.

Why are many health professions called a PRACTICE? If I went to my financial advisor and asked if he were practicing his profession, he’d probably say, “I do better than practice. I try to get it right every time.”

Is his profession any more exacting than pharmacy or medicine? He doesn’t always get my investments right. Sometimes we win and sometimes we lose, and then I take a tax loss. In pharmacy, however, when you lose, there’s no tax loss. The results are often life threatening.

Eventually, I decided that the beauty of PRACTICING your profession is to always get better at it. Most people are good at their jobs and mistakes happen only rarely. I might get upset if my financial advisor makes a less than perfect judgment about my investments, but at the end of the day life still goes on.

When I practiced pharmacy, it was intense stuff: clinical trials, intravenous therapies and life or death situations. If I had made less than perfect judgments regarding those therapies, there was the real possibility that someone would end up dead. There was no “Oops, I’ll do better next time.”

The wisdom in understanding why some professions are called PRACTICES and others are known as WORK or ART is this.

My work as a novelist is an expression of art; but if I don’t get the story right theMH900262322 first time, it’s not a problem. No one dies; no one has a funeral (except maybe for one of my characters). I always get a “do-over.” Writers are lucky that way, except when the rewrites and edits go on and on—but that’s another whole blog.

The point is that it takes practice to be good enough at something to make a decent living at it. I’ve read that it takes 10,000 hours to really be good at something. I had a friend guest blog about that once (see here). It seems that 10,000 hours of “practice”—about five years if that’s all you’re doing—is what it takes to be really good at something.

So I guess we all practice our professions when we continue to work to get better at our jobs. I practiced pharmacy for a great many years and was very good at it, but I also practice my writing everyday now to get better.

PrintLeathal Medicine CoverThe five-star reviews of my last two books tell me that I must be doing something right as an author.

In the end, as much as I liked pharmacy practice, I love writing even more. Whatever it is you want to accomplish, practice to be better than you were yesterday and you’ll wind up getting five-star reviews in whatever you do.

Thoughts? Comments? I’d love to hear them!

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A Book Hangover!

 This past weekend I read a great book and I have a book hangover!

I’ve experienced such an event many times in the past, but I’ve never attempted to write about it. So . . . I googled the words “book hangover” to make sure I had accurate information before confessing to such emotions.

I soon realized that there are many types of hangovers that don’t involve alcoholIMG_0523 or any other substance abuse, but the effects can be just as unpleasant; and a book hangover is only one of many that can make a person feel as if they’re in a boat without a rudder in an ocean of waves.

A book hangover is defined as the condition one experiences when finishing a book causes a psychological effect—either good or bad—resulting in the person wanting to remain emotionally immersed in the story.

It usually lasts from a few hours up to a couple of weeks, depending on the severity of the emotional response, usually psychological distress, resulting from reading that last page. The cure is often one of two things: 1) replacing that loss with a book of higher quality to erase the distress, or 2) “time heals all.”

The usual symptoms can be quite severe—crying, irritability, anger, inability to express those feelings to loved ones or the opposite effect of an irrational elation c8be543a2ad84aa8ea0aac40c32f754ethat colors the world around you and everything you do. The primary result of a book hangover, however, is the inability to pick up another book. Starting to read another book can seem like a betrayal of either the author, the characters that you emotionally connected with so well, or both.

That’s where I am today! I liked how the author treated the subject matter so much that I want to savor that experience and carry it with me a little longer before washing it out of my brain.

I usually write during weekdays but read on the weekends, and I always have another offering in my “book pipeline” that’s next on my reading list. I must admit that I don’t want to read anything else at present! Maybe time will remove the feeling and, by the weekend, I’ll be ready to pick up that next book on my “to read” shelf and dig right in. Right now, however, I can’t commit to that.

I’m even having trouble getting back to my writing. I was supposed to continue the editing on my next novel that’s coming out this summer—the sequel to my Lethal Medicine thriller—but I simply had to finish reading this book first and now I can’t seem to extricate it from my mind.

So what was this book that intrigued me so much? The events leading up to reading this book actually started about a month ago when my wife finished Inside the O’Briens written by Lisa Genova. My wife praised the book and said that I might enjoy it. I read it and certainly did enjoy it . . . so much so that I ordered another one of Ms. Genova’s books, Still Alice.

Still Alice is the book that’s left me with such a hangover. Ms. Genova’s fictionalenhanced-12177-1397760504-26 treatment of a very real, extremely devastating disease that ruins not only the lives of patients but the family and friends around them. The plot involves a person navigating the progression of early onset Alzheimer’s disease and the emotional connection the author achieves with her readers is stunning. That’s not only my opinion but it stems from the many glowing reviews this book has received.

I must admit that I might have been a bit more invested in the characters since I have a friend who is a caregiver to both of her parents who have Alzheimer’s disease. This friend is writing a book that guides caregivers to a better understanding of how to deal with the extensive issues involved in managing loved ones who slowly become mental shells of what they once were. I’m offering some editorial and composition support to her book project and possibly that’s a major contributing factor why I can’t get this book “out of my head.”

At any rate, I loved the book and this author’s writings. I suppose the best thing I can do now is get right back on that proverbial horse and find another book that intrigues me—possibly an epic thriller may be just the hangover remedy I need at this point. Any suggestions?

Thoughts? Comments? I’d love to hear them!

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~ ALMOST DEAD ~

Almost Dead_3d PhotoMy 2nd Novel is NOW AVAILABLE in PAPERBACK as well as eBook!

Order it here: http://www.amazon.com/dp/B01AEU2RAG

Posted in About James J. Murray, About Writing, Achieving Writing Perfection, All About Writing, Almost Dead, Better Fiction Writing, Blog Writers, Blogging, Book Hangover, Character Driven Writing, Connecting With Your Reader, Developing a Writing Career, Developing Better Writing Skills, Developing Writing Skills, Good Books Create Emotions, Growing As A Writer, James J. Murray Blog, New Book Release, Plot Development, Proper Use of the Written Word, The Art of Storytelling, The Art of Writing, The Writings of James J. Murray, Writing Skills, Your Favorite Book, Your Last Book Hangover? | Tagged , , , , , , , , , , , , , , , , , , , , , | 1 Comment

Mysteries vs Thrillers

A few years ago, mysteries were the hot genre. It seemed as if everyone was reading aMH900427785 mystery novel. The thrill of guessing “Who done it!” was the excitement that kept me, and many others, reading book after book.

More recently, however, thrillers make up a greater portion of the bestseller lists. The passion for solving the puzzle of a mystery, even a murder mystery, is taking second place to the thrill of the chase between the protagonist and the antagonist. It seems as if no one is immune to the adrenaline rush of an excellent thriller!

This evolution is subtle but the psychology behind the shift is not. In order to fully explain this, allow me to take a step back and explain the basic differences in these genres.

A Mystery Novel:  These stories involve a puzzle, a specific unknown that the reader MH900385446isn’t expected to know about until the end. Mysteries are often more cerebral and are considered works of revelation. There’s more mental action than physical in a mystery. The primary action (or crime) has already occurred, so the element of suspense is not necessarily the main focus of the novel. The focus is in solving the puzzle.

A Thriller Novel:  These stories involve intrigue and action. A catastrophic event may have happened, as in a mystery, but a thriller differs in that the event triggers the possibility of an even greater catastrophe. In a thriller, the protagonist’s job is to prevent further calamity.

If the above explanation is about as clear as mud, then let me dig a little deeper. Various charts have been developed that characterize these types of novels as follows:

Mysteries ═►Suspense Novels ═►Thrillers

The main difference is in the delivery of suspense. Mysteries let the reader know up front that something bad has happened, but the reader doesn’t know who the villain is. The reader must plow through to the end of the book, or be very clever at identifying the clues along the way, to find out who the antagonist is. The mystery of “Who done it!” is not revealed until the end.

In a thriller, however, the writer is appealing to the emotions of the reader who yearnsMH900443241 for excitement. Thriller plots create a desire to confront extreme danger and defeat nasty villains. This differs from a mystery in that the reader is informed at some point early on who the villains are.

The thrill does not revolve around solving the mystery because we already know who the bad guys are. The excitement is the heightened emotions brought on by the chase—the literary dance that happens between the hero and the villain when you’re not really certain who will win.

It’s been said that the threat from an unknown source is never as great as a known, villainous danger. There’s much more suspense when we know what our hero is up against but can’t quite figure out how the hero will either survive, eliminate a specific threat or save the world. The key word here is SUSPENSE. It’s both the link and the difference between mysteries and thrillers.

Signature-baed3687aecc9fc02b05e033f52ab04b5ac34144c6f0702c4e0cfe36f9d34041A mystery may have a degree of suspense, but the story progresses logically toward a resolution of the puzzle and this stimulates the mind. A thriller, on the other hand, stimulates the senses as well. The emotional rush of apprehension and exhilaration imbedded within the plot of a thriller drive the narrative at a constant, and at times a breakneck, pace. The SUSPENSE is heightened by the known threat of the villain and his/her unexpected actions.

Often the difference between a mystery novel and a thriller is in the presentation of the characters. In a thriller, the villain drives the story, whereas in a mystery, the protagonist drives the story. It’s an interesting explanation that brings me back to the idea that it’s the degree of SUSPENSE that distinguishes these genres.

SUSPENSE happens when the protagonist is in danger. In a pure suspense genre novel, the protagonist becomes aware of the danger only gradually and the suspense builds slowly as the story unfolds. Thus, the relationship among the mystery, suspense and thriller genres become somewhat blurred.

But the basic premise of protagonist danger and degree of suspense defines what genre a book falls into. In mysteries, the main character is occupied with tracking down the truth about an event, often a murder, but the protagonist is in relatively little danger. In thrillers, however, the protagonist is often in danger from the onset or is placed in jeopardy by his actions and/or that of the antagonist.

So, which are my favorites?

Thoughts? Comments? I’d love to hear them!

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~ ALMOST DEAD ~Almost Dead_3d Photo
My Second Novel is NOW AVAILABLE in PAPERBACK!

Order it here: http://www.amazon.com/dp/B01AEU2RAG

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Super Bugs = Super Killers

We perceive bacterial infections to be little more than a nuisance—with the simple fix of taking an antibiotic for a few days and we’re back to feeling one hundred percent.MH900430501 Fortunately, that’s often the case.

Certain bacteria, however, are resistant to many commonly used antibiotics and that makes these little bugs much more ominous. When infectious bacteria become resistant to treatment, they’re labeled as SUPERBUGS.

The SUPERBUG phenomenon occurs with overuse or improper use of antibiotic MH900407492therapy. Simple infections of the skin, urinary tract, ear and lungs are becoming increasingly more stubborn to cure and often require stronger antibiotics than in the past. Sometimes, the infections require combinations of antibiotic drugs.

New strains of the best-known superbug, MRSA (Methicillin-Resistant Staph Aureus), are attacking people outside of health care facilities and causing very aggressive infections that are difficult to cure.

The U.S. Centers for Disease Control and Prevention (the CDC) estimates that MRSA cause serious infections in over 82,000 patients per year and kill over 11,000 of them. It has been noted that the elderly population are the most susceptible to contracting a superbug.

A recent study suggests that up to 25% of senior citizens discharged from a hospital or other institutional health care facility leave with more germs on them than they had before entering the facility. The study also identified that seniors who go into a nursing home or other post-acute care facility continue to acquire new superbugs during their stay.

So just how have we allowed these tiny organisms to get stronger and become so difficult to battle? The simple answer is that we’ve saturated our environment with antibiotics, the same amazing drugs that were created to fight bacterial infections. And it’s not just healthcare professionals who are to blame.

While over 7 million pounds of antibiotics are sold for human use each year, over 29MH900144424 million pounds are sold for use in food animals. Experts argue that animal injections or adding antibiotics to feed stock represent a gross overuse of antibiotic drugs and that this makes the drugs less likely to work when we need them to battle infections in the human population.

Bacteria exist in astronomical numbers in our environment. They reproduce rapidly and evolve readily to pass on genetic traits—including antibiotic resistance—to succeeding generations as well as to other bacteria. The more often bacteria encounter antibiotics, the more readily they cultivate hardier versions of themselves capable of overcoming a drug attack.

Researchers tell us that there are several actions that can be taken to minimize bacterial antibiotic resistance:

MH900401001Ask your doctor to prescribe an antibiotic only if it’s absolutely necessary. Inappropriate prescription use for simple coughs and colds are the number one problem area with antibiotic use. Medical professionals estimate that only one in five infections require antibiotics. The great majority of infections are due to viruses, not bacteria, and an antibiotic is ineffective against viruses.

When an antibiotic is appropriately prescribed, take all the medication—even if you feel better. In that way, the drug will completely eradicate the offending bacteria rather than merely weakening the organisms.

Consider buying meat raised without antibiotic use. Experts agree that fewer antibiotics in food animals will slow the development of resistant bacteria.

Use simple soap and water frequently to clean hands rather than an antibacterial soap or cleanser. Just as with animal feeds, the use of antibiotics in cleansers can foster the emergence of resistant bacteria.

Increased casual use of antibiotics is a global phenomenon, and it causes a greater degree of bacterial resistance to available antibiotic therapies.

SUPERBUGS are on the rise! The simple solution is to remove indiscriminate use of antibiotics from our environment. That’s a responsibility our government, agricultural and healthcare professionals must shoulder. But we, as individuals, must share some of that responsibility also.

Thoughts? Comments? I’d love to hear them!

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