Physician opposition

Treatment of individual episodes is described above. The treatment or monitoring of individual episodes of mania or depression should also take into account the risk of a swing to the opposite polarity induced by the treatment of the current episode (i.e., depression triggered by neuroleptic treatment of manic episode, or mania following antidepressant treatment). The speed of such a swing may take unwary physicians by surprise. 

Some policies may cover medications but not therapy, and other policies may do the opposite. In addition, patients may be willing to pay out of pocket for some services but not others. Limits or caps may be placed on medication charges or on the number of psychotherapy sessions allowed. Only certain types of providers may be covered by insurance, that is, only a psychiatrist or only certain types of situations, such as case management or crisis intervention only. Some services might require a primary care physician s referral, even when that physician knows very little about the patient or the problem. Finally, the deductible (the amount the patient must pay initially to obtain the service) can vary, depending on the insurance policy. 

Boerhaave s name still lives on in the Netherlands. In Leiden we find the Boerhaave History of Science Museum, a statue opposite the hospital, a chemist called after the famous physician, and even an abortion clinic bearing Boerhaave s name Almost every respectable town in the country has a street called after Boerhaave and in orthodox Calvinist circles the name Boerhaave stands for the only real Christian doctor the Dutch have ever known. Herman Boerhaave deserves the attention of historians and this book is an attempt to understand the driving motives of some of Boerhaave s intellectual endeavours. 

See Elvira Powers, Hospital Pencillings Being a Diary While in Jefferson General Hospital, Jeffersonville, Ind., and Others at Nashville Tennessee (Boston Edward L. Mitchell, 1866), p. 64. On the opposition of physicians to women in the camp and general hospitals, see Culpepper, Trials and Triumphs, p. 322. 

The occasionally pronounced polypragmatism was confronted by the opposite extreme of therapeutic nihilism in the sense of treatment based on expectation. This inevitably led to frustration on the part of the physician and to resignation on the part of the patient suffering from a liver disease. Thus, the realization of provable treatment also became an urgent challenge in hepatology. 

Pharmacists, like physicians, have to be aware of the sovereignty of the patient. Although the protection of human subjects is critical, there is little opposition to the protection of human rights. However, opposition to other critical issues does exist to various degrees. 

There may still be oppositions to the use of the essential medicines list. Physicians may see it as questioning their prescription freedom, pharmacists may be worried about the financial implications, while manufacturers may fear a market erosion, and consumers may think that they are being offered second-rate cheap medicines. These concerns must be considered and addressed, and this is why the selection process should be consultative, and why education plays an important part. In fact, an essential medicines policy is nothing but an extension of the selective exercise carried out by the state, on behalf of the rights a community has to useful and safe products, to identify medicines that deserve marketing approval. The principle of convenience is under consideration in an increasing number of countries, especially as the pharmaceutical industry becomes more prolific, more complex, and uses products that are increasingly powerful and, consequently, more hazardous. 

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