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Math

Canary Islands Health Service, for which work has developed from a few years ago Register Cumulative Psychiatric Case as an information system of health care in the mental health field. A few days ago, we asked the makers of this tool data which had long interested us, and we were supplied quickly and efficiently, so we want to record our thanks and highlight the usefulness of this system to see how we play our work in actual practice and under what conditions, do not always coincide with what our (more or less attractive) theories prescribe.

The data request was simple:

• Number new patients seen in mental health units (USM) on the island of Tenerife in 2010.

• Number of patients discharged in such USM during that period of time.

And then a little math, that not everything will be literature ...

• The USM de Tenerife (island with a population of approximately 850,000 inhabitants) in 2010 saw a total, including both adult patients as child and youth, people 7746.

• During the year 2010, USM was released to a total of 3754 patients.

• With a calculation too complex, we conclude that the population attending public consultations increased community mental health during the past year in 3992 people.

words, the USM of our public health system who have started 2010 with a considerable overload rather than care, inherited from previous years, finished the year with a net increase of nearly 4000 patients who attend. To give you an idea, if not already, several of these appointments with a psychiatrist USM are given every 2 or 3 months, if not more. With psychologist frequency is somewhat higher, but often exceeds the month. A psychiatrist may see a patient 4 or 5 times a year for about half an hour at most, with agendas that sometimes have 12 patients a day. We do not currently work at USM, but it seems difficult to see a person 30 minutes every 3 months and be able to remember what happens, as if to ask to do something to help, beyond adjusting or adding medications, which in turn will take 3 months to assess both efficacy and side effects. A psychologist must conduct psychotherapy sessions on a monthly basis, where indicated, in almost all therapeutic orientations, would be weekly at least.

However, this state of affairs, añádanle 4000 patients every year ... and so every year. Know the number of patients recommended to bring a psychiatrist in a USM, but we would say that beyond 500 would be too much, taken as a ballpark figure. By recalculation, even without great complexity, we would need new ones every 8 psychiatrists year (or mixture of psychiatrists and psychologists, to our argument is irrelevant and not at all intend to take up any flag in the boring old war psychiatrists, psychologists, we have always seen as non-combatants). Given the economic situation and the Canarian autonomous community, we can be happy if not trumped any that work now (and do not even tell if they also do not follow us down the salary).

overload seems clear that the welfare of the USM will continue to grow unchecked and that the era of new and abundant recruitment is over for quite some time. In addition, people dress in consultation on the USM are much more likely to go to the psychiatric emergency or to be admitted to the psychiatric facilities, which reaches more overload devices mental health network. All this in a context where, from various associations and by different professionals, not to be stressed in the early diagnosis of any discomfort conceptualized as mental illness, recommending to the people before any manifestation of sadness or anxiety, go to your USM . No need to insist here in our critique of the medicalization of suffering which has always been vital, with the consequent collapse of the system, resource consumption and iatrogenic that entails.

view our mathematical problem, if growing demand can not be absorbed by a parallel increase in supply (professional) seems to be only one solution: reduce that demand .

And before you accuse us, as has happened ever want to condemn people to suffer and not wanting to serve the suffering, we would like to make some clarifications.

According to data obtained from colleagues in informal conversations, and therefore not coincidental but clearly contrasted in various professional, places and moments, about three quarters of the pathologies treated in USM falls into categories such as: dysthymia, adjustment disorders, personality disorders, neurotic depression, mild depression , etc. Ie, they are not psychotic or melancholic patients, what we call today, with little grace, severe mental disorders. And there are places in this country where units are being created to cater exclusively to mental health psychotic episodes. And it seems a laudable effort to address this group of patients that both can benefit from appropriate intervention, if it were not for that you just created the USM, which are now collapsed basis, roughly what is human suffering.

and clarify our position: we do not like people to suffer. And if someone who is sad and worried because he has been out of work because their family life is hell, because they are lonely, and so on., Would be better to come to USM to take one (or two or three) antidepressant (s) or receiving therapy 30 minutes per month, then we would be in favor of trying to maintain the current state of affairs. But we think not. We believe that treating a patient who has an economic problem or a difficult life, or personality problems, causing it to be seen as sick people treat them as sick and end up behaving like the sick.

believe it is absurd that an unemployed person and concerned about how to raise her family, go to USM for us to send a list of drugs whose monthly cost will resolve many of their problems, but whose effect hardly get to feel good before I go back to work, not to mention the side effects appear and how the wait fact that the pill acts not promote precisely its effort to get out of their situation.

believe it is absurd that a person caught in a difficult family life will the USM to tell it what happens is that serotonin is wrong, you have to wait until the drug is the fix and should not make decisions until well ... When perhaps you need to be better is to take a decision.

believe it is absurd that a person immersed in mourning for a loved one comes to USM to be treated as a patient with a lot of anxiety to sleep and not be anxious ... Hindering rather than facilitating grief work to be performed.

Anyway, these are just some examples to try to convey what we mean. Not only is that psychiatric and psychological consultations should not serve as many people as they do because there are no resources. Is that although there were, we think that many times that performance, but full of good intentions, is directly iatrogenic. Patients may benefit greatly from monitoring and Mental Health. For ejmplo, psychotic patients may develop an anchor point at USM, confidence, to influence their care and the focus placed on his recovery ... But this requires to see them often, available for visits after hours, for care at home ... And that takes time which is not available now because there is another claim to address.

Clearly, the influence of industry drug is not at all alien to all this. Professionals with more than curious conflicts of interest and sponsorship, as well as professional associations and even family insist diagnose masked depression , the ADHD without hyperactivity, behavioral addictions, etc., etc. Thus achieving greatly increase the prescription of super-selective molecules-to-serve-for-all and super-safe-but-no-you-read-the-art-tab-o-see-what- fright. And if the price is to sink the USM, burning psiquiatrizar professionals and all people, to whom he matter? And if we, because ultimately who makes the diagnosis and prescriber's us, the disease where there is pain, we take responsibility and then claim them back, do not benefit iatrogenic ... Who cares?

In short, our position (to then not be said that only pointing out problems but provide solutions) is that demand in the USM should be checked, if we want those devices, which marked the psychiatric reform can remain. Will not be able to hire more staff to absorb this demand (although we have made clear our view that this option as well as impossible, it would be undesirable), so there is only limited demand. That, or the explosion of the system: psychiatric consultations to 5 minutes every 6 months. It may sound exaggerated, but with math we're talking about, as we come in 10 years ...

Concrete:

could establish a timetable was closed many patients can be and how often, for example, 8 patients to see a psychiatrist every 3 weeks (obviously, these figures are only by way of example). That is, 5 days per week, 120 "holes" in the agenda for patients. And when the 121, will have to wait for any of the others are discharged. This may sound ugly, but start to shoehorn on the agenda to every patient who arrives, causing the 12 patients a day seen every 3 months. In hospital wards, where beds are not free, nobody would think to put stretchers in the hallways ... It is hoped that someone could go.

And speaking of waiting lists, we do not fail to note a curiosity: now in objectives of some priority USM soon see the first few times , the new queries. With which can then brag to the press by the political head of turn of the waiting list for psychiatric or psychological consultation is 10 or 15 days. But there are two problems: first, then the patient is again seen until 3 months, the second, and not least, a certain number of patients, according to various studies, improve their suffering before resorting to consultation if they had a little more time, are seen before, with all that implies medicalisation of discomfort or unnecessary use of drugs. But at the press conference before the election looks great reducing waiting lists .

The question is, in our opinion, that the USM should be dealing with cases of severe mental disorders and also those who, without being one, could benefit, but always providing adequate care. If a person in a difficult situation develops a major depressive syndrome may benefit from psychotherapeutic or pharmacological, should be given. But it must be properly: that is, weekly or fortnightly sessions of psychotherapy, medication if it is believed necessary to closely monitor possible side effects. But it makes sense to start to see 30 minutes every 3 months, maybe years. And if can not provide treatment the first type, then we should not providing the second. And the funny thing is that if we give this second type treatments and do not address these cases in these conditions, perhaps when we begin to have time for the treatments of the first type.

Imagine if we had 10 doses of a vaccine for a population of 100 people. "We vaccinate ten to be protected? Or dilute the vaccine to give something to each of the 100, but it will not protect anyone? We believe that the example, although picturesque, may be relevant. Although the question is obvious: who decides than 10?

occurs to us, for instance, offer the possibility of brief psychotherapeutic treatment to patients with adjustment disorder or reactive or neurotic depression. And after this treatment, proceed to discharge. Even no improvement. Because if there is no discharge, the patient often become chronic, in a spiral of psychoactive drugs and interventions, increasingly assuming the role of chronic patient, consuming resources, not just economic, but also in availability of hours will not be used more frequently to meet someone else maybe it will benefit from it. As one our friend, if you go to the orthopedist and, after a consultation, concludes that you're lame, seeing is not a lifetime. We know that sounds harsh. And, in an ideal world, there would be infinite in the infinite USM professionals, and all treatments would be effective and safe and all the suffering could be cured and everyone would be happy. But look at the world we live in and tell us if they think so.

For if, as we believe, is to restrict the entries in the USM, we should establish clear criteria for it. And, of course, be dependent on the criterion of a professional or a USM isolation but should take place a process reflection among professionals and administarción and more national level, to determine these criteria. The advantages, in our opinion, such a process were to develop would be considerable:

• Many people would not really benefit from a mental health treatment, and may even become harmed by it, and not go into the USM.

• Many people who really could benefit from these treatments, USM would receive without the overhead of the current, much more effectively than we can now provide.

• current situation in the country, the savings that this would not be left to be taken into account. Especially since, if such savings are not caused by roads and treat only those in need and can benefit from it, along with pharmaceutical costs, then it must occur in hospitals closing plants, cutting staff and wages down (and this hypothesis is not tremendous because, in fact, already happening).

Finally, we will cite us to ourselves (you know, the article just published and we are so proud): We

another Psychiatry may be possible and indeed, necessary. A psychiatry that is devoted to an understanding of their subject (the mind, behavior, insanity or as we like to call it ...) without interference from commercial interests that skew our data. Psychiatry able to put a limit to itself and not try to treat it all, knowing that normally, in psychiatric consultation, often does not improve but becomes chronic, and if you try to sound like a sick person, most probably end seeing, feeling and behaving like a patient. A psychiatry that focuses mainly on the mad and the sick, suffering, and let the sane and healthy to fight for your happiness no false remedies.

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psychosis as a disease

Following previous entries in which summarize different texts about the vision of psychosis as syndrome or structure, we turn now to the vision of psychosis as a disease. Luque and Villagrán continue in his already cited work descriptive psychopathology: New trends .

One of the many approaches to the concept of disease is one that conceptualizes as a injury. The development of pathology and histology during the nineteenth century provided a range of evidence that the disease is accompanied by structural alterations. As increased knowledge of physiology and biochemistry, the concept of lesion was extended to include biochemical and physiological alterations without changes in the basic statement: the disease necessarily involves a demonstrable physical abnormality. In this context, it was almost inevitable that they consider essential attribute of the disease the presence of an identifiable lesion. This definition has been maintained for years and is the fundamental basis of known biological or medical model of disease which, without doubt, has a number of advantages: it provides a definition of disease that is not subject to social or fashion therapeutic as well as an explanation, though not always complete, the patient's symptoms. However, it also involves a number of drawbacks: the process of their physical condition is unknown can not, strictly speaking, be considered diseases do not distinguish between minor and serious illnesses or disabling, in some cases it difficult to establish where normality ends and pathology begins where, as there is a vast structural variability that can be tolerated by the human body without detection of any biological or clinical change, and it is becoming increasingly clear that the old concept of a single cause, necessary and sufficient for each disease, is not applicable and instead there are a number of factors acting together and determine the onset of the disease.

The vision of psychosis as a biological disease (and only biological) is the most common nowadays in professional or lay, whether explicitly or implicitly. This vision undoubtedly part of the concept of disease as injury that we have discussed and is part of the medical paradigm, dominant in psychopathology and psychiatry in a way that some feel stifling and impoverishing, possibly due to different causes, some of which , as Kuhn would say, are much more social than scientific, in relation to professional interests or commercial , perhaps not fully aware and certainly not at all confessable. Let us now come in a few words about this medical paradigm that dominates, and psychotic professionals alike (or perhaps more willingly than we them.)

As Luque and Villagrán remind us, the medical paradigm (organic, biological, mechanical or biophysical) model is based on the anatomo-clinical disease that appears in the nineteenth century and extending until today. To this paradigm, psychopathology is considered a form of medical description of two fundamental principles: mental disorders are diseases and the conceptualization and study of mental illness must be fundamentally biological. The medical paradigm health equates total absence of symptoms and abnormal behavior considered a result of physical and chemical changes that usually occur in the brain. The disease is defined as the qualitative deviation of the statistical norm and the damage it causes to the individual. In psychiatry, this paradigm was championed by Kraepelin to be used as general paresis medical paradigm. In this defense influenced a number of facts: influence of anatomical-clinical method, the discovery of Treponema pallidum as the cause of syphilis and, consequently, the application of the infection in psychiatry, and the current influx of taxonomist, from previous centuries and other branches of science such as botany and zoology, which generated a movement in medicine that reached nosology in psychiatry. The medical paradigm for Maher (1974), implies: the person who shows some changes with respect to the traits considered normal in a population is ill, the disease is caused by a demonstrable etiology (or are supposed to be evident in the future) is in principle and by definition, biological or organic (the possibility of psychological or sociological is only allowed where it is found that is not organic, the organic nature of the cause may be at different levels (tissue injury or biochemical genetic disorder, metabolic , endocrine, infectious, etc..) organic etiology produces a series of signs and symptoms, along with complementary examinations, can reach a diagnosis and identified the disease, symptomatic treatment can be established, and ideally etiological, and assumed a course determined disease, allowing a prediction rule. This medical concept requires a series of successive steps to be taken before stating that mental illness belongs to the medical domain as the other disease entities. These stages are: description of symptoms and the main features of the disorder (clinical syndrome), identification of the underlying pathology, ie structural or biochemical changes that cause the disease natural history of the syndrome and determination of the causes . As a result of this process, the patient takes the sick role in society, with all the positives and negatives that entails. On the one hand, enjoys certain advantages and may require certain labor and social privileges, on the other, you are required to comply with the conditions involving the sick role.

Work on brain structure and function, facilitated by advances in medical technology, have revealed abundant evidence of biological abnormalities in different psychiatric disorders budgets that support the medical paradigm. However, it also has been some criticism of a draft. In general, the medical paradigm has been identified with a reductionist and biologist for which mental illness is caused by a biological disorder that do not translate into physical-chemical terms. Moreover, although the biological model of disease may be central, can not provide a complete description thereof. Therefore, the best futile and at worst leads to a distorted and unacceptable human. For these critical biological phenomena must be explained in terms of biological mechanisms, but diseases are not only biological entities. They do not only in biological organisms but also in humans. Another set of criticisms are epistemological break, noting that the medical paradigm seeks causal explanations, and they are not suitable for the study of psychopathological behavior. However, as stated by Luque and Villagrán, this assertion of a concept of causal explanation particularly close, inherited from the empiricist tradition, Hume and association or subject to hempeliana of universal rules, and forget, for example, the teleological explanation. For our authors, it is difficult to imagine a scientific endeavor with care and medical aspect of Psychiatry that investigates the causes. Causal explanatory activity, common currency in clinical practice from any paradigm, is denied in the epistemological level by advocates of the autonomy of the behavioral sciences, proponents of the exclusive pursuit of reasons or meanings that infuse sense of deviance. However, just as there are anomalies in a system is when the causal inquiry finds its raison d'etre. realistic vision of science has to accept that causal relations between events are objective features of the world we see, not just ideas in the mind of the observer. The scientific realist has to accept a generative theory of causation why we say that X causes Y if X contributes to Y through some mechanism. This theory, which in psychiatry should be applied to individual cases, no precise terms such as cause necessary and sufficient , and envisages a complex causal amounts to the sum of factors that produce the observed behavior. The psychiatrist must determine what factors are not redundant (an indispensable part of complex causal) and which are redundant or accessories, and this already requires interpretative activity.

must say, after this vision of the approach of Luque and Villagrán the medical paradigm, which, by definition, considers psychosis as a biological disease, which unfortunately often in our environment we are professionals and pundits since the pulpit, and on behalf of the medical paradigm and scientism, which really do is get away from the positivist scientific position and think they want or defend. An abundance of confusing information about genetics and neurochemistry fills many of those considered prestigious publications in psychiatry, with, in our opinion, a little (perhaps impossible) job of integrating in any coherent theory to account for reality. Guidelines are criticized as psychoanalysis for not being scientific , based on the sacred model of Newtonian physics and evidence of falsification of Popper, and possibly with some justification, but the science of selling (and with good benefits) rests about faith in a coming Messiah to come to the gene or the neurotransmitter of schizophrenia under his arm and a final remedy shaped molecule in phase III study in a world-class laboratory. The medical paradigm has contributed much to medicine and, we believe, not least in psychiatry, but it presents two dangers, at least from our point of view: the risk of being exclusive and not allow other potentially enriching visions (risk, moreover, shared with any other paradigm, including psychoanalysis), and the risk that said, taking his name in vain use it to carry out good business without respect for our discipline and care to our patients.

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One of the reasons used to defend the health-visitor interaction is the fact that RESTATEMENT provides professional information about their discipline and on different and new pharmaceutical options. Is a valid argument if one does not have realized that we already installed a few years old in the XXI century ... Today, the possibilities offered by the Internet for information (and help to spread it) are so tremendous that represent a revolution about the state of scientific publication ten years ago. As an example, the network offers twitter, if one follows the right people (we, as in life itself) abundant medical information and specifically therapeutic. And again, not necessarily biased information as you provide our beautiful relationship with pharmaceutical industry. We strongly recommend monitoring, for example, Carlos Oropesa or Vicente Baños. High quality information.

And it was precisely because of information found on twitter as we learned of more severe adjustment plan (the etymology of adjustment supposed to come over oh, what a fright that justice is not ) that the Catalan government has designed for the public health community. The journal Public stated in a recent news some of the consequences of such adjustment: various hospitals of Catalonia in summer care of your plants and significantly reduced their surgical activity. A general reduction of salaries and increased workload due to the lack of substitutions, adding the non-recruitment of many specialists now completing their training. But these measures, burdensome to us as professionals, will be on anecdotes if you start to fire workers or the lowering of salaries continues, or if our residents year after year begin to systematically go to the street ... And do not say what has already announced to close hospital wards, with the consequent collapse of emergency and operating rooms, with which you can imagine what will happen with the famous waiting lists ... What do you tell the patient will have to wait days in ER in a corridor because there are fewer beds to enter, or does that, instead of six months, will take a year in operation? ... As I said once, we can be accused of being alarmist. And really, I wish I be.

But we will radically change of pace. No more talk of health spending and public deficit. No more prophesying the end of the welfare state and public health equality for all. No more bad feeling. Let's talk now, as the title of our input, sweet dreams. And sweet remedies to get them.

In current psychiatric care is very, very common prescription insomnia and hypnotic medication immediately. Not just talking about patients admitted psychotic episode or severe depressive and manic phases. We talked of many patients with varying degrees of discomfort or anxiety of mind more or less diffuse or paroxysmal and even people is difficult to define as a patient but has trouble falling or staying asleep. Although our current ratings and those to come, the true challenge is not listed as patient a wide variety of categories and / or dimensions ... Wonders of comorbidity ....

And the question arises: what is the proper hypnotic? There is a whole range of possibilities, depending on the type of insomnia severity, patient clinical characteristics, etc. This entry is not intended as a lecture on the treatment of insomnia (because that is in any book and it's a very very interesting), but noted some general options based on our clinical practice:

• Insomnia mild settlement lorazepam or lormetazepam perhaps zolpidem.

Insomnia
• conciliation and / or maintenance: flurazepam.

• mnatenimiento Insomnia conciliation or more severe: levomepromazine, clotiapine.

Of course, all this as indicative only and without any desire to create school. Although we are seeing more on our various partners around the prescribed as hypnotic quetiapine, either as immediate-release or extended-release form (although we still do not understand how a drug with a half life allows once-daily, it lasts 24 hours, can be used as a hypnotic ...).

And now, for as our loyal readers and would imply, a relationship should have the first part of the entrance to the second, let's make a list of hypnotics with their prices (as vademecum, 2008 except seroquel prolong, which is data, 2009). You'll see what education:

• Lorazepam (orfidal) 1 mg (50 comp.): 1.72 €.

• Lormetazepam (Noctamid, loramet) 2 mg (20 comp.): 2.36 €.

• Zolpidem (Stilnox) 10 mg (30 comp.): 3.11 €.

• Flurazepam (dormodor) 30 mg (30 comp.): 3.75 €.

• levomepromazine (Sinogan) 25 mg (20 comp.): 1.64.

• Clotiapine (etumina) 40 mg (30 comp.): 2.17 €.

And the winner is ...

• Quetiapine (Seroquel) 25 mg ( 6 comp.): 3.2 €.

• Quetiapine (Seroquel) 100 mg (60 comp.): € 88.06.

• Quetiapine (Seroquel) 200 mg (60 comp.): € 133.88.

• Quetiapine (Seroquel) 300 mg (60 comp.): € 187.29.

• of Quetiapine Prolonged Liberación (seroquel prolong) 50 mg (60 comp.): € 91.79.

• of Quetiapine Prolonged Liberación (seroquel prolong) 200 mg (60 comp.): € 165.06.

• of Quetiapine Prolonged Liberación (seroquel prolong) 300 mg (60 comp.) 195.63.

• of Quetiapine Prolonged Liberación (seroquel prolong) 400 mg (60 comp.) 226.21.

Obviously, one would think that quetiapine is much better than all other hypnotic. Because if it were not so, what is the justification for prescribing under the public health system that, in turn, is lowering wages to their workers, not hiring specialists and threatening form of plant closures and operating rooms, not to mention various copayments ...?

So we set out in search of data and studies to justify the use of quetiapine in insomnia, so rest assured that our money (and yours) was was well spent. And we have a comprehensive document published by the Canadian State University of British Columbia (Vancouver capital, for details) in 2010, which summarized a few paragraphs especially clarifiers below

have been published only two randomized clinical trials to study the hypnotic effect of quetiapine. One in healthy subjects, with a sample size of 14 ( uauh ... ), 2 of whom left for orthostatic hypotension. The others were distributed randomly and double blind between placebo and doses of quetiapine of 25 g and 100 mg. Both doses of quetiapine resulted in increased sleep time. The other study was conducted with 25 patients with primary insomnia, distribute them randomly between placebo and quetiapine. There was no statistically significant differences in any sleep variables studied.

Regarding the possibility of side effects have been associated with the use of quetiapine at both high and low doses, other extrapyramidal symptoms such as dystonia, akathisia or tardive dyskinesia. Frequently Secundary effects at high doses (considered these as 150 to 800 mg / day) are: weight gain, drowsiness, increased cholesterol and triglycerides, insulin resistance, dry mouth and orthostatic hypotension. In rare cases you may receive neuroleptic malignant syndrome or neutropenia. A small double-blind trial found that Quetiapine worsens cognitive decline in dementia.

The findings from the report reproduced in full:

• Quetiapine is not approved or recommended for primary insomnia.

• Quetiapine is commonly prescribed off-sheet as a hypnotic, but only A clinical trial examined its use in patients with insomnia. Found no benefit.

• No published clinical trials comparing quetiapine with other drugs for insomnia.

• The management of primary insomnia should focus on education and promoting healthy sleep habits.

• drugs should be limited to short-term, intermittent or daily use only in exceptional cases.

summary, quetiapine prescribed (Seroquel) or, even more surreal, quetiapine extended release (Seroquel XR) as a hypnotic, although there is no evidence of efficacy for such use and although there are other much cheaper options ... We can be proud.

Finally, to conclude with the post title, we sweet dreams to all our dear readers ... We also try to sleep without too many turns to some of the money that the state has failed to pay us or to be saved by not hiring residents coming years, or do not say which will be trimmed at the expense of delaying operations and income of patients, will be used to pay for AstraZeneca boxes and boxes of seroquel seroquel and prolong hypnotic prescription and ...

prefer what he said Estopa :

Do not have pasta, then sleep for a while,

not spend it sleeping, is much cheaper ...

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A Lacanian Sweet dreams and a stoic enter a bar ...

... Not really. Despite the title, the entry is not a joke. What we have just to try to attract (more) readers, because if we put the real, as frighten us. This is a work we did on Stoic philosophy, particularly in its ethical aspect, and a possible interpretation of their problems from the viewpoint of Lacanian psychoanalysis. Then, the real title and the essay:

" Stoic ethics and conflict free / destination and pathos / logos: notes from psychoanalysis "

"Stoic" is a term referring to an attitude of serenity to fate and to overcome the passions, on the assumption that metaphysical reality is rational order. The reality would, therefore, a natural whole governed by a causal sequence logos provident as necessary. Chance does not exist, is just a way of saying we do not know the causes. Everything happens by necessity: the destination ( heimarmene, fatum ) prevails without limitations. Based on Heraclitus, the Stoics identified the universal law of nature with the logos.

divine Logos is the source of all things, the foundation of the legality of the events, and to establish a relationship between human reason and the cosmic, universal law because the things are included and the subject, so that match reality with the conceptual structures of thought. Just as the logos dominates the universe, man is encouraged and driven by the soul, which is not purely intangible, material it is a breath (pneuma ).

The doctrine of the logos, pneuma processes makes it possible to conceive of nature not only in a mechanistic, but teleologically, and where there is also for standards to be achieved. To the extent that apprehends teleologically, nature is revealed as a regulatory and therefore be concluded that is not random but due to a cause, since the objective law-policy has that have some merit.

There is only one perfect wisdom, which is the Logos or Reason of God, eternal and subsisting, which is like an infinite seed from which the individual logos of men, all of which are participation the only divine logos.

The constant transformation of the universe unfolds in rhythmic cycles and periodic governed by law and necessary immanent ( logos) that is the cause of all things, past, present and future. Each cycle of development of the universe ends with a conflagration ( ekpirosis ) in which destroys all individual beings, leaving nothing but the two eternal principles: matter and the primordial fire. Of them will never be reborn all things in the same order, repeated endlessly ( palingenesia ). The worlds will occur in successive cycles. All things are repeated countless times exactly.

The Cosmos absolute stoic rationality corresponds an absolute necessity. In his world there is no room for contingency. Nothing happens by chance, but all necessary. There is no movement without a cause. Some facts are because of others. All gear is developed within the cosmic cause and effect. In this cosmic unity everything is rigorously sorted, concatenated and determined by the logos, which is identified with Reason, Providence, Fate or necessity, and would not be blind necessity or purely mechanical, but this logos orders all things to an end of perfection, which it always does best.

In the Cosmos, governed by logos, everything would be perfectly ordered in the set. The specific disorders are only from a limited and partial view. The evil is apparent and only exists in the particular, but even those who appear evil, they are well integrated into the overall purpose of the universe.

Within finalist Stoic determinism, it is essential to leave some space for freedom if you will make it possible to develop some sort of ethics. This freedom is trying to save Chrysippus reconciled with the need, distinguishing between perfect and principal causes (remote) and auxiliary causes (forthcoming). The destination would be the main reason remote drives us to action. But a move to get to be need not be barred by the proximate causes, to which we give or refuse our assent. The destination determines the order, and perhaps provides the means.

Anyway, it is futile to pretend to rebel the impulse of necessity, being such a claim the cause of our suffering. It would be best to let go, to cooperate with our free consent to the movement of Nature. This will achieve the perfect serenity and peace of mind, typical of the sage who is referred to the need providential. However, this freedom is reduced to a power, ineffective resistance to the destination. One can only useless or cooperation or resistance to universal impulse necessary but not sufficient to invalidate the rigid determinism that carries all things.

The ideal Stoic sage is perfect virtue, and therefore also of perfect happiness, because only he has a perfect insight of what is in their power and what goes beyond. Like other human beings, the sage experience passions and emotions, not let it influence their actions or not in attitude and thus in a state of complete freedom. The wise man is free because he understands, accepts and lives by the strict law that orders all events. For the Stoics, the telos is perfect to live in total agreement with nature. To be happy is to live according to nature. So obey rationality itself is to follow the order and harmony of nature, because if the reason is the same in the universe and man, if human nature is essentially rational, and if the kosmos is equally rational, in that case as regards our rationality will concern both the immediate and nature. This situation can be described as the desire to live according to nature or to follow nature.

The supreme principle of virtue is to live according to nature and, thus, the wise man also lives in accordance with himself, or vice versa, living by himself, the wise man also lives under the universal nature . This is also the means to ensure true happiness, which is always linked to virtue, and suffering vice.

An equivalent formula is to live according to reason, then live up to the individual right is to live according to the Reason that rules the world order. In all things there is an instinctive impulse to self-preservation and to achieve perfection, which is the proper end of nature. In minerals, plants and animals that momentum is unconscious. The man, meanwhile, is the largest among animals and has intelligence (logos), which should raise the natural impulse of appetite simple rational volition and choice. Human life, therefore, be characterized as rational and free. And the virtuous life consists in acting rationally and freely, adjusting conduct the universal order of all nature, governed by universal Reason.

Zeno, founder of the school of Stoicism, had merely stated that the purpose of human life is "living consistently" Cleanthes appearing to be adding "according to nature." Some authors argue that "living consistently" Zeno and must be inferred "according to nature." In any case, the addition is important because it means moving on the nature of man to nature as a whole. Chrysippus says that the end becomes the live according to nature, which is equivalent to according to nature and the universe.

When considering the possibility of acting irrationally is when we face various problems. First, the logical problem of trying to obtain a duty of someone (as happens when rules are derived from nature). In fact, the idea of \u200b\u200ba natural order of nature is useless from a practical point of view until they determine their content in any way, since the requirement to live according to nature is empty, or rather too abstract and therefore unable to reach specific duties, if not filled in some way the idea of \u200b\u200bnature, which is necessary to resort to the experience. The Stoics take standing on the observable fact instinctive regularities in the behavior of certain animals. The attempt to determine the universal natural law from the generalization of empirical features of behavior only makes sense under the assumption that in this particular case the law is also universal.

A key problem in Stoic ethics is that if the metaphysical determination of duty is strong to the point of being is rooted in the universal law of nature, and whether it is universally required, how is it possible to act against the duty? Either the objective reason determines all in need and then it is superfluous all called to act in the sense of duty (for all work would be "natural"), or, if such a requirement makes sense, man is not subject unconditionally to the law of nature (here is human freedom) must think that the passions and affections can deflect the soul, so you lose control over the shares. Hence the need to eliminate a stoic and others, for only thus ensuring the rationality of actions and the harmony of the soul, but the passions and affections are to remain "natural" in some sense. And another problem arises: how can act outside the law of nature if it establishes a causal concatenation needed between events past, present and future?

The Stoics, on the one hand, presented as natural and instinctive behavior metaphysical foundation for the thesis that moral action is an action in accordance with nature. But on the other hand, are forced to accept an opposition between reason and instinct, because only thus can speak of irrational behavior and moral demands.

For Zeno, passion is an "irrational and innate movement of the soul as a boost intemperate", with deviations from normal operation and because of reason, ie, are perturbations of reason. Passion, and generally evil is irrational as a loss of reason, not as arising from some authority or power that is not right, because human beings are essentially logos.

Chrysippus in turn argued that although the subjects were acting from external stimuli, the manner in which responses to such stimuli, the behavior is determined by the intrinsic structure of the subject. Chrysippus tries to reconcile the submission of all processes to the universal law of nature with the recognition of human freedom and responsibility for one's actions. The solution is to hold that man is logos, the hegemonikon is pure logos, then must say that man is determined by the logos will be the same as support that determines itself.

The Stoics puzzle over much on the analysis of the passions (pathos ). The passions have their origin in the general thrust of primitive nature. When the initial impulse in man is not governed by reason and is not subject to it is irrational, it deviates from righteousness and since it goes against nature itself. The passions of the disorder consist of reason caused by the ignorance that clouds the mind and causes of false opinions and misjudgments. The ignorant always does wrong.

Stoic moral rationalism is revealed in his concept of passions, it is necessary not only to dominate and submit to reason, but remove them to get the impassivity essential to the serenity of the soul and freedom characteristic of wise and base their happiness.

consist The Stoics make virtue and wisdom in a kind of freedom, this freedom, in turn, is responsive in the absence of determination, of pathos ("affection" from a root meaning "suffering" or "be concerned" .... "passion"). Absence is said in Greek pathos apathy (impassive). The passions are, for example, pleasure, pain, desire and fear.

The first dichotomy is striking to address the issue of Stoic ethics is what stands between freedom or fate or necessity. Despite his runner-deterministic view, the Stoics attempt to safeguard the freedom enough, through the proximate causes of Chrysippus, to maintain accountability of the subject. In the wise this freedom is acceptance of destiny (destination, for its part, the irrational animal also accepts without freedom). Then this freedom, if exercised to break or modify the path of destiny, is the freedom to make mistakes, to err. And if you can not break down that path, then there is no freedom or responsibility, and it is impossible to speak of an ethic worthy of the name. Then the alternative apparently arises whether freedom exists is between being free to accept the slavery of fate or be free to fall into error and evil.

And the problem is not minor or less obvious, how a universal right that all orders and is perfect, you can live with error, ignorance and evil that denounced the Stoics in most men being so few scholars. This avoids saying that even what looks bad due to a perfect outcome plan. But if evil is part of the universal plan, how accountable and punish the wicked?

One possible solution to these issues is that the determinism of the universal logos is the same individual reason, which one is given but in a sense, himself. And if one is determined by itself, in a sense also preserved their freedom and their responsibility as well. It is a similar idea expressed by the psychoanalysis to consider the subject led by their unconscious, their first experiences, their hidden desires, secret defenses. While on a conscious level we often ignore why we do what we do, everything has a cause and an address in the negotiations that unconscious level established between desires and impulses of the id and superego prohibitions, with the ego and its defenses in the middle of this fight, making agreements acceptable to all parties that give rise to symptoms in the psychoanalytic sense, beyond the morbid. The subject, therefore, is determined by his unconscious, but did not know or see, and choose freely their choices and is responsible for them. Not your self, only part of the psyche, but all its instances we call, precisely, subject.

Another problem arises in the comparison between animals and man as a rational animal. The animals have no human reason, live by instinct and based on these instincts follow the nature, the universal logos without the possibility of error. Man as rational animal is higher, but the logos decide to obey or not the instincts, and there arises the possibility of error. Moreover, these instincts in man may degenerate into passions that cloud reason and rush into evil. The question is, if that human reason is part of universal reason, how is it possible that just the only animals that have are the ones who can do evil and ignorance. Or that human reason in such high regard were the Stoics, as we do, implies the germ of those passions whose existence leads to disaster.

A first entry could be made from psychoanalytic concepts of instinct and drive. Animals have instincts, which can be understood as operating rules that decide and organize their behavior at all, whether relating to self-preservation or perpetuation of the species. Therefore, we would say from a Stoic point of view, following the universal law governing the kosmos . Man as rational animal, as well as instincts, is understood as forces drives or impulses that cry out to your satisfaction. But, unlike instincts, do not have a default object to be addressed. The uniquely human instinct is, so say, blind. And from that blindness, each subject (from his unconscious and from its responsibility) must choose each object that runs the drive. That is, the man, unlike animals, do not come with operating rules. No instruction book. Not tied to the universal law, which may or may not follow.

stoic vision evokes the image of a compelling reason to fight and in the wise, wins and removes these unhealthy passions. From psychoanalysis, that reason would be more aware as part of the psyche, like a nut shell drifting in the ocean of the unconscious, full of desires unconfessed of drives / irrational passions which, if controlled, are equally unaware of defense forces, no reason as such even know of such struggles.

Then
or reason is weak, as claimed by psychoanalysis and not against passions and impulses, or that human reason is not part of the universal logos but opposed to it. How do you explain that the only beings endowed with reason in the world are the ones who make mistakes? No men in the world, the universal law would be fulfilled smoothly without errors. The world would be in equilibrium, marked by nature, consisting of a sum of ecosystems (understanding biological systems such as those in which man is absent), away from danger, that the Stoics could not anticipate and we can not ignore, climate change, nuclear wars and various planetary disasters.

That human reason, the Stoics as high as banal for psychoanalysis, what is specific? A Lacanian view would insist on the role of language as a structuring of the psyche, leaving the subject as its level. That is, the language which is not complete us. Leave a rest is not predictable, not specified, you can not put into words, a lack native to which is added after passage through the Oedipus, the frustration, incompleteness, castration, ie the terrible discovery that you can not have everything you want. The full introduction of the fault, causing the desire and essential part of being speaker. Therefore, the superior animal endowed with reason implies its own contradiction: the higher rationality that accompanied language gives no remedy the fault that generates the desire, drive, passion, and that makes it so difficult to impassivity aspirations of the Stoic sage, leading to the best of a standard and normalizing neurosis. Lacanian language that we determined and inevitably generates both and desperately reason and passion, logos and pathos , constituting the subject human as we know it.

Bibliography:

• Salvador Mas, "History of Ancient Philosophy. Greece and Hellenism. " UNED.
• Salvador Mas, "Hellenistic Philosophy. Selected Texts. " UNED.
• Guillermo Fraile, "History of Philosophy. Volume I ". BAC.
• Marzoa Felipe Martinez, "History of Philosophy. Volume I ". Isthmus.
• Sigmund Freud, Complete Works. " RBA.
• Jacques Lacan, "Selected Works." RBA.

Una Ragazza Molto Viziosa Con Lilli Carati

"Merchants in the temple paradigm hegemony of commercial bio-psychiatry"

With this title, Journal of the English Association of Neuropsychiatry we just published an article in which we work hard few months ago. As you can imagine such a thing fills us with pride and is an honor for us. This paper talks about the (more problematic) relationship between the pharmaceutical industry and psychiatry through the review of different studies and different opinions that we believe are relevant, including our personal conclusions on the matter.

hope you like it (though perhaps not so).

Neuropsiq Rev. Asoc Esp., 2011, 31 (110), 321-341.

Broken Capillaries In Infants

We know that this entry will like (or not)

a while ago, talking to a person who started work on our discipline, left the issue of depot neuroleptics (it's true that they have increasingly cool names, but is a neuroleptic neuroleptic and depot is a depot, what you call it). Our correspondent said that the use of deposit these drugs had the obvious advantage of ensuring compliance . Nice. But, as we break some illusions and because we know that kings are the parents, I said yes, which effectively ensures compliance, but only for two weeks. Then the performance will be as the patient wants.

The fact is that many times we use medications to deposit precisely because we believe in ensuring compliance. And, in our opinion, is something wholly correct in many cases where the patient prefers well, take less medication by oral or convenience of administration. But we think it should be taken into account the patient's opinion on an issue that concerns him so directly. And it appears that we understand that sometimes it is necessary to administer medication even against the patient's opinion, at the time of a flare that requires involuntary admission to control anxiety and psychotic phenomena that cause. But forcing a stable patient psychopathologically preferred oral medication to prick a depot (or vice versa), it seems, apart from subtle, somewhat fascist.

But despite saying that you can go the opposite, as Scientists have interests and we like things as proven possible, we feel uneasy at the fact of not knowing the different studies comparing depot medications. As always, if any of our dear readers know of such a study and would enable us, we would be very grateful. Because we would hope to have proven through good randomized double-blind study the benefits of risperidone injection ( risperdal consists ) versus zuclopenthixol depot ( Cisordinol / CLOPIXOL ) or fluphenazine decanoate ( Modecate ), for example. For (almost) everyone says it is better but, hobbies of the scientific method, we would like something a little more, how to say ... based on more than opinions and discussions with visitors. Because we would like to know exactly the advantages of risperdal consists and, incidentally, if these benefits are clinically relevant for the patient to justify the price difference.

Recalling a previous post , the price per patient per month of risperdal consists of 100 mg every two weeks is 800 euros, that of zuclopenthixol two vials every two days is 33 euros and Modecate that of two ampoules every fifteen days, 6 Euros. Not to be demagogic (well, just a little), but considering everything out of the box of common public money, we ask whether the patient would not prefer to be one of the two flights and pass some of the money saved your pension or payment of rehabilitation devices, supervised apartments and perhaps more useful things. Because if we can not pay for everything (and taking into account that money is not only infinite but is tending to acabársenos) would like to know how to prioritize a bit.

The case is not aware of studies that compare typical depot neuroleptic with atypical, so far is only the RISPERDAL CONSTA. But we have found an interesting study on the drug, published recently in the New England Journal of Medicine ( going, silly magazine, we can dispense with a dismissive gesture if we do not like what the article said. .. ). This was a randomized, double-blind study comparing a group of schizophrenic and schizoaffective patients treated with RISPERDAL CONSTA, another oral antipsychotic medication group of different types. Give us verbatim (and kindly translated) findings:

The long-acting injectable risperidone duration was not superior to oral therapy chosen by the psychiatrists in patients with schizophrenia and schizoaffective disorder, who had been hospitalized or near the hospital, and also associated with more adverse effects in terms of damage to the injection site and extrapyramidal effects.

Wonderful. So, it's more expensive (remember that oral risperidone to 12 mg / d worth 150 euros) is not superior in symptoms, quality of life or function, and last but not least, causes more extrapyramidal side effects (not to mention the lesions on the buttocks or, if we care about the patient's dignity in deltoides). Really great.

But at this point, let us pause. When we compare the prices of these antipsychotics, we chose these doses (12 mg / d of oral risperidone, 100 mg/14 days intramuscularly) because they are the maximum doses used in our environment. Or so we thought when we wrote that entry, because then we have learned that some fellow, no doubt with more ability to manage psychotropic drugs, come with some frequency at doses of 150 mg/14 days of RISPERDAL CONSTA ( Update price per patient per month: EUR 1200 which is not bad for people who earn less than 400 pension ). It is striking It seems that one is more scientific biologist and the greater the dose used, the greater the amount of antipsychotic drugs together increased the amount of other medications that also requires, in the same patient.

But we assaulted a small but terrible question: do we really know what the recommended maximum sheet?. Because it is true that a doctor can prescribe higher doses of these if you think, preferably based on studies that will be better for clinical outcome. But it is also true that, beyond these maximum doses, the drug's safety is lower and the possibility of side effects More frequent and severe there. Let's look at the technical, easily accessible on the Internet:

oral Risperdal : doses above 10 mg / day have not proved more effective than lower doses, and may increase the incidence extrapyramidal symptoms. Since it has not been evaluated for safety to higher doses of 16 mg / day, doses should not be used above this level. Sheet as of February 2009.

Risperdal has : For most patients the recommended dose is 25 mg every two weeks intramuscularly. Some patients may benefit from higher doses of 37.5 mg or 50 mg. [...] In clinical trials, there was no additional benefit at doses of 75 mg. Not recommended higher doses of 50 mg every two weeks. Factsheet updated in November 2009.

We were, excuse the technicality flipped.

Let

repetition:

Risperdal has : For most patients the recommended dose is 25 mg every two weeks intramuscularly. Some patients may benefit from higher doses of 37.5 mg or 50 mg. [...] In trials clinical, no additional benefit was observed at doses of 75 mg. not recommend higher doses of 50 mg every two weeks. Factsheet updated in November 2009.

And we wonder: Are all those patients who are at doses of 100 or 150 mg could not perhaps have been with 50 mg?.

And also: when a patient takes 100 mg of intramuscular and also 12 mg of oral risperidone how much you have in your body?

hope, as we said before, do not accuse us of scaremongering. All this information is readily accessible on the internet and we believe legitimate and almost necessary, ask the questions that we are doing to improve our clinical practice. As we believe a patient's right to know the information available about the drugs they prescribe.

Returning to the question of dose is also the easy way out and witty type studies is that they are Americans and they use very low doses because they have fewer receptors, ha, ha, ha ... Grace messing with the Americans is very handy, and we have practiced for years like this and other issues, but something we stop to ponder why in the Schizophrenic patients is stable together with 12.5 mg every two weeks of intramuscular risperidone and in this country south of the Pyrenees (natural border of Europe, as everyone knows) we use in most patients 100 mg. And we wonder how we can distinguish patients who would respond to 12.5 mg if you have already put 100 ...

Finally, questions the wind ... The truth is that there are more important, because soon, soon, soon ... ( drumroll) ... We will have between us xeplion ! (To be clear, INVEGA depot), the expiration of the patent consists of on the horizon already. And we say (well, we do not) it's great, superb, the final antipsychotic ... (Well, until its patent expires in turn) and, furthermore, that can be given once a month and that is the height of comfort for the patient (and it will preserve its dignity, because you prick shoulder, not ass, teach that a nurse's ass really is undignified and stigmatizing). And, as today we are inquisitive, we also want to know how much public money will cost the great advantage of monthly injection ...

And you'll see as the risperdal has, so now seems wonderful to all, begins to stop as prescribed xeplion out the brand new, without any studies that compare.

But it will, as always, for the sake of patient.

Why Is My Vision Cloudy After Cataract Surgery?

Entering politics ...

One of our favorite blogs is called Psychopharmacology Institute. We find impressive outreach and scientific criticism that the authors carried out Pol Yanguas Emilio and Francisco Martinez Granados . The truth is that there are so many entries that we consider absolutely essential that we do not recommend any in particular. You have to read and frequent this blog, which gathers original research papers, articles and book chapters translated, all under the concern for the rational prescription of psychotropic drugs, from the point of view of the critical dose abuse and polimedicaciones without any empirical basis. I said: a blog essential.

Recently, one of the authors of this blog made an interesting comment on an entry ours, we gather here, "We usually all responsibility the industry of many evils, and we're right, but lately I prefer to think that "the greater evil is the weakness of health systems. If our health system had strength, had the elements you need to have to act with sensitivity analysis, we simply do not worry about the pharmaceutical industry, because it could not do many of the things that allow you to do. The focus of the debate must be to be moved to the weakness of our system. Drug consumption in an irrational and lacking in security can not depend on a clinician is more or less sensitive to sustainability the system can not depend on this . "We felt successful and relevant commentary (as we have ever said, not everything is going to be to rock the pharmaceutical industry ), and in that sense we answered. But we that the issue deserves a full entry to make clear our position.

So for that matter.

believe that the government in this country, starting with the Ministry of Health and following the most autonomous health service, with honorable exceptions, carry out an unfortunate neglect of duties in different areas:

The pharmacological research has been completely in the hands of private pharmaceutical companies, whose objectives are first and as is evident in a market capitalist logic of profit. This leads to no research on diseases of poor countries, that prevail over medication long-term maintenance and not curative, to persist in drug known lines too I dare not open new lines, more risky in terms of business, but potentially source de descubrimientos nuevos, etc.

La formación continuada del personal sanitario ha quedado también de forma casi absoluta en manos de las mismas empresas farmacéuticas, que deciden así cuáles son las líneas de investigación y avance teórico que florecen y cuáles quedan relegadas casi a la clandestinidad. Y no son inocentes en ello las asociaciones profesionales y otros colectivos con intereses formativos que establecen precios de inscripción para sus actividades absolutamente prohibitivos sino va uno pagado por las mismas empresas que comercializan los fármacos que se anuncian en tales eventos y que luego el médico prueba a ver how about , giving the impression that goes well (and passing at the same time backing any assessment of the placebo effect or observer bias, if one puts the edge, to see how you're going to Honolulu. ..).

The administration also systematically practiced an obvious hypocrisy approves public funding (which in the case of psychiatric drugs, most of the time is almost the full value of the product in question) for certain products with studies showing efficacy against placebo ... but not to existing drugs, cheaper and more popular (or, which is the same: more insurance). And I approve: more expensive, less safe because of ignorance, wildly sponsored guests, lectures, gifts, conferences ... And then, and here comes the hypocrisy, public administrations in documents that discuss various pharmaceutical products, we recommend that prescribers do not prescribe. Cojo. Well then, why do you fiancian (with our money, do not forget)?. Because we agree that the State, especially in these times, you can not pay for everything. In fact, our glasses and our fillings we pay to us. And, if we had no money to pay, we would be farsighted and caries, but the state would not comprárnoslos.

And in this vein, recently the Ministry of Health of the Galician regional government approved a list of available drugs to be prescribed in the Community. The list included all active, but left only prescribe cheaper presentations, we assume that essentially generic. And in an economy measure as sensible as that, the Health Ministry itself is up in arms, arguing that freedom is under attack limitation (will prescribe the coolest visitor mark, because active ingredients could prescribe all) and the fairness of the system (ie, that equity is that if you send the expensive brand in Asturias, Galicia can not save the generic cheap though, as we should already know , no differences in either efficacy or safety, equity must be squandering money equally in all communities).

We say in this connection that the Medical College (which is not very saint of our devotion to his usual corporatist policy and its not very striking concern by public health) has written an admirable document we can read the entire here. We quote a few paragraphs:

" Freedom of limitations is based on the physician's ability to prescribe a particular substance or its therapeutic equivalent, not whether to have a trade name or other. [.. .] Freedom of limitations also entails taking into account the economic aspects of medical decisions. The doctor can not forget that the resources are paid the requirements belong to the whole society. It is therefore particularly liable to prescribe with economic rationality and good sense. It is unacceptable deontologically prescription drugs higher price when their effectiveness is identical to that of other lower cost .

Clarito, clearly.

Well, now going our immediate environment, we say that we find it regrettable management Canary Islands Health Service on this issue. It is true that there is a service Control and Rational Drug Use , which provides freely accessible publications of interest. But the moment of truth, it downloads all the prescribers responsibility to control the excessive expenditure on health (and, obviously, as prescribers that's one of our responsibilities), but the Canary Islands Health Service itself do something about it. The last straw was the publication in the Official Journal of Canary a series of conservation measures, given the terrible situation of economic crisis and rampant unemployment that exists in the islands. The decree in question, apart from measures that we liked a little like going to charge less for our hours of duty, leaving to have free parking, lost days of the agreement, etc. (Not go into the relevance or justification of such measures or not, but obviously we did not like), including (by finally) clear measures of health cost containment:

" In order to rationalize public spending on the prescription and use of drugs in the area of \u200b\u200bthe Canary Islands, that the requirement is prioritized of drugs by doctors of the Canary Islands Health Service or centers with the Canary Islands Health Service, is carried out by identifying the active ingredient in the prescription official. "

" In order to rationalize the prescription and use of drugs, medical devices, effects and accessories and reducing expenditure on medicines, the doctors of the Canary Islands Health Service, as well as the centers with the Canary Islands Health Service, shall ensure that the requirement to carry out whatever it costs less to generate the Autonomous Community Canarias. To do this, those involving the treatment groups increased spending in the pharmaceutical bill is set by the body that determine the active ingredients, having the same or equally effective alternative therapy involving the most economical. If the patient's clinical circumstances is not possible the prescription of these active principles, will require that the physician prepare a supplementary medical report setting out the reasons justifying the prescription clinical .

this decree was supposed to came into force on January 1, 2011. We're running in March and we already have convention at days and we have no free parking, but no reports that have forced people to prescribe by substance (I do, but on a strictly voluntary basis and agree to be listed in that regard as the ultimate fan service ). We have no evidence that any competent body has made that list of active ingredients, but since then, competent body or not, nobody has sent doctors to the Canary Islands Health Service list of similar characteristics.

What we understood: we are totally in favor of forcing to prescribe by active. Only from interest away from the public for which (supposedly) work that can be understood as an attack on freedom of prescription (do not tell ourselves, says the Medical College). But not enough to make a good law. It is necessary to enforce compliance. And that, once again, our governments neglect to make functions. It's been three months and continue to squander the money of all.

Lords of the Canary Islands (including government), please make a damn time to apply the decree made yourself. You are responsible for managing it effectively and decent, but it is our money that is lost.