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By X. Dargoth. Southern Wesleyan University.

The regional leadership endorsed the demonstration strongly buy cefadroxil 250 mg lowest price, but local commanders exhibited mixed levels of commitment, and changes in command eroded this support yet further over time. Given that this was the first demonstration in a new MEDCOM initiative, it is understandable that it might be met with mixed reactions due to concerns regard- ing the initiative’s effects on MTF workloads and costs. Further, many providers, including physicians in leadership roles, have instinctive negative reactions to practice guidelines as "cookbook medicine," which indeed we heard in our evaluation. Unfortu- nately, passive or "wait and see" positions by command teams can become a self-fulfilling prophecy leading to failure because im- plementation teams are not given the motivation and support they need to change clinic procedures and mobilize providers and staff to accept the new practices. We believe these dynamics con- tributed to the limited results of the low back pain guideline demonstration. The demonstration did not perform well in the area of monitoring, in part because this was the first demonstration and it began very quickly as the DoD/VA practice guideline was being completed. The guideline expert panel did not select the key metrics for systemwide monitoring until well into the demonstration period. Further, MEDCOM did not have the resources early in this demonstration to establish a monitor- ing system at the corporate level. Without structured guidance from the corporate level, the sites varied widely in their approach to monitoring. One of the sites was quite aggressive in tracking utilization, but the other sites did not routinely monitor many measures. Some sites performed chart reviews to assess compli- ance with checking for red-flag conditions and documentation of Lessons from the Low Back Pain Demonstration 99 care, but these reviews were one-time events that were not estab- lished as regular monitoring mechanisms. Within the limi- tations of available staff resources, MEDCOM made a solid commitment to provide the MTFs with policy guidance and technical support to enhance their ability to implement best practices for low back pain treatment.

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Some doctors who "sympathize" with these movements have been ac- cused (rightly) of actively order cefadroxil 250mg without prescription, if discreetly, supporting harmful cult prac- tices when they have been publicly exposed and attacked. Several practitioners have been convicted for having proselytized on behalf of one cult or another. They strongly de- nounce the relationships between certain "soft" or alternative medi- cines and cults, relationships that are very clear in some cases. Alterna- tive medicines and pseudo-medicines are often preached and used in- side cults, and there is considerable danger in the fact that alternative and pseudo-scientific therapies are promoted by associations or groups known to serve as "screens" for cults. Similarities between Cults and Alternative Medicine In many cases, there are clear parallels between alternative medi- cines and cult practices, and their guiding principles are often very similar (both may reject scientific medicine, both may lean toward "orientalist" and/or "ecological" notions, etc. In the general context of alternative medicines, the border is diffi- cult to establish between tolerable and harmful prescriptions (whether active or passive — by rejecting recognized forms of treatment), and between appropriate and charlatanesque practices. In certain cases, a possible relationship should also be suspected between esoteric, 220 The Authorities vs. It may be time for a general reminder of the guiding principles that come from the "Primum non nocere" and the Hippocratic oath: The doctor’s role is to contribute to maintaining the health (the physical, moral and social well-being) of his patients and to respect their autonomy, to oppose point by point the goals of coercive cults, which are harmful to their followers. In the pursuit of his occupa- tion, the doctor is called upon (and is given the privilege) to pene- trate the intimacy of the life of his patients. Various incidents have been reported, personally implicating doc- tors, directly or indirectly, in reprehensible practices of cult groups. If a doctor takes part in any activity that destroys someone’s health, dis- avowing the commitments he has made, he should not be able to claim clemency on the basis of his profession. On the contrary, his status as an "expert" should mean all the more vigorous sanctions against him.

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