Blog About Health & Medicine

This article gives this elegantly simple answer: “The problem starts when, for reasons no one fully understands, a few misguided T-cells incite other immune system cells called macrophages to attack the joints.”

Those so-called “misguided T-cells” are actually what are known as memory T-cells. In the arthritic process (whether rheumatoid, osteo, or other) these memory T-cells develop an internal program, just like some sort of computer,, which commands macrophage cells to attack and destroy cartilage. This destructive process results in the inflammation of the joints that is so typical in people afflicted with the disease.

The inflammation, in turn, affects the nerves and that’s what usually causes the associated pain. The inflammation may also push some bones out of place resulting in the disfigurement that is so typically found in arthritic joints.

Unfortunately, those memory T-cells never give up. It seems their malfunctioning programs go on forever. Moreover, they clone themselves, generating more and more misprogrammed

T-cells that direct more and more attacks against your cartilage. That’s why, as time passes, arthritis only gets worse, virtually never gets better.

But how does it all start? No one is absolutely certain, but probably it’s because some macrophages discover some particles of diseased or damaged cartilage that needs to be disposed of. Macrophages are like garbage collectors inside your body. Their job is to get rid of any foreign matter and organisms they encounter. They destroy invading organisms like viruses and bacteria, and they clean up waste matter as well. That includes any fragments of unhealthy cartilage damaged by some physical trauma or produced by some invading organism like that which causes rheumatic fever – or maybe even the flu. (Remember those achy feelings in your joints when you had a serious bout with the flu?).

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Article begins like this: “A KILLER WAS ON THE LOOSE … It was her own immune system, which had gone berserk, attacking the joints in her body and crippling her so badly that she often had to use a wheelchair. Left unchecked, rheumatoid arthritis might have shortened her life 10 to 15 years.”

The article reports on how all three of the most advanced scientific research projects today are intensely focussed on intervening in the immune system involvement in the arthritic process.

Of course the first thing you probably want to know is how any of this, can benefit you personally-specifically, how you, like the thousands before you, can be rescued from the crippling pain and inflammation of arthritis. First, it’s important for you to know a bit about the arthritic process in order to understand how it can be reversed.

Stopping the symptoms doesn’t stop the disease-There have been thousands of volumes written by thousands of authors on the how-and-why theories of arthritis. There are almost as many different theories as there are authors. Some of them are pretty screwy, but all of them are pretty scary.

The scary part is that no one has been able to stop the relentless, destructive advance of arthritis – until now!

Sure, you may sometimes slow it down a bit through diet and nutritional supplements. You can ease the symptoms with anti-inflammatory drugs and pain relievers. Your doctor can clobber your system with highly toxic anti-cancer drugs like

Methotrexate (also disguised under the less frightening name of Rheumatrex), which just maybe could give you some temporary relief at the cost of sacrificing your liver. But, until now, nobody has been able to halt the destructive onslaught against your cartilage and your joints.

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From the viewpoint of practicality, it is impossible to summarize in any adequate way the enormous and highly diverse amount of data on which this sex-offender study is based. Consequently this epilogue should not be construed as any summary, but as more of a postscript listing some thoughts we wish to leave with the reader.

It is clear that there is such a wide variety of types and subtypes of offenders that no sweeping generalizations should be made. There is no common denominator distinguishing all sex offenders. One cannot speak of “the sex offender,” and only in well-defined circumstances can one speak of “most sex offenders.”

Certain variables of behavior or vital statistics are important in particular types of offenders as, for example, the high frequency of self-masturbation characteristic of homosexual offenders, but inconsequential in other types of offenders, and the sexual restraint typical of the incest offenders vs. adults.

Some of the variables common in the sex offenders are seen also in the prison group and should not be considered as peculiar to sex offenders, but rather as associated with poverty, emotional and material deprivation, familial and employment instability, and lesser education. Persons who have grown up under and never escaped from such adverse conditions are likely to be convicted for some sort of offense, sexual or otherwise.

We interpret our data to show that there are two broad classes of sex offenses:

1.    Offenses consisting of behavior which is statistically normal and otivated by desires which most laymen and clinicians would consider within our cultural norms. One might summarize these offenses as “normal” but for various reasons inappropriate and punishable. Such offenses would include sexual activity with willing postpubescent unrelated females and occasional opportunistic peeping. These offenses do not seriously threaten social organization, and psychological damage to the individuals is generally absent or minimal. Consequently our

social sanctions should be tempered accordingly and society should expend a minimum of time and money with such cases.

2.    Offenses consisting of behavior which is statistically uncommon and motivated by desires which most laymen and clinicians would consider definitely outside our cultural norms and/or pathological. Such offenses would include those involving force or serious duress, those involving prepubescent children, most incest offenses, exhibition, and compulsive peeping. These offenses tend to disrupt social organization, if only by the furor they cause; the possibility of individual psychological damage is greater; and the offense may constitute a public nuisance. It is on these offenders that society should focus attention and be prepared to spend money for detention, treatment, and research.

Some behavior, such as homosexuality between consenting adults, falls in neither broad class. When an activity does no direct harm to the individual or others and yet is frowned upon by the layman, clergyman, and clinician, we have a problem of great philosophical complexity. Concepts of individual freedom, the relation of the individual to society, religion, mental health, and social function are all interwoven. No single answer can be sufficient for this problem, and the solution probably lies in a series of alternatives of action and attitude gradated to suit circumstances and permitting freedom but preventing public affront.

It is obvious that within the foreseeable future there will be no great reduction in the number of sex offenders unless our laws are changed to an unlikely degree. Man’s sexual drive inescapably clashes with the numerous, complex, and often contradictory demands society makes upon its members. Consequently, sexual behavior which is legally punishable is commonplace, and the question of who is caught and punished depends upon variables such as intelligence, impulse control, socioeconomic status, alcohol intake, and simple chance. However, we need not be pessimistic. With increasing knowledge we can ascertain more accurately what situations predispose toward the more serious sex offenses and, armed with such knowledge, prevent some of them. Given the data in this present volume and life histories of individuals comparable to the histories we took, one could predict with an accuracy better than chance what sort of sex offense an individual would commit were he to commit one. Deficient and crude though it may be at this stage of our knowledge, such predictability is most useful to the psychiatrist, psychologist, parole officer, and social worker. Furthermore, with increasing knowledge we can improve not only our diagnostic and therapeutic measures but also arrive at more rational viewpoints ourselves.

Ultimately our society may solve many of its sexual problems by

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It is obvious on logical grounds that we were destined to find significant differences between sexual psychopaths and other offenders. It would be strange indeed if several screening operations which included sexual criteria resulted in two groups with essentially identical sexual characteristics. Assuming that the clinicians did not change their criteria when examining persons in different offense types, we were also bound to find some uniformities existing among the sexual psychopaths, giving an impression of some homogeneity.

The sexual psychopaths may be described as a relatively intelligent, better educated, younger group of males who had difficulty in adjusting emotionally and socially with their parents and peers. Not unexpectedly they had even greater difficulty in working out sexual adjustments with adult females. This trouble was associated with greater inhibitions, especially moral inhibitions, concerning heterosexual activity. Despite these inhibitions the sexual psychopaths were more inclined toward socially unacceptable sexual behavior: homosexuality, cunnilingus, and contact with animals. Lastly, they did not avail themselves of the common escape mechanisms of gambling, alcohol, and drugs.

Refining this description still further, the sexual psychopaths must appear to the clinicians as a reasonably bright, well-educated group of younger men tied up with inhibitions and emotional and sexual problems giving rise to socially unacceptable sexual behavior, some of which resulted in their imprisonment. Note that this abbreviated description contains three vital elements:

The sexual psychopaths are amenable to treatment because of their intelligence, youth, and education.

The sexual psychopaths are more like the private patients with whom the clinician has worked than are the other offenders.

The sexual psychopaths are in many respects like the upper socioeconomic level male (including the clinician) in their greater education, inhibition, morality, and conservative heterosexual life.

This description partially answers the basic question: does the division of sex offenders into two sexually differing groups—sexual psychopaths and others—serve any useful purpose? If the sexual psychopathy procedure winnows out those men with whom the clinicians can work most effectively and comfortably, and with a higher probability of alleviating their problems or at least ameliorating their behavior, then its existence’ is justified. This procedure would also redefine the sexual psychopath simply as a sex offender more amenable to treatment than others.

But such a definition and procedure bring us to a deep confusion in the sexual psychopathy laws. If the primary function of these laws is to segregate the dangerous, their objective is not being achieved, for some of the most dangerous men are those rejected as sexual psychopaths merely because they are not amenable to treatment, while some of the least dangerous (e.g., homosexual offenders vs. adults) are retained. If, conversely, the primary purpose is to select those more amenable lo treatment, we must then ask, “treatment to what end?” The judge and the public at large would answer that the aim of treatment is to pro

vent the repetition of socially unacceptable sexual behavior. If we accept this definition, then the sexual psychopathy laws should exclude most of the confirmed homosexuals as untreatable. However, on the whole, clinicians define the aim of treatment as simply making at possible for the person to return to society and function without serious trouble. From this point of view, the confirmed homosexual need not be “cured,” as the judge or layman would probably desire, but instead can be taught how to live without offending others and how to avoid undue risks. If we now restate the question and ask whether the sexual psychopathy laws are useful in sifting out persons who can best be treated and returned to society, we can answer that this appears to be true in California and could be true in other jurisdictions.

In summary, the concept of sexual psychopathy is vague and probably invalid from a psychiatric and scientific viewpoint, but has a certain practical utility in sorting out those patients who are more likely to benefit from treatment.

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Among our six comparative sex-offense types from roughly three quarters to one half of the sexual psychopaths and other offenders had some gambling experience. In five of these six groups the sexual psychopaths had fewer individuals with such experience, the differences ranging from three to 23 percentage points. Only among the aggressors vs. adults did the sexual psychopaths exceed their nonpsychopath counterparts in the proportion with gambling experience.

From 7 to 29 per cent of the sexual psychopaths and other offenders had used, at least once, some drugs or marijuana. In five of the six sex-offense types the proportion of sexual psychopaths was smaller, the difference between their figures and those of the other offenders being seven to 12 percentage points. The exception was the incest offenders wherein the proportion of sexual psychopaths with drug experience was substantially increased by an unexpectedly large number of marijuana smokers.

A tabulation of whether or not a person ever drank alcoholic beverages did not differentiate sexual psychopaths from other offenders, but a subdivision based on the degree of alcohol use proved very illuminating. The sexual psychopaths were far more moderate in their alcoholic consumption than were the other offenders. In all but one of our comparisons they had substantially larger proportions of men who used alcohol very little or rarely, and substantially smaller proportions of alcoholics. For example, the sexual psychopaths had from 7 to 18 per cent of their number rated as having been alcoholic, whereas the range for the other offenders was 20 to 33 per cent. In the individual comparisons the differences were from eight to 25 percentage points.

This lesser use of alcohol by the sexual psychopaths is certainly to some unknown degree the result of the clinicians’ using amenability to therapy as a criterion in determining who shall be called a sexual psychopath. Because heavy drinking and particularly chronic alcoholism create such an unfavorable prognosis there appears to have been a tendency to eliminate such men from the initial step in the sexual psychopathy procedure (i.e., asking for an examination). Even if an alcoholic were caught up in the sexual psychopathy procedure, there was again a tendency to regard him as untreatable and hence not diagnose him as a sexual psychopath.

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Whether or not the organisms that cause proctocolitis, proctitis, and enteritis are acquired sexually, the symptoms are usually those of a gastrointestinal illness. How much time elapses between initial infection and the appearance of symptoms depends on which infection is present. Although abdominal pain and rectal discharge are common, the specific symptoms depend on which area of the gastrointestinal tract is involved.

The symptoms of proctitis include pain in the anal area, a mucous discharge from the anal area, constipation, and feeling an urgent need to have a bowel movement without being able to do so, despite straining. Blood may be noticed in the stool or when wiping after a bowel movement. If the proctitis is caused by herpes or syphilis, then lesions may be present. Infections such as chlamydia and gonorrhea usually produce far fewer symptoms in men when they are present in the rectum than when they are present in the urethra.

The symptoms of proctocolitis are generally the same as for proctitis, with the addition of diarrhea and abdominal pain. Less often, proctitis and proctocolitis are symptom free.

The symptoms of enteritis include diarrhea and cramping or pain in the abdominal area, often in the lower left abdomen. Nausea and bloating often accompany these symptoms. The diarrhea may be bloody, depending on which organism has caused the infection, and there may also be a mucous rectal discharge. Other possible symptoms include fever, chills, and malaise (a generalized sense of not feeling well). Significant weight loss can result if food is not absorbed well because of inflammation in the bowel.

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A woman who is infected with herpes before pregnancy has antibodies in her bloodstream, which are the body’s immune response to infection and offer protection against new herpes infection. These antibodies (and the immunity they convey) are transmitted to the fetus in the womb, so there is a low risk of the fetus becoming infected in the womb if the mother had herpes before she became pregnant. The greatest risk of infection in this situation occurs during delivery, when the newborn may be exposed to a large quantity of virus, especially if the woman is experiencing an outbreak. If a woman with herpes is having an outbreak at the time of delivery, then a cesarean section is recommended to prevent the passage of the baby through the infected birth canal. (Rarely, babies born by cesarean section are nevertheless infected with HSy probably because they were infected in the womb or during premature rupture of the membranes.) If the mother is not having an outbreak, there is a very small chance (0.35-1.4%) that she will be shedding virus through the birth canal at delivery; if she is shedding, there is a small chance (probably less than 1%) that the child will become infected. So, for women who have herpes and who give birth vaginally the overall risk is less than 1 percent that the baby will become infected.

The decision whether or not to perform a cesarean section is an individual one, and it must be discussed with one’s health care provider. Cesarean sections are not routinely performed on all pregnant women with herpes, since this procedure is not in itself without risk, and the risk of transmission to the baby when there is not an outbreak is very low. A woman who knows she has herpes can prepare for this decision well in advance.

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For both men and women, antifungal medications provide dependable treatment for yeast infections. Men usually have success with over-the-counter creams applied to the affected area twice a day for two weeks. Treatment with antifungal medication is recommended only for a woman with symptoms, and then only for a woman who has been diagnosed with yeast infection in the past and is certain that yeast is again the cause of her symptoms. For women, there is no reason to treat yeast colonization if it is not causing symptoms.

Many antifungal creams are available without a prescription, and most of them are well tolerated, except for the rare allergic reaction. Since all over-the-counter creams are equally effective (they cure infection 80-90 percent of the time), using the least expensive cream seems to make sense. Butoconazole, clotrimazole, miconazole, and tioconazole are some of the most frequently used medications; they are applied at night, some as a single dose, some for three days, and some for a week.

Women can use either creams, which are inserted into the vagina with an applicator packaged with the cream, or vaginal suppositories, which are pills that are inserted into the vagina. When using a cream, for best results the medication should be rubbed on the vulva (the outside of the genitals) as well as inserted into the vagina. For women with a history of difficult, recurrent yeast infections, the longer, seven-day course is a better option from the start. Some women experience irritation from the frequent use of the treatments themselves, and in this case an alternative treatment (see the next paragraph) should be used. Because the creams are oil based, they may weaken latex condoms and diaphragms.

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Having said that, it’s important to repeat that every STD is different and can be transmitted in different ways.

This is important for couples who know that one of them has an STD, or who suspect that an STD may have been transmitted from one of them to the other. It will help explain how they can protect themselves or how transmission may have taken place.

Finally, unprotected sex is not unsafe for a couple who are mutually faithful, have tested negative for all of the STDs, and are beyond any waiting periods that are necessary for a positive test for infection to show up, as long as neither of them has other risk factors for infection (such as a recent exposure to infected material by a health care worker, or intravenous drug use).

Before turning to the more general guidelines, I list the practices that we know are absolutely unsafe if you are having sex with a partner whose status for infections you don’t know:

— Receiving vaginal sex without a condom

— Giving vaginal sex without a condom

— Giving oral sex without a condom or barrier

— Receiving oral sex without a condom or barrier

— Receiving anal intercourse without a condom

— Giving anal intercourse without a condom

— Oral-anal contact (rimming) without a barrier

— Contact with your partner’s blood

The following practices are possibly unsafe and should be avoided with a partner whose status for infections you don’t know:

— Hand contact with your partner’s genital or anal area without a glove

— Sharing sex toys without cleaning them or using a new condom on the toy

In the following list of possibly safe, or safer, practices, the first five are unsafe if the condom or barrier breaks. Even with the condom intact, some STDs, such as herpes, may be transmitted. In the first three examples, condoms or barriers must be used for the entire contact, since pre-ejaculate (the small amount of fluid released prior to ejaculation) can transmit infection. Wet kissing is possibly safe if neither person has bleeding gums or other open sores in the mouth.

—Anal intercourse (giving or receiving) with a condom —Vaginal intercourse (giving or receiving) with a condom

— Oral sex with a condom or barrier

— Oral-anal contact with a barrier

— Sharing sex toys with a barrier —Wet (French) kissing

Finally, practices that we know are safe are the following:

— Masturbation in each other’s presence (touching your genitals, nor your partner’s)

— Sensual massage

— Dry kissing

— Hugging

— Fantasizing together

— Rubbing clothed bodies together (without genital to genital contact)

— Bathing together (without contact with a potentially infected area of a partner)

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One reason so many cases of prostate cancer are not caught early is obvious: Too many men don’t get regular physicals that include a digital rectal examination (DRE), the first step in diagnosis, when a doctor feels for a knot, lump, or anything abnormal that might be a tumor. (In men with cancer, the doctor uses the rectal exam to learn as much as possible about the cancer—does it encompass part of one lobe, one entire lobe, or both lobes of the prostate? Has the cancer spread outside the prostate, into the pelvic side wall or the seminal vesicles?)

But even for those who do get checked yearly, the digital rectal exam is not an ironclad guarantee that cancer will be found in time. As many as 40 percent of all prostate cancers begin their growth in an inopportune spot, at a point where a doctor’s finger simply can’t reach. Therefore, many patients have advanced disease by the time it is diagnosed with a digital rectal exam. Also, the digital rectal exam is only as good as the doctor performing it; it is a subjective test.

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