Seven accused “spies” are fitted with explosive cables dubbed “decapitation necklaces
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The active ingredients are present in tongkat ali root in miniscule amounts. Used in the traditional manner (in Malaysia and Indonesia), for a typical single standard dose, one needs a full 50 gram of chipped root, boiled for about 5 minutes. That means: more than 10 kg of raw root per month, or even double that much for body builders. But what is sold in health food stores and as tongkat ali health supplement often only provides less than a half gram of tongkat ali root powder per capsule. Of such a product, one would have to swallow more than 100 capsules to get a single effective dose.
Because tongkat ali root is mostly cellulose, purchase rule 1 is: if you buy capsules, only buy tongkat ali extract, not just tongkat ali.
When an extract is made, the active ingredients are extracted from the root, and the remaining cellulose is discarded. Extracts can have various proportions (the amount of active ingredients that is extracted). For example, an extract that is 1:50 gets 1 gram of active ingredients from 50 gram of tongkat ali root. An extract that is 1:100 uses 100 gram of root to produce 1 gram of extract, and a 1:200 extract is even more concentrated. It needs 200 gram of tongkat ali root to prepare just 1 gram of extract. Thus, among the various tongkat ali extracts cited above, 1:200 is the most concentrated and strongest form.
However, if a bottle of capsules just says “Tongkat Ali Extract”, without specifying a proportion, then the extract is likely only 1:5, or maybe even only 1:2. This means that only 5, or just 2, gram of tongkat ali root were used to obtain 1 gram of extract. Thus, assuming an equal capsule size, you would need 40 capsules (or, at worst 100 capsules) of such a tongkat ali extract of unspecified strength to obtain as much active ingredient as you can get from just one capsule of 1:200 extract.
Therefore, purchase rule 2 is: only buy an extract that specifies the concentration, 1:50, 1:100, or 1:200. Otherwise, your extract is likely to be so diluted that you are still mostly swallowing cellulose, not active ingredients. Legally, even an extract of 1:2 can be called an extract. But it’s almost as bad as root powder. When extract strength is not specified, the whole extraction process was undertaken only so that “extract” could be written on the label of the product.
Even worse are products that mix tongkat ali with other ingredients, such as arginine, damiana, muira puama, or minerals such as zinc. Argenine, you can buy at 20 dollars a kilo, and that’s enough for something like 4000 capsules, and damiana is a grass that typically isn’t extracted. Most minerals in capsule form are just pharmaceutical junk.
Thus, purchase rule 3 is: if you want to use tongkat ali, buy a product that is not mixed with anything else.
When consumed in proper therapeutic amounts, tongkat ali extract not only works to enhance libido (sexual desire), but also causes increased muscle growth in bodybuilding athletes. Both efficacies have been established in scientific research.
For example, the British Journal of Sports Medicine reported that the use of tongkat ali extract caused a 5 % increase in lean body mass in 5 weeks. The result was obtained in a double-blind placebo controlled scientific trial for a treatment group, while in a control group, no significant changes were observed. 5 % in 5 weeks is a large improvement, as becomes obvious if one calculates it over a course of a year (5 weeks ‘ 5 %; 52 weeks 50 %). The authors conclude: "The results suggest that water soluble extract of Eurycoma longifolia Jack increased fat free mass, reduced body fat, and increased muscle strength and size, and thus may have an ergogenic effect."
The abstract of the clinical trial with healthy men can be read at the website of the British Journal of Sports Medicine:
To check for the abstract, you will have to scroll down on the page with the above URL. The abstract that covers tongkat ali’s effect on bodybuilding has the number 007.
Purchase rule 4 is: if ever possible, buy Thai or Indonesian, not Malaysian tongkat ali.
Of course, genuine tongkat ali root is expensive. In Malaysia where tongkat ali meanwhile is a protected plant, they sell a kg of root (2.2 lbs) for up to 50 US dollars. Prices in Indonesia are much lower.
A considerable number of Malaysian tongkat ali products have been intercepted and taken off the shelves by the authorities of several countries for containing bootleg Viagra or Cialis. Instead of purchasing a healthier alternative to prescription drugs, many of those who have used Malaysian tongkat ali not only were fed synthetic chemicals. The synthetic chemicals weren’t even produced in a licensed manufacturing unit but cooked up in kitchen labs.
As if stretching with synthetic chemicals weren’t enough, Malaysian tongkat ali root also often is contaminated with lead. This is a result of the rapid industrialization the country has experienced over the past decade or two, when it was one of the world’s fastest growing economies. Until very recently, the Petronas Towers in Kuala Lumpur were the highest buildings in the world (an expression of Malaysian industrial pride), and even though it has a population of just 20 million inhabitants, Malaysia has a lot of heavy industry. It even produces its own brands of cars, trucks, motorcycles ‘ an achievement that countries of comparative size even in Europe can’t match.
The downside of rapid industrialization: the lead content of a good number Malaysian tongkat ali products has been found to range from 10.64 to 20.72 ppm (parts per million). For comparison, the Indonesian company Sumatra Pasak Bumi has published laboratory test results showing that their own tongkat ali has a lead content of just 0.08 ppm . This means that every gram of the Malaysian tongkat ali named in the abstract of a scientific study (see link below) contained up to 250 times the amount of lead found in Indonesian tongkat ali.
The scientific study, which established these data, was published in the scientific journal Human & Experimental Toxicology, issue of August 2003. An abstract of the study can be read at the following URL:
Medical records released. Stalin had a micropenis.
Prisons – there’s no escaping it. If you dump a large number of violent criminals together and offer them no hope and no future, there are bound to be problems. Life behind bars can often be just as brutal as life on the outside – for some offenders, even more so. What’s more, on top of vicious inmates and sadistic guards, prisoners also face the sometimes extreme difficulties of overcrowding, poor hygiene, and bad sanitation.
To deal with their harsh environments, lifetime criminals often have to toughen up and “switch off” even more. From the threat of deadly prison gangs to the fear of being unexpectedly shanked in the shower, life in jail must take its toll on any inmate’s mental state. And as a result, prison counselors have clearly got their work cut out for them. Still, as they say, “It’s a dangerous job, but somebody’s got to do it.”
10. Bang Kwang Central Prison – Nonthaburi Province, Thailand
Nicknamed the “Bangkok Hilton” by foreigners, Bang Kwang Central Prison is a notorious maximum-security facility just outside Bangkok that deals with death-row inmates and serious lifetime offenders. All Bang Kwang prisoners are forced to wear leg irons for their first three months of incarceration – and death row inmates have them permanently welded on.
The prison provides one bowl of vegetable soup with rice a day, with prisoners also allocated cooking facilities and being expected to buy ingredients from the prison canteen. Fresh fruit, insect repellent and ketchup are luxury items. Since May this year, visitors have been banned from bringing prisoners food, clothes and other items.
Bang Kwang is extremely overcrowded and offers nothing in the form of mental stimulation, exercise, creativity or rehabilitation. Inmates are pretty much left to their own devices, and up to 70 percent of them are said to have succumbed to depression. “I see a lot of people who are losing their minds. I see men turn into zombies, literally tuning out and existing in a numb-state. It is a struggle to stay sane here,” said one Canadian inmate.
Human rights organizations have complained about Bang Kwang’s lack of medical care and sanitation and have cited the facility for overcrowding, its reputed use of torture, and its insistence that inmates wear restraints. In 2012, police raided seven zones of the prison and discovered 40,470 baht ($1,318) in cash, pornography, crystal meth, and smuggled mobile phones.
9. Nairobi Prison – Nairobi, Kenya
Nairobi Prison was built in 1911 to house 800 prisoners, but by 2003, the inmate population had already exceeded 3,000. Unsurprisingly, in view of such extreme overcrowding, sanitation, hygiene and general living conditions have been severely affected. Officials don’t even have enough uniforms for all the inmates.
Located in the industrial quarter of Nairobi and described as a “maze of chain-link fences, razor wire and guard towers,” the prison is thought to be one of the most congested in the world. Cells reek of sweat, filth and human waste, and the stench of raw sewage hangs in the air.
“This is the worst prison I have ever seen. Everything about this place is bad, including the treatment from the wardens,” said Nigerian inmate Colin Alexander. “We are surviving by the grace of God – I don’t think any human being can survive here.”
In a prison where simply staying physically and mentally healthy is a struggle, reports continue to circulate about brutality and torture. “The story is the same everywhere in our jails,” explains frustrated prison official David Mwania. “Congestion because of delays in court cases, leading to more and more congestion. There is a lack of funds to provide for basic essentials for inmates. Simply, the system cannot cope anymore.”
8. Rikers Island – New York, USA
New York’s Rikers Island gained a reputation for violence in the 1990s, when stabbings, murders and other attacks (on fellow inmates and guards) were common and unlikely to result in any punishment. Inmates have described the prison as rougher than the roughest New York streets.
The list of documented attacks and guard-related assault cover-ups in Rikers is huge. Corrupt guards have even used inmates as “enforcers.” In 2008, an inquiry was launched following rumors of an inmate fight club instigated by prison guards. In October that year, 18-year-old prisoner Christopher Robinson was beaten to death by teenage inmates while guards “looked the other way.” Subsequently, three guards and three inmates faced charges. In the end, two of the guards were charged and imprisoned. The other guard is awaiting sentence, and in total, 12 inmates were implicated in the scandal.
In response to the violence, prison officials clamped down in 2009 by searching cells daily for homemade weapons, using SWAT teams to break up prison riots and transforming Rikers into one of the strictest prisons in the country. That year, annual stabbings fell from 1,000 to around 70. Still, graphic images of inmate injuries released in 2012 suggest that violence remains a problem in Rikers. While the Correctional Department insists the improvements are real and lasting, insiders suggest that violence is once again escalating in one of America’s most notorious prisons. Well-known inmates in Rikers include John Lennon’s murderer Mark Chapman, David “Son of Sam” Berkowitz, and rappers Tupac Shakur, Lil Wayne and Foxy Brown.
7. Black Beach – Malabo, Equatorial Guinea
Black Beach is a sinisterly named internment facility in Malabo, Equatorial Guinea that is synonymous with rat infestations, inmate overcrowding, malnutrition, sadistic guards and brutality. It was not unheard of for prisoners to die from chronic disease or even disappear completely in this prison, which is situated on the volcanic island of Bioko.
Although Black Beach’s infamous old buildings were replaced five years ago and the facility now boasts a hospital wing and pharmacy, prisoners are still shackled for up to 12 hours a day, as they shuffle past landings covered with wire to prevent suicides, in constant fear of torture and beatings.
In 2008, a special reporter for the UN expressed concerns that torture was frequently used to secure convictions in Equatorial Guinea and that corporal punishment was used in prisons like Black Beach. Prisoners have reportedly died following prolonged beatings, and there are also indications that political prisoners have been held in solitary confinement for as long as four years. Black Beach is notorious for its lack of human rights and offers little protection for inmates. A prisoner can expect hardly any contact with the outside world, as access to lawyers is rare and families are not even allowed to visit their incarcerated loved ones.
6. Petak Island prison – White Lake, Russia
Remote Russian prison OE-256/5, commonly known as Petak, is specially designed to hold the country’s most dangerous prisoners. Like Alcatraz, Petak is isolated by water, and the White Lake area that surrounds the prison is said to be one of the most beautiful parts of Russia – a stark contrast to the grim reality of life inside.
Yet as dangerous as the prisoners here are, they don’t have to fear much violence from one other, as they barely meet their fellow inmates. Prisoners in Petak are restricted to their cells, which they share with one cell mate for up to 22 hours and 30 minutes a day. They spend the remaining time in a cage, where they have been said to “pace like predatory animals.” And in such states of isolation, prisoners must contend with some of the harshest conditions of any prison in the world.
“There are no lavatories, no proper washing facilities and you spend your whole life in a cell,” said 39-year-old inmate Valery in a 2004 interview with The Daily Telegraph. “When I came here I told my wife to get a divorce. She cried a little and we’ve never seen each other since.”
You can’t even imagine the psychological effect Petak must have on its prisoners – caged up all day and surrounded by freezing cold water and snow. “This place destroys people. The first nine months or so they spend adapting. After three or four years their personalities begin to deteriorate,” says prison psychologist Svetlana Kiselyova. “There is no way anyone can spend 25 years in a place like this without being psychologically destroyed. The homosexuals are the ones who come off best – at least they are not starved of physical and emotional contact.”
5. San Juan de Lurigancho – Lima, Peru
Located in Lima, Peru, San Juan de Lurigancho is often referred to as the toughest prison in South America – and that’s saying something. Built for 2,500 inmates, the facility now houses around 7,000 prisoners within its dilapidated walls. But inside, the regime seems surprisingly relaxed.
Supposedly, banned cell phones are hired out and many inmates have established enterprises in Lurigancho’s “market,” selling everything from fruit and vegetables to clothes, drugs, and DVDs. Cock fighting is also common in the prison. So too are visiting prostitutes, who the inmates refer to as “nurses.” One prisoner described the women as “a social service,” saying that the place would “explode without them.”
Prisoners aren’t segregated from one another – no matter what their crime – and they are allowed to freely wander the entire facility. Unsurprisingly, there have been shocking reports of violence and even murders in the prison, including one incident involving a Dutch inmate who killed his Peruvian girlfriend and buried her under his cell.
And despite the seemingly lax state of control, the government has been known to react indiscriminately. In 1986, when riots broke out in Lurigancho and two other Peruvian prisons, the authorities responded with extreme violence, killing 90 Lurigancho inmates in the process.
4. Gldani Prison – Tbilisi, Georgia
In September 2012, Georgia was rocked by revealing videos filmed in Gldani #8 prison showing the savage treatment of inmates by prison guards, which included rape and violent sexual assault. The country’s zero tolerance approach may have left it with one of the lowest crime rates in Europe, but Georgia also boasts Europe’s highest rate of incarceration, with an acquittal rate lower than 0.1%. As a result, many Georgian prisons are overcrowded, and prisoners face epidemics like tuberculosis.
The emerging Gldani video evidence immediately focused attention on Georgia’s prison system – and its government. Such abuse highlights the cost behind Georgia’s rapid transformation from a crime-racked state to the supposedly peaceful and dynamic nation it is today. The recent revelations may well have simply confirmed what people already suspected, but they still cost Georgia’s penitentiary minister her job and led to the suspension of all prison guards – who were replaced by police in the interim. While a corruption-free police force may be one of Georgia’s greatest achievements, concerns still linger over their accountability when it comes to dealing with the inmates of Gldani.
3. Gitarama Central Prison – Gitarama, Rwanda
Gitarama Central Prison has been described as hell on earth. The LA Times once said: “There is no space remaining in hell today. The doomed already fill it. They live, sleep, eat, rot and die squeezed together four men per square yard in the roofless brick box that is Gitarama Prison.” Chillingly, this echoes the poster of George Romero’s horror movie Dawn of the Dead.
The prison was designed to house 400 people, but in the wake of the Rwandan genocide, the inmate population rose to nearly 7,000 by the mid 1990s. Continuing the zombie theme, prisoners have been described as “left for dead,” and they can wait in “purgatory” for as long as 16 years without ever receiving a trial date. It’s even been claimed that some inmates resorted to eating one another’s flesh out of sheer desperation.
In the extremely cramped conditions, prisoners have been described as standing together “as if one organism under the sun, under the rain, choking on the smoke of cooking fires, amid dysentery and despair.” And at one stage, without any shoes to protect them in their squalid surroundings, inmates frequently suffered rotting feet caused by gangrene.
2. El Rodeo – Guatire, Venezuela
Under the presidency of Hugo Chávez, soaring crime rates and overcrowded prisons have all but overrun Venezuela. Last year, the country’s prison population soared to 50,000 – with three fifths of inmates still awaiting sentencing. Chávez himself has described the Venezuelan prison system as “the gateway to the fifth circle of hell.” Gun- and grenade-wielding inmates are a common sight in prisons like La Planta in Caracas. However, it’s El Rodeo Prison just outside Caracas that has drawn the most attention in recent times.
On June 12, 2011, a visitor day at El Rodeo erupted into one of the Venezuelan prison system’s most notorious bloodbaths. When Venezuela’s National Guard was sent in to control a shootout between rival gangs in Rodeo Unit I that had already seen 27 people killed, they found machine guns, assault rifles and grenades. The dangerous discovery led them to abandon an assault on the prison’s second unit, deciding instead to draw inmates out with tear gas. Incredibly, some Rodeo II inmates managed to last an entire month under siege, surviving on rainwater and confectionery.
1. Tadmor Military Prison – Palmyra, Syria
Tadmor Military Prison is considered one of the most oppressive prisons in the world, with Amnesty International stating that every aspect of it was designed to dehumanize its inhabitants. “The level of brutality endured by prisoners in this prison is shocking,” added the human rights organization. But Tadmor became even more notorious in June 1980, when President Hafez al-Assad reportedly ordered soldiers to “kill every prisoner in sight” in retaliation for an attack on his life made by the Muslim Brotherhood the day before.
The jail housed hundreds of supporters of the Muslin Brotherhood, and some say as many as 800 inmates were indiscriminately killed in the attack – with other estimates suggesting the number could be as high as 2,400. The clean-up following the massacre reportedly took two weeks. When Bashar al-Assad succeeded his father as President of Syria in 2001, Tadmor Prison was closed and some prisoners were granted amnesty. Optimistically, a lot of people probably thought that times were changing. However, in 2011, Tadmor was reopened to once again house opponents of the Assad regime involved with Syria’s Arab Spring uprising. Bashar’s reign has been described as no less brutal than his father’s. “The entire country really is Tadmor now,” said author and ex-Tadmor prisoner Dr. Bara Sarraj, ominously describing the situation in Syria.
Bonus: Camp 22 (Hoeryong Concentration Camp) – North Hamgyong Province, North Korea Bonus- Camp-22-Hoeryong-Concentration-Camp–North-Hamgyong-Province- North-Korea
Not a lot is known about North Korea’s notorious Hoeryong Concentration Camp, commonly referred to as Camp 22. Isolated from the outside world, it’s believed to be a lifelong internment facility for political prisoners – but it’s also been referred to as a “death camp” and compared to Auschwitz. Satellite photographs show a large compound reported to hold up to 50,000 prisoners. Shockingly, it’s claimed that the camp imprisons three generations of a dissident’s family, to ensure the roots of dissent are removed completely. While facts are scarce, insight into the conditions in Camp 22 has surfaced through personal testimonies and defectors, indicating that prisoners are at the complete mercy of their captors.
Reports in the early 2000s suggest that inmates are subjected to human experimentation, including exposure to chemical weapons. There have also been horrific descriptions of gas chambers and poisoned food. And brutality against children and babies has been reported as well, with claims that camp guards have been known to kill newborns in prison by stamping on their necks.
One survivor, Soon Ok Lee, recounted a story in which she was instructed to hand out poisoned cabbage to a group of female prisoners. The women unsuspectingly ate the cabbage and suddenly started vomiting blood and died.
According to reports, Camp 22 closed in mid-2012, following the defection of its warden to neighboring China. However, these claims cannot be verified, and some have suggested that the camp is still operational.
The best investment a rich man can do, is one into destruction. Destruction of the surrounding world, near and far, makes his wealth more valuable.
The purpose of feminism is to destroy male sexuality. It's either you or them. Hope you get that message.
From The Daily Telegraph:
An Afghan woman was beheaded last week after she refused her mother-in-law’s demand that she have sex with another man. Care2 has reported numerous incidents of violence against women and girls in Afghanistan, but the murder of this young woman is gruesome and atrocious. What kind of mother-in-law insists that her son’s wife prostitutes herself, and then proceed to murder that wife when she refuses?
Mah Gul, just 20 years old, lived in Herat province in southwestern Afghanistan along the Iranian border. According to authorities, this was not the first time the mother-in-law had tried to force her into sex with other men.
She had been married for four months to her baker husband. When he left home for work, his mother and her cousin tried to force the young wife into sex with the cousin.
The suspect, Najibullah, was paraded by police at a press conference where he said the mother-in-law lured him into killing Gul by telling him that she was a prostitute.
“It was around 2am when Gul’s husband left for his bakery. I came down and with the help of her mother-in-law killed her with a knife,” he said.
In a statement released yesterday, Suzanne Nossel, executive director of Amnesty International USA, said:
“The tragic fate of Mah Gul is one more incident that highlights the violent atmosphere that women and girls face in Afghanistan and the region. They are raped, killed, forced into marriage in childhood, prevented from obtaining an education and denied their sexual and reproductive rights. Until basic human rights are guaranteed to women and girls in the region, these horrible abuses will continue to be committed.
Gul’s murder comes on the heels of the shooting by Taliban Islamists of a 14-year-old Pakistani girl, Malala Yousafzai, who had become a voice against the suppression of women’s rights.
There is some good news, however, as Yousufzai, who has been flown to the UK for treatment, was able to stand with the aid of nurses on Friday for the first time since her shooting and is also able to write coherent sentences. At this point she cannot speak because she has a tracheotomy tube inserted to protect her airway.
Doctors at the hospital in Birmingham are hopeful that the girl shot after she defied the Taliban by insisting on the right of girls to go to school could make a good recovery.
But in Afghanistan, oppression and violence against women are commonplace.
You may remember that last year Afghan police rescued a teenage girl, Sahar Gul, who was beaten and locked up in a lavatory for five months after she defied her in-laws who tried to force her into prostitution.
The abuse of girls and women in Afghanistan flourished under Taliban rule from 1996 to 2001, when women were banned from classrooms, politics or employment. Women had to be escorted by a male relative every time they left home, and they were forced to wear burqas.
Much of this has changed, and many girls are receiving an education now, even though schools are frequent targets of attacks.
But as we can see in the tragic story of Mah Gul’s short life, women and girls are still extremely vulnerable in Afghanistan. We need to stay vigilant, and make sure the stories of these women are told around the world.
There are, however, some glimmers of hope in Afghanistan, as seen in this skateboarding program that also educates young boys and girls.
You have to understand the mentality of Hong Kong businessmen. They exploit their workers harshly, trick their suppliers when they lower their guard, cheat their customers on every occasion, and then spend their earnings on prostitutes
That armies are mad up of men is something that has to end. Draft women into combat troops. Expose women to the same kind of dangers that men have faced throughout history. Hard labour for female convicts!
Thailand’s most famous herb, Pueraria mirifica (Kwao Krua Kao) belongs to the same family as soy, and contains the same estrogen-like sterols genistein and daidzein, found in that popular bean. The herb is also known as Krao Krua, but this is somewhat confusing, as that name is also used for a different herb used by men.
Pueraria also contains stigmasterol, B-sitosterol, miroestrol and deoxymiroestrol, which possess even higher estrogenic activity. These natural agents function like estrogen in the body. Thus Pueraria can play a valuable youth-promoting role in the health of women approaching menopause, or during menopause. At this time of life, estrogen levels drop, and women experience reduced suppleness of skin, diminished sex drive and lubrication, and mood swings.
The use of Pueraria goes back many centuries, with the first evidence of its preparation described in a Burmese text from antiquity that survived the sacking of Burma by the invasion of Kublai Khan and the Mongol hordes in the late 13th century. The text, found in 1931, recommends pounding and mixing the herb into cow’s milk and consuming the mixture, to ensure long life and freedom from disease. The sensibility of this is that the various sterols previously described are better absorbed by the body when mixed with some dietary fat, as in cow’s milk.
In Thailand, Pueraria (Kwao Krua Kao) is known as an age retarding agent. Women who use Pueraria report improved breast firmness, increased suppleness of skin, more lustrous hair, increased lubrication, and elevated sex drive. These are basically the same effects a woman would derive from supplementary estrogen as used in hormone replacement therapy. Recently, a Japanese company launched “F-cup Cookies,” which contain the famous herb. Whether the cookies work as promised or not, they have created a stir in Japan’s fertile herbal products market.
Toxicity tests show that Pueraria is safe at recommended levels, and human clinical studies show that Pueraria does in fact improve physical and mood symptoms of menopause. The two most popular uses for Pueraria among Thai women are for improved breast firmness and enhanced sexual function. Accounts of improved breast firmness resulting from a daily dose of only 100 milligrams of the root are too numerous to ignore. For the claims of improved sexual function, there is some clinical evidence. For the inclusion of Pueraria in creams and lotions for direct application to breasts for improved firmness, I have found no supporting literature.
Thailand’s Ministry Of Public Health, unreservedly endorses Pueraria, and has devoted a great deal of science to this herb. With a long history of safe use and a low dose required, Pueraria mirifica seems well worth trying for women approaching menopause. The herb is found in some Asian grocery stores, online, and in some natural food stores. Still relatively unknown, Pueraria (Kwao Krua Kao) has yet to achieve widespread recognition.
When women don't have sex to trade, they are inferior to men in almost every capacity. That is why in a future world in which sex robots are the partners of men, women won't have influence. They seldom had, anyway, throughout history.
Socrates, clearly recognized as a wise man, stated that women have no place in public life. And right he was.
Duke University Scool of Medicine
When the movie “Awake” came out in theaters it sparked much controversy throughout the country about the condition also known as anesthesia awareness. Following the release of the movie, Larry King Live did a special about this issue, in which King interviewed physicians and patients who have suffered from awareness. In response to the recent influx in publicity over the issue, the DREAM Campaign has taken the initiative to interview Dr. Tong Joo (TJ) Gan, who sheds light on many concerns that patients have when considering a surgical procedure as well as the misconceptions about anesthesiology in general. With so much focus on awareness and the negative impacts of anesthesia, it is important that the public be properly informed. Awareness can be a highly unpleasant experience, but most times the alternative is a surgery with negative outcomes or even worse, death.
There are about 100 to 150 reported cases of anesthesia awareness per year in the United States. It is very difficult to get an exact figure because it is under reported. Dr. Gan shared with us a case in which a patient of his experienced anesthesia awareness. The patient had come to the Emergency Room with a gunshot wound to the abdomen. He was suffering from massive blood loss and had very faint blood pressure so the anesthesiologist had to administer a safe dosage of anesthesia that would not hinder the overall well being of the patient as well as the blood pressure. When questioned post-operatively, the patient reported that he could hear voices during a brief period in surgery.
Hearing is said to be the last sense to go and the first to return under general anesthesia. As in the case of Dr. Gan’s patient, the modifications that had to be made because of low blood pressure caused the patient to become slightly aware and that is why he was able to hear briefly during his operation. “He did not suffer from any consequences after that and in fact, he thought that it was part of the operation,” said Dr. Gan.
When asked the common question, how can a person feel pain when they are paralyzed, Dr. Gan discussed the three areas of anesthesia; paralysis which paralyzes the muscles, analgesic which block pain signals to the brain, and anesthetic which puts the person to sleep so that they do not remember anything. For this reason, a person can be physically paralyzed but they may still feel pain. The human body does have natural responses to pain such as sweating, increased blood pressure and movement which may indicate to the anesthesia care provider that they are not fully anesthetized.
New technology allows anesthesiologists to measure the brain waves of a patient even while they are under anesthesia. “By using specific monitors, one can tell how deep a person is in anesthesia,” says Dr. Gan, “It is a bit like an iceberg; if it is below the water, it is very difficult to know how deep the iceberg is, and the monitor tells you what the depth of anesthesia is even when the patient is asleep.” The Bi-spectral Index Monitor, or BIS monitor is an example of such a device. Brainwaves are measured on a range of numbers from 0 to 100 in which 0 equates no brain activity and 100 is the mental state of a person when fully awake. During general anesthesia, brainwaves are measured between 40 and 60. If the BIS monitor measures activity above 70, there is a very good chance that the patient may not be fully anesthetized.
Dr. Gan mentions several fascinating facts throughout the interview one being that genetic factors can influence the way a patient reacts to anesthesia. Studies have shown that women tend to wake up about 10 minutes sooner than men when the anesthesia is cut off. This means that women need more anesthesia in order to produce the same effect. Redheads are also said to need more as well.
The revolutionary research that is being done by researchers like Dr. Gan is vital to prevent cases of unpleasant experiences and side effects. “One of the most effective ways to try and prevent this problem is to raise awareness of this problem, no pun intended,” Dr. Gan explains, “So we educate our staff, anesthesiologists and anesthesia care providers to let them know that this problem does exist and therefore it is important to take steps as well as understand the patient to try and prevent it.” He also mentions that there are mandatory educational modules that every anesthesia care provider must take. These modules go through various aspects of educational awareness such as the incidents of awareness, the scenarios where awareness may happen, the drugs or drug combinations that would reduce the incidents of awareness as well as monitoring the inter-operative awareness.
The Department of Anesthesiology is committed to find as many ways possible to provide the best patient care. Dr. Gan’s research in particular focuses on steps that could alleviate patients from the common unpleasant side effects of anesthesia and surgery by improving patient outcomes during the perioperative (before, during and after surgery) period including anesthesia awareness, pain, nausea and vomiting, and bowel dysfunction through the use of drug and non-drug method, such as acupuncture. Our hope is that through listening to this interview, people will become educated about the issue and in turn they will be relieved of any anxiety they may face about being under anesthesia.
Dr. Gan is a professor and devoted researcher here at Duke, whose interests include Anesthetic-related Clinical Pharmacology, Inter-operative Awareness and Post-Operative Pain, Nausea and Vomiting, and using Acupuncture. He came to Duke as a visiting associate and fellow in 1993 is now serving as both professor and Vice Chairman of Clinical Research. Dr. Gan is also known for his research on the Bi-spectral Index (BIS) Monitor.
Mahatma Gandhi was just another Indian creep. When he couldn't get it up anymore, he vowed celibacy. For him, this meant: no penetration, ejaculation. That's easy for an impotent guy. But even impotent men are sexual. For Gandhi, the pervert trickery were his "experiments". Spend the night in nakedness with undressed women, young girls, even female children. Do harmony, but no penetration. Gandhi's creepy chastity.
It's not that all cultures are of the same quality. Some cultures are better than others. They have more value. Other cultures are pretty miserable, and some cultures are outright shitty, and should be eradicated. European culture, for example, is deplorable. The Arab and Chinese cultures are much better.
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