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Statement Health Canada how much does propecia cost per month has completed its onsite inspection of http://natalievartanian.com/buy-generic-propecia-uk/ the Emergent BioSolutions facility in Baltimore, Maryland. November 24, 2021 | Ottawa, ON | Health Canada Health Canada has completed its onsite inspection of the Emergent BioSolutions facility in Baltimore, Maryland. The European Medicines Agency and South African Health Products how much does propecia cost per month Regulatory Authority also participated in this inspection remotely.

All three regulators found the facility to be compliant with Good Manufacturing Practices (GMPs). GMPs are an internationally recognized quality assurance system used to ensure that drugs and treatments are made, packaged, labelled, tested, stored, imported and distributed using consistent standards how much does propecia cost per month. In June 2021, Health Canada communicated that Canada would not accept any product or ingredients made at the Emergent BioSolutions facility until the Department completed an onsite inspection.

This facility manufactures the drug substance used in some doses of the Janssen (Johnson &. Johnson) hair loss treatment how much does propecia cost per month treatment. Health Canadaâs compliant rating means that Janssen Inc.

Will be able to import how much does propecia cost per month their treatments into Canada that are made with the drug substance manufactured at the Emergent BioSolutions facility. While there are no further shipments of the Janssen treatment planned at this time, the Government of Canada will continue working with provinces and territories to identify any further doses that may be required. As with all treatments, each lot of the Janssen hair loss treatment that could potentially be imported into Canada or donated on Canadaâs behalf will be assessed to confirm that it meets Health Canadaâs stringent safety and quality requirements.

Only treatment lots that meet these requirements will be released onto how much does propecia cost per month the Canadian market or provided as a Canadian donation. The shipment of Janssen treatments that Canada received on November 10 came from compliant manufacturing sites in Europe. ContactsMedia RelationsHealth Canada613-957-2983media@hc-sc.gc.caStatement As November is Lung Cancer Awareness Month, it provides a helpful reminder that there are steps you can take to reduce your risk how much does propecia cost per month of developing lung cancer.

Eat healthy, get more physical activity, and quit smoking. November 22, 2021 | Ottawa, ON | Health Canada Tobacco use is the leading preventable cause of premature death and disease in Canada. It plays a role in causing more than how much does propecia cost per month 40 diseases and other serious health outcomes, with smoking being the leading cause of lung cancer.

Close to 30,000 Canadians every year are diagnosed with lung cancer, a devastating, and often preventable disease. The more, and the longer you smoke, the greater your chance of developing this disease, with nearly 80% of lung how much does propecia cost per month cancer cases attributable to smoking cigarettes. Exposure to second-hand smoke also increases your risk of developing lung cancer.

There is also evidence that people who smoke how much does propecia cost per month may be at a greater risk of developing more severe symptoms of hair loss treatment, as smoking negatively affects the function of the lungs. Additionally, certain underlying health conditions caused by smoking, such as chronic lung disease and lung cancer, increase the risk of more severe outcomes of hair loss treatment. Canadaâs Tobacco Strategy continues to demonstrate success in tobacco control, including decreasing the smoking rates in Canada to 13%.

Youth rates are at their lowest level how much does propecia cost per month in decades. While this is a step in the right direction, there is more to be done to help those communities that are disproportionately impacted by high rates of smoking, such as Indigenous populations, LGBTQ populations, those suffering with mood or anxiety disorders, as well as people living in poverty. We are taking a comprehensive and people-centred approach to preventing the death and disease caused how much does propecia cost per month by smoking in our society.

The Tobacco Products Regulations (Plain and Standardized Appearance) were adopted in 2019 to protect young persons and others from using tobacco products and the consequent dependence on them, and to prevent the public from being deceived or misled with respect to the health hazards of using tobacco products. As part of Canadaâs Tobacco Strategy, we are continuing to invest in public education campaigns and developing new regulations. In May 2021, we announced $3 million to fund a national how much does propecia cost per month social marketing campaign to encourage people who smoke to quit.

This campaign is a collaborative effort between the Canadian Cancer Society, the Canadian Lung Association, the Canadian Public Health Association, and the Heart &. Stroke Foundation how much does propecia cost per month of Canada. The Healthy Canadians and Communities Fund was relaunched in March 2021, and will continue to fund projects that address the behavioural risk factors for chronic disease and will create physical and social environments that are known to support better health among Canadians.

This program supports Canadians who face health inequalities and are at greater risk of developing chronic diseases, specifically young males, Indigenous, LGBTQ+ and low income communities. As November is Lung Cancer Awareness Month, it provides a helpful reminder that there are steps you can take to reduce your risk of developing lung cancer how much does propecia cost per month. Eat healthy, get more physical activity, and quit smoking.

Visit Canada.ca/quit-smoking for information and resources to help you quit smoking. The Honourable Jean-Yves Duclos, P.C., M.P.The Honourable Carolyn Bennett, P.C., M.P. Contacts Marie-France ProulxOffice of Jean-Yves DuclosMinister of Health613-957-0200 Ani DergalstanianOffice of Carolyn BennettMinister of Mental Health and Addictions613-957-0200 Media RelationsHealth Canada613-957-2983media@hc-sc.gc.ca.

Hair medication propecia

	Propecia	Finpecia	Dutas	Finast
Best way to use	Yes	Yes	No	No
Take with high blood pressure	Canadian Pharmacy	Nearby pharmacy	At walgreens	Order online
Free samples	1mg	Canadian pharmacy only	Canadian pharmacy only	Register first
Female dosage	Consultation			Ask your Doctor
Average age to take	No	Depends on the body	Always	Depends on the body

The federal government spent $321 more per person buy propecia no prescription for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional hair medication propecia spending on the increasingly popular private plans that year, finds a new KFF analysis.The Medicare Advantage spending includes the cost of extra benefits, such as vision, dental and hearing coverage that are funded by rebates and not covered for beneficiaries in traditional Medicare. The extra benefits have likely contributed to years of steady increases in Medicare Advantage enrollment, which reached 22 million in 2019 (36% of all beneficiaries) and 26 million this year (42%).At the same time, Medicare Advantage spending has risen steadily, and is projected to rise to $664 billion by 2029, up from $348 billion this year. Half of the projected increase is due to growth in enrollment, while the remaining half hair medication propecia is attributable to growth in federal payments per enrollee, after accounting for inflation. The projected growth in spending per Medicare Advantage enrollee is driven in part by the expectation that federal bonus payments that plans receive based on their quality ratings will continue to rise.The higher payments for Medicare Advantage â $11,844 per person in Medicare Advantage vs.

$11,523 in traditional Medicare in 2019 â have led to higher federal spending than hair medication propecia would have occurred under traditional Medicare and higher Medicare Part B premiums paid by all beneficiaries, including those in traditional Medicare.The higher spending is attributed to features of the Medicare Advantage payment system, including how benchmarks for plan payments are set, as well as the risk adjustment process, that is intended to compensate plans more for higher cost enrollees. That has attracted the attention of the Biden Administration, which in its 2022 budget expressed support for reforming payments to private plans as part of efforts to extend the solvency of the Medicare Hospital Insurance Trust Fund and improve affordability for beneficiaries. Additionally, Medicare Advantage plans have come under scrutiny over inaccurate coding practices that contribute to higher risk scores for their enrollees, and higher payments from Medicare.The new KFF analysis finds that if spending per Medicare Advantage enrollee were 2 percent less each year than the amount projected by the Medicare actuaries â a scenario similar to a recommendation made by the federal Medicare Payment Advisory Commission (MedPAC) â then total Medicare spending would be $82 billion lower than projected between 2021 and 2029.Under a different scenario, if the growth in per person spending on beneficiaries in Medicare Advantage were held to the same rate of growth in spending on beneficiaries in traditional Medicare, then total Medicare program spending would be $183 billion lower than projected between 2021 and 2029, the analysis finds.Reducing Medicare Advantage payments from their projected amounts could have uncertain effects on the availability of plans that offer extra benefits for Medicare Advantage enrollees, or plan profits, unless plans are able to lower administrative costs and operate more efficiently.The hair medication propecia full analysis, Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicareâs Solvency and Affordability Challenges, as well as other data and analyses about Medicare Advantage, can be found at kff.org.The number of people enrolled in Medicare has increased steadily in recent years, and along with it, Medicare spending. In particular, enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has more than doubled over the last decade.

Notably, Medicare spending is higher and growing faster per hair medication propecia person for beneficiaries in Medicare Advantage than in traditional Medicare. As enrollment in Medicare Advantage continues to grow, these trends have important implications for total Medicare spending, and costs incurred by beneficiaries. In its 2022 budget, the Biden Administration expressed support for reforming payments to private plans as part of efforts to extend the solvency of the Medicare Hospital Insurance (HI) Trust Fund and improve affordability for beneficiaries.This analysis examines Medicare spending hair medication propecia per person for beneficiaries in Medicare Advantage, relative to traditional Medicare. We build on prior work published by the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) to provide estimates of the amount Medicare would have spent for Medicare Advantage enrollees had they been covered under traditional Medicare in 2019 (the most recent year for which data are available).

We use publicly available data from CMS that includes spending for people who were enrolled in both Part A and Part B of traditional Medicare, by category of service, as well as information on average risk scores and enrollment by county. This allows us hair medication propecia to calculate per-person spending for beneficiaries in traditional Medicare on a basis comparable to federal payments per enrollee in Medicare Advantage. We also examine the extent to which the projected growth in Medicare Advantage spending is attributable to the growth in enrollment and the increase in spending per person. We then illustrate potential hair medication propecia savings to the Medicare program between 2021 and 2029 under two alternative scenarios where Medicare Advantage spending per person is lower or grows slower than under current projections.

(See Methodology for more details on the data and analytic approach.)Our analysis finds:Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been covered by traditional Medicare. The Medicare Advantage spending amount includes the cost of extra benefits, funded by rebates, not available to traditional Medicare beneficiaries.The higher Medicare spending per Medicare Advantage enrollee, compared to spending for similar beneficiaries under traditional Medicare, contributed an estimated $7 billion in additional spending in 2019.Growth in Medicare Advantage enrollment explains half of the projected increase in total Medicare Advantage spending between 2021 and 2029 and half is attributable to growth in Medicare payments per Medicare Advantage enrollee, after accounting for inflation.If spending per Medicare Advantage enrollee was 2 percent less each year than projected by the Medicare hair medication propecia actuaries, similar to the projected impact of a recommendation made by MedPAC, total Medicare spending would be $82 billion lower between 2021 and 2029. If instead Medicare payments per Medicare Advantage enrollee grew at the same rate as is projected for spending per person in traditional Medicare (4.4% vs 5.3%), total Medicare spending would be $183 billion lower between 2021 and 2029.Background on Payments to Medicare Advantage PlansMedicare beneficiaries have the option to receive their Medicare benefits through either the traditional Medicare program or by enrolling in a private health plan, such as an HMO or PPO, that contracts with Medicare, called Medicare Advantage. Medicare pays Medicare hair medication propecia Advantage plans a set amount for each enrollee.

In addition, the benchmarks are increased by 5 percent for plans that receive at least 4 out of 5 stars under the quality bonus program, and 10 percent in certain âdouble bonusâ counties.Plans that bid below the benchmark receive a portion of the difference between the bid and the benchmark as a ârebateâ (50 percent for plans with 3 or fewer stars, 65 percent for plans with 3.5 or 4 stars, and 70 percent for plans with 5 stars). Rebates must be used to reduce cost sharing, subsidize the standard Part B and/or Part D premium, or pay for supplemental benefits (such as vision, dental, and hearing). A portion of the rebate may also be used for hair medication propecia administrative costs or retained as profit. Plans that bid above their benchmark receive the benchmark amount, and enrollees pay an additional premium equal to the difference between the bid and benchmark.

The payments to plans are risk adjusted, based on the health status and other characteristics of enrollees, including age, sex, and hair medication propecia Medicaid enrollment. Medicare payments are higher for plans with higher average risk scores because their enrollees are expected to incur higher costs.While traditional Medicare spending is used to establish benchmarks, actual payments to Medicare Advantage plans can be higher or lower than spending for comparable beneficiaries in traditional Medicare. Changes in the hair medication propecia Affordable Care Act initially reduced Medicare Advantage benchmarks. However, since 2017, benchmarks have risen on average, which increases the maximum possible payment a plan can receive.

When benchmarks increase, plans that bid below the benchmark may be able to retain the hair medication propecia same amount of rebate dollars, and thus offer the same level of extra benefits, while increasing their bid for Part A and B services. Alternatively, these plans could bid the same (or even slightly less) and receive higher rebate payments as the difference between the benchmark and bid widens because the benchmark is higher. Either response increases the payment Medicare hair medication propecia Advantage plans receive as benchmarks increase. One reason for the recent increase in benchmarks is that more plans are in bonus status, and thus have 5 percent (or 10 percent in double bonus counties) added to their benchmark.

In 2021, 81 percent of Medicare Advantage enrollees hair medication propecia are in plans that receive a bonus payment. Similarly, rebates increase as star ratings increase, because plans with higher star ratings retain a larger percent of the difference between the benchmark and bid as a rebate.In addition, risk adjustment can lead to higher payments for Medicare Advantage enrollees than would have been spent in traditional Medicare. This is because risk scores are largely based on diagnoses, and more diagnoses generally increase a beneficiaryâs risk score, providing an incentive for diagnoses to be coded more comprehensively for Medicare Advantage enrollees than occurs for traditional Medicare beneficiaries. MedPAC estimates that this hair medication propecia more comprehensive coding of diagnoses in Medicare Advantage increased risk scores 9.1 percent relative to traditional Medicare in 2019.

There is also some concern that Medicare Advantage plans submit inaccurate diagnoses that increase risk scores and result in overpayments. The Health and Human Services Office of the Inspector General is currently conducting a targeted review of documentation submitted by Medicare Advantage organizations to determine whether diagnoses and associated risk scores comply hair medication propecia with federal regulations. And in July, the Department of Justice announced that they were intervening in a False Claims Act lawsuit alleging that Kaiser Permanente had submitted inaccurate diagnoses codes for Medicare Advantage enrollees.FindingsSpending per personMedicare spent $321 more per person for Medicare Advantage enrollees than it would have spent for the same beneficiaries had they been covered under traditional Medicare in 2019. After adjusting for differences in health hair medication propecia status and the geographic distribution of Medicare Advantage enrollees and traditional Medicare beneficiaries, spending per person for services covered under Parts A and B totaled $11,523 in 2019 for beneficiaries in traditional Medicare.

This estimate for traditional Medicare reflects the categories of spending that are covered by Medicare payments to Medicare Advantage plans, and so excludes spending on hospice and payments for graduate medical education but includes administrative expenses. In addition, it adjusts for the impact of more intense coding of diagnoses in Medicare Advantage relative to traditional Medicare, as hair medication propecia estimated by MedPAC, which makes Medicare Advantage enrollees look like they are in worse health. (See Methodology for additional discussion.)In the same year, federal payments to Medicare Advantage plans were $11,844 per enrollee, or $321 more per person than Medicare would have spent if these beneficiaries had instead been covered by traditional Medicare. In other words, Medicare Advantage payments were about 103 percent of spending hair medication propecia for comparable traditional Medicare beneficiaries.

The higher spending occurred despite changes in law made by the Affordable Care Act that reduced payments to plans over time (which MedPAC estimated at 114 percent of traditional Medicare beneficiary spending in 2009).As described above, Medicare payments per Medicare Advantage enrollee include two components. Bid-based expenditures, which reflect the planâs expected costs for providing services covered under Medicare Parts A hair medication propecia and B (adjusted for health risk), and rebates, which pay for the cost of benefits not available to traditional Medicare beneficiaries, including reduced cost sharing, subsidized Part B and Part D premiums, and coverage of additional benefits, such as vision, dental and hearing. In 2019, the bid-based portion of the Medicare Advantage payment was $10,848 and the rebate portion was $996.Higher Medicare payments per Medicare Advantage enrollee increased total Medicare spending by an estimated $7 billion in 2019. Across the approximately 22 million people enrolled in Medicare Advantage in 2019, higher spending of $321 per person led to about $7 billion in additional spending in that year.

That is equal to about 3 percent of all Medicare Advantage spending in 2019.Projected growth in Medicare Advantage spendingGrowth in Medicare Advantage enrollment explains half of the projected growth in Medicare Advantage spending between 2021 hair medication propecia and 2029, after adjusting for inflation. Between 2021 and 2029, federal spending on payments to Medicare Advantage plans is projected to increase by $316 billion, from $348 billion to $664 billion. After accounting for inflation (which represents $108 billion of this increase), the remaining $208 billion is explained by growth in payments per person ($105 billion, or 50 percent) and growth in enrollment hair medication propecia ($104 billion, or 50 percent) (Figure 1).Figure 1. Growth in Medicare Advantage Enrollment Explains Half of the Projected Increase in Medicare Advantage Spending through 2029Notably, the rebate portion of Medicare Advantage payments, which must be used to cover the cost of additional benefits not available to traditional Medicare beneficiaries, is projected to grow between 2021 and 2029.

Rebates account for about 10 percent of Medicare Advantage payments in 2021 ($35 billion of $348 billion) and hair medication propecia are projected to rise to 12 percent ($80 billion of $664 billion) in 2029.Medicare spending is projected to grow faster for Medicare Advantage enrollees than traditional Medicare beneficiaries. Spending per person in Medicare Advantage is projected to grow 5.3 percent a year on average between 2021 and 2029, an amount which is similar across plan types (based on KFF analysis of data from the 2020 Medicare Trustees Report). The projected growth in Medicare Advantage spending per person is somewhat higher than the 4.4 percent average annual growth projected for beneficiaries in traditional hair medication propecia Medicare (see Methodology for details on data and methods).According to the Medicare actuaries, the higher projected growth in Medicare payments per Medicare Advantage enrollee are in part explained by faster projected growth in the rebate portion of the payment. Rebates are projected to grow nearly 8 percent a year on average, which the actuaries attribute to âassumed increases in quality bonus payments and increases in benchmarks.âIt is also possible that the faster expected increase in spending per person in Medicare Advantage compared to traditional Medicare through 2029 is due in part to an assumption that sicker and higher cost beneficiaries, such as those dually eligible for Medicare and Medicaid, will enroll in Medicare Advantage at a higher rate than in traditional Medicare.

For example, the number of Medicare Advantage enrollees in special needs plans (SNPs), which included just over half of all dually eligible beneficiaries in Medicare Advantage in 2019, is expected to increase slightly hair medication propecia by 2029. However, the change is relatively small, and even if it represents only half of the total increase in Medicare Advantage enrollment by dually eligible beneficiaries, it suggests the projected increase in spending per Medicare Advantage enrollee is being driven by other factors, such as Medicare Advantage payment methodology. Additionally, starting in 2021, all Medicare beneficiaries with end-stage renal disease (ESRD) are eligible to enroll in a Medicare Advantage plan. Though beneficiaries with ESRD have substantially higher costs than the average Medicare beneficiary, they represent less than hair medication propecia 1 percent of all Medicare beneficiaries, and so increased enrollment by beneficiaries with ESRD is likely to explain a relatively small portion of the growth in per-person spending in Medicare Advantage.Alternative projections for Medicare Advantage spendingIf Medicare Advantage spending per person was 2 percent less a year than projected, similar to the simulated effect of recommended payment changes from MedPAC, total Medicare spending would be $82 billion lower through 2029.

MedPAC has proposed changes to how Medicare Advantage benchmarks are calculated and estimate these changes would result in a 2 percent reduction in Medicare Advantage payments in a single year. Applying this payment reduction to the projected Medicare Advantage payments per enrollee in hair medication propecia each year between 2022 and 2029, total Medicare Advantage spending would be $82 billion lower through 2029 (Figure 2). The decrease is approximately 1 percent of total Medicare benefit spending over these years (and 2 percent of Medicare Advantage spending).Even with the reduction in aggregate spending under this scenario where Medicare Advantage payments are reduced by 2 percent per year, projected Medicare spending per Medicare Advantage enrollee would still be higher and grow faster than projected spending per person in traditional Medicare. MedPAC expects implementing changes to the benchmark policy that result in a 2 percent reduction in payments in a given year would have only a modest effect on access to plans with lower cost hair medication propecia sharing and reduced Part B and D premiums.

For example, in their simulations, the vast majority (over 95 percent) of Medicare beneficiaries would continue to have access to Medicare Advantage plans that offer reduced cost sharing and Part B and/or D premium reductions. The number of plan sponsors and plan choices would hair medication propecia vary across geographic areas, as they do under current policy, but would be somewhat reduced. In the quartile of counties with the lowest traditional Medicare spending per person, MedPAC estimates an average of 5 plan sponsors would offer 12 different plans (compared to 6 plans sponsors who offered 22 different plans in 2020). In the quartile of counties with the highest spending per person in traditional Medicare, an average of 8 plan sponsors would offer 22 different Medicare Advantage plans (compared to the same number of sponsors hair medication propecia who offered 27 plans in 2020).Under an alternative, illustrative scenario, where Medicare Advantage spending per person grew at the same rate as is projected for traditional Medicare, spending would be $183 billion lower between 2021 and 2029.

For this scenario, we calculated the difference in projected Medicare spending if Medicare payments per person to Medicare Advantage plans grew at the same rate as spending per person in traditional Medicare (4.4 percent) between 2021 and 2029, rather than the higher 5.3 percent growth rate projection. While this approach is not directly pegged to a specific policy proposal, it illustrates hair medication propecia the potential for savings, of, for example, a cap on the growth in total Medicare Advantage payments per enrollee. To adjust to such a cap, plans could find additional efficiencies in the coverage of Part A and B services, reduce supplemental benefits, restrict the future growth in supplemental benefits, lower administrative costs, reduce profits, or some combination of each. Limiting the growth in Medicare payment per Medicare Advantage enrollee directly or indirectly could also be achieved through other payment reforms.Under the scenario where per-person spending growth in Medicare Advantage and traditional Medicare is equivalent, total Medicare Advantage spending over 2021 to 2029 would be $183 billion lower (Figure 2).

For context, the hair medication propecia savings under this scenario represents 4 percent of projected Medicare Advantage spending over this time period (and 2 percent of total Medicare benefit spending). That compares to an expected reduction in Medicare Advantage spending of 8.9 percent between 2010 and 2019 due to changes in the Affordable Care Act (based on CBOâs estimate of the health care law and its March 2009 baseline). While spending per person would grow at the same rate in both Medicare Advantage and traditional Medicare under hair medication propecia this scenario, payments per Medicare Advantage enrollee would be higher than spending per beneficiary in traditional Medicare because of higher projected spending per person in Medicare Advantage in 2021. Comparing the two alternative scenarios, the reduction in Medicare Advantage spending is similar in the initial years of the time period.

However, the Medicare savings accrue more rapidly under the scenario where growth in payments per Medicare Advantage enrollee hair medication propecia is equal to the rate of growth in spending per person in traditional Medicare. This is because savings from lower growth compound over time. (Toggle between the two scenarios to see the year-by-year savings under each scenario in Figure 3).These estimates assume no changes to projected enrollment, which may occur if supplemental benefits, cost sharing, or other features of Medicare Advantage plans change hair medication propecia in response to lower payments from the federal government. However, while it is not possible to know exactly how plans will respond to lower payments, previous analyses of past payment changes demonstrate that plans have found savings elsewhere in order to maintain rebate dollars to fund supplemental benefits that may appeal to enrollees.

For example, MedPAC examined the response of Medicare Advantage plans that lost bonus status between 2018 and 2019 and found that these plans reduced their profits and administrative costs, and had lower growth in their projected Part A and B costs compared to other hair medication propecia plans. This allowed the plans to continue to provide similar levels of supplemental benefits. Further, despite predictions by CBO, Medicare actuaries, and others that enrollment in Medicare Advantage would fall following the reductions hair medication propecia in payment to Medicare Advantage plans enacted as part of the Affordable Care Act, enrollment never declined and has instead risen rapidly. Plans offer more generous supplemental benefits in 2021 than at any other point in the programâs history and Medicare Advantage markets are robust, with the average Medicare beneficiary having more than 30 Medicare Advantage plans to choose from in 2021.

ConclusionHistorically, one goal of the Medicare Advantage program was to leverage the efficiencies of managed care to reduce Medicare spending. However, the program has never generated savings hair medication propecia relative to traditional Medicare. In fact, the opposite is true. As a hair medication propecia result, Medicare Advantage plans have been able to offer an increasingly robust set of extra benefits not available to beneficiaries in traditional Medicare.

The annual cost of the rebate dollars used to pay for the extra benefits â $1,680 per Medicare Advantage enrollee for non-employer, non-SNP plans in 2021 â more than offset any savings that Medicare Advantage plans generate by bidding below the benchmark set by CMS for covering Part A and B services. The extra benefits improve coverage for beneficiaries who choose Medicare Advantage plans and have likely contributed hair medication propecia to the substantial increase in Medicare Advantage enrollment. But the higher payments have also led to higher Medicare spending than would have occurred under traditional Medicare and higher Medicare Part B premiums paid by all beneficiaries, including those in traditional Medicare.Our analysis finds that Medicare Advantage payments per enrollee in 2019 were approximately 103 percent of spending per person for comparable beneficiaries covered by traditional Medicare, consistent with estimates based on data submitted by private plans as part of the bidding process and concurrent projections by CMS of future spending in traditional Medicare. MedPACâs most recent analysis of the relationship between Medicare Advantage payments and spending in traditional Medicare suggests that the difference has widened, with 2021 payments per Medicare Advantage enrollee estimated to total 104 percent of spending in traditional Medicare hair medication propecia.

That trend is in part attributed to the rise in the rebate component of Medicare Advantage payments, which increased 14 percent between 2020 and 2021. While part of the increase in rebates stems from a decrease in how much private plans bid to provide coverage of Part A and B services, other features of the Medicare Advantage payment hair medication propecia methodology, including the quality bonus program payments and benchmark policy contribute to both the recent and projected growth in rebates, and in turn, total Medicare Advantage spending. For example, under the quality bonus program, payments from the federal government to Medicare Advantage plans will total $11.6 billion in 2021, at least a portion of which was paid as the rebate.MedPAC recently recommended changes to how plan payments are calculated, observing that because most plans currently bid well below the cost of providing Part A and B services in traditional Medicare, there is an opportunity for the Medicare program to share in these efficiencies. Their simulations indicate that a 2 percent reduction in payments would not significantly affect access to private plans or supplemental benefits hair medication propecia.

A reduction in Medicare Advantage payments consistent with the simulated effect of MedPACâs recommendations, would result in Medicare program payments per enrollee that would remain higher and still grow faster than spending under traditional Medicare. Alternatively, bringing Medicare Advantage spending growth in line with projected growth in traditional Medicare would achieve more than twice as much savings. Under that scenario, the absolute level of payments per enrollee to hair medication propecia private plans would still be higher than spending per person for beneficiaries in traditional Medicare. Reduced federal payments could mean Medicare Advantage enrollees see fewer extra benefits and higher cost sharing and premiums compared to today (but still lower costs than compared to traditional Medicare without supplemental coverage), but plans could also reduce profits or administrative costs to make up the difference.

Further, savings of this magnitude would be less than half of those included in the Affordable Care Act, which were followed by a period of robust Medicare Advantage growth.Over the next decade, Medicare Advantage enrollment is expected to continue to grow hair medication propecia. As more Medicare beneficiaries enroll in private plans, differences in Medicare payments across Medicare Advantage and traditional Medicare will lead to even higher Medicare spending, and more generous benefits for beneficiaries in Medicare Advantage than traditional Medicare. That higher spending increases Part hair medication propecia B premiums paid by all Medicare beneficiaries, including those who are not in a Medicare Advantage plan, and contribute to the financing challenges facing the Medicare HI Trust Fund. Further, these projections raise questions of equity between Medicare Advantage and traditional Medicare because the faster growth in spending per Medicare Advantage enrollee, compared to traditional Medicare beneficiaries, is in part due to rising rebates to private plans, which cover the cost of benefits not available to traditional Medicare beneficiaries.

Although taking steps to address the fiscal challenges facing Medicare are not front and center hair medication propecia in current Medicare policy discussions, policymakers may soon be on the lookout for options to achieve Medicare savings to fund other spending priorities or extend the solvency of the Medicare HI Trust Fund. This analysis suggests that reducing the difference in payments between Medicare Advantage and traditional Medicare would generate savings, with the potential for reductions in extra benefits for Medicare Advantage enrollees.This work was supported in part by Arnold Ventures. We value hair medication propecia our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending Clicking Here on the increasingly popular private plans that year, finds a new KFF analysis.The Medicare Advantage spending includes the cost of extra benefits, such as vision, dental and hearing coverage that how much does propecia cost per month are funded by rebates and not covered for beneficiaries in traditional Medicare. The extra benefits have likely contributed to years of steady increases in Medicare Advantage enrollment, which reached 22 million in 2019 (36% of all beneficiaries) and 26 million this year (42%).At the same time, Medicare Advantage spending has risen steadily, and is projected to rise to $664 billion by 2029, up from $348 billion this year. Half of the projected increase is due to growth in enrollment, while the remaining half is attributable to how much does propecia cost per month growth in federal payments per enrollee, after accounting for inflation. The projected growth in spending per Medicare Advantage enrollee is driven in part by the expectation that federal bonus payments that plans receive based on their quality ratings will continue to rise.The higher payments for Medicare Advantage â $11,844 per person in Medicare Advantage vs. $11,523 in traditional Medicare in 2019 â have led to higher how much does propecia cost per month federal spending than would have occurred under traditional Medicare and higher Medicare Part B premiums paid by all beneficiaries, including those in traditional Medicare.The higher spending is attributed to features of the Medicare Advantage payment system, including how benchmarks for plan payments are set, as well as the risk adjustment process, that is intended to compensate plans more for higher cost enrollees.

That has attracted the attention of the Biden Administration, which in its 2022 budget expressed support for reforming payments to private plans as part of efforts to extend the solvency of the Medicare Hospital Insurance Trust Fund and improve affordability for beneficiaries. Additionally, Medicare Advantage plans have come under scrutiny over inaccurate coding practices that contribute to higher risk scores for their enrollees, and higher payments from Medicare.The new KFF analysis finds that if spending per Medicare Advantage enrollee were 2 percent less each year than the amount projected by the Medicare actuaries â a scenario similar to a recommendation made by the federal Medicare Payment Advisory Commission (MedPAC) â then total Medicare spending would be $82 billion lower than projected between 2021 and 2029.Under a different scenario, if the growth in per person spending on beneficiaries in Medicare Advantage were held to the same rate of growth in spending on beneficiaries in traditional Medicare, then total Medicare program spending would be $183 billion lower than how much does propecia cost per month projected between 2021 and 2029, the analysis finds.Reducing Medicare Advantage payments from their projected amounts could have uncertain effects on the availability of plans that offer extra benefits for Medicare Advantage enrollees, or plan profits, unless plans are able to lower administrative costs and operate more efficiently.The full analysis, Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicareâs Solvency and Affordability Challenges, as well as other data and analyses about Medicare Advantage, can be found at kff.org.The number of people enrolled in Medicare has increased steadily in recent years, and along with it, Medicare spending. In particular, enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has more than doubled over the last decade. Notably, Medicare spending is higher and growing faster per person for beneficiaries in Medicare Advantage than how much does propecia cost per month in traditional Medicare. As enrollment in Medicare Advantage continues to grow, these trends have important implications for total Medicare spending, and costs incurred by beneficiaries.

In its 2022 budget, the Biden Administration expressed support for reforming payments to private plans as part of efforts to how much does propecia cost per month extend the solvency of the Medicare Hospital Insurance (HI) Trust Fund and improve affordability for beneficiaries.This analysis examines Medicare spending per person for beneficiaries in Medicare Advantage, relative to traditional Medicare. We build on prior work published by the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) to provide estimates of the amount Medicare would have spent for Medicare Advantage enrollees had they been covered under traditional Medicare in 2019 (the most recent year for which data are available). We use publicly available data from CMS that includes spending for people who were enrolled in both Part A and Part B of traditional Medicare, by category of service, as well as information on average risk scores and enrollment by county. This allows us how much does propecia cost per month to calculate per-person spending for beneficiaries in traditional Medicare on a basis comparable to federal payments per enrollee in Medicare Advantage. We also examine the extent to which the projected growth in Medicare Advantage spending is attributable to the growth in enrollment and the increase in spending per person.

We then illustrate potential savings to the Medicare program between 2021 and 2029 under two alternative scenarios where Medicare Advantage spending per person is how much does propecia cost per month lower or grows slower than under current projections. (See Methodology for more details on the data and analytic approach.)Our analysis finds:Medicare spending for Medicare Advantage enrollees was $321 higher per person in 2019 than if enrollees had instead been covered by traditional Medicare. The Medicare Advantage spending amount includes the cost of extra benefits, funded by rebates, not available to traditional Medicare beneficiaries.The higher Medicare spending per Medicare Advantage enrollee, compared to spending for similar beneficiaries under traditional Medicare, contributed an estimated $7 billion in additional spending in 2019.Growth in Medicare Advantage enrollment explains half of the projected increase in total Medicare Advantage spending between 2021 and 2029 and half is attributable to growth in Medicare payments per Medicare how much does propecia cost per month Advantage enrollee, after accounting for inflation.If spending per Medicare Advantage enrollee was 2 percent less each year than projected by the Medicare actuaries, similar to the projected impact of a recommendation made by MedPAC, total Medicare spending would be $82 billion lower between 2021 and 2029. If instead Medicare payments per Medicare Advantage enrollee grew at the same rate as is projected for spending per person in traditional Medicare (4.4% vs 5.3%), total Medicare spending would be $183 billion lower between 2021 and 2029.Background on Payments to Medicare Advantage PlansMedicare beneficiaries have the option to receive their Medicare benefits through either the traditional Medicare program or by enrolling in a private health plan, such as an HMO or PPO, that contracts with Medicare, called Medicare Advantage. Medicare pays Medicare Advantage how much does propecia cost per month plans a set amount for each enrollee.

The payment is determined through an annual process in which plans submit âbidsâ for how much they estimate it will cost to provide benefits covered under Medicare Parts A and B for an average beneficiary. The bids submitted by how much does propecia cost per month each plan are compared to a benchmark, which is an amount based on a set percentage of the projected average spending for beneficiaries in traditional Medicare in the same county. The benchmarks range from 95 percent in high spending counties to 115 percent in low spending counties. The benchmarks how much does propecia cost per month are subject to caps, meaning they cannot exceed the benchmarks that were in place before the Affordable Care Act. In addition, the benchmarks are increased by 5 percent for plans that receive at least 4 out of 5 stars under the quality bonus program, and 10 percent in certain âdouble bonusâ counties.Plans that bid below the benchmark receive a portion of the difference between the bid and the benchmark as a ârebateâ (50 percent for plans with 3 or fewer stars, 65 percent for plans with 3.5 or 4 stars, and 70 percent for plans with 5 stars).

Rebates must be used to reduce cost sharing, subsidize the standard Part B and/or Part D premium, or pay for supplemental benefits (such as vision, dental, and hearing). A portion of the rebate may also be used how much does propecia cost per month for administrative costs or retained as profit. Plans that bid above their benchmark receive the benchmark amount, and enrollees pay an additional premium equal to the difference between the bid and benchmark. The payments how much does propecia cost per month to plans are risk adjusted, based on the health status and other characteristics of enrollees, including age, sex, and Medicaid enrollment. Medicare payments are higher for plans with higher average risk scores because their enrollees are expected to incur higher costs.While traditional Medicare spending is used to establish benchmarks, actual payments to Medicare Advantage plans can be higher or lower than spending for comparable beneficiaries in traditional Medicare.

Changes in the how much does propecia cost per month Affordable Care Act initially reduced Medicare Advantage benchmarks. However, since 2017, benchmarks have risen on average, which increases the maximum possible payment a plan can receive. When benchmarks increase, plans that how much does propecia cost per month bid below the benchmark may be able to retain the same amount of rebate dollars, and thus offer the same level of extra benefits, while increasing their bid for Part A and B services. Alternatively, these plans could bid the same (or even slightly less) and receive higher rebate payments as the difference between the benchmark and bid widens because the benchmark is higher. Either response how much does propecia cost per month increases the payment Medicare Advantage plans receive as benchmarks increase.

One reason for the recent increase in benchmarks is that more plans are in bonus status, and thus have 5 percent (or 10 percent in double bonus counties) added to their benchmark. In 2021, 81 percent of Medicare Advantage how much does propecia cost per month enrollees are in plans that receive a bonus payment. Similarly, rebates increase as star ratings increase, because plans with higher star ratings retain a larger percent of the difference between the benchmark and bid as a rebate.In addition, risk adjustment can lead to higher payments for Medicare Advantage enrollees than would have been spent in traditional Medicare. This is because risk scores are largely based on diagnoses, and more diagnoses generally increase a beneficiaryâs risk score, providing an incentive for diagnoses to be coded more comprehensively for Medicare Advantage enrollees than occurs for traditional Medicare beneficiaries. MedPAC estimates how much does propecia cost per month that this more comprehensive coding of diagnoses in Medicare Advantage increased risk scores 9.1 percent relative to traditional Medicare in 2019.

There is also some concern that Medicare Advantage plans submit inaccurate diagnoses that increase risk scores and result in overpayments. The Health and Human Services Office of the Inspector General is currently conducting a targeted review of documentation submitted by Medicare Advantage organizations to how much does propecia cost per month determine whether diagnoses and associated risk scores comply with federal regulations. And in July, the Department of Justice announced that they were intervening in a False Claims Act lawsuit alleging that Kaiser Permanente had submitted inaccurate diagnoses codes for Medicare Advantage enrollees.FindingsSpending per personMedicare spent $321 more per person for Medicare Advantage enrollees than it would have spent for the same beneficiaries had they been covered under traditional Medicare in 2019. After adjusting how much does propecia cost per month for differences in health status and the geographic distribution of Medicare Advantage enrollees and traditional Medicare beneficiaries, spending per person for services covered under Parts A and B totaled $11,523 in 2019 for beneficiaries in traditional Medicare. This estimate for traditional Medicare reflects the categories of spending that are covered by Medicare payments to Medicare Advantage plans, and so excludes spending on hospice and payments for graduate medical education but includes administrative expenses.

In addition, it adjusts for the impact of more intense coding of diagnoses in Medicare Advantage relative to traditional Medicare, as estimated by MedPAC, which makes Medicare Advantage enrollees look like they are how much does propecia cost per month in worse health. (See Methodology for additional discussion.)In the same year, federal payments to Medicare Advantage plans were $11,844 per enrollee, or $321 more per person than Medicare would have spent if these beneficiaries had instead been covered by traditional Medicare. In other words, Medicare Advantage payments were about 103 percent of spending for comparable traditional Medicare how much does propecia cost per month beneficiaries. The higher spending occurred despite changes in law made by the Affordable Care Act that reduced payments to plans over time (which MedPAC estimated at 114 percent of traditional Medicare beneficiary spending in 2009).As described above, Medicare payments per Medicare Advantage enrollee include two components. Bid-based expenditures, which reflect the planâs expected how much does propecia cost per month costs for providing services covered under Medicare Parts A and B (adjusted for health risk), and rebates, which pay for the cost of benefits not available to traditional Medicare beneficiaries, including reduced cost sharing, subsidized Part B and Part D premiums, and coverage of additional benefits, such as vision, dental and hearing.

In 2019, the bid-based portion of the Medicare Advantage payment was $10,848 and the rebate portion was $996.Higher Medicare payments per Medicare Advantage enrollee increased total Medicare spending by an estimated $7 billion in 2019. Across the approximately 22 million people enrolled in Medicare Advantage in 2019, higher spending of $321 per person led to about $7 billion in additional spending in that year. That is equal to about 3 percent of all Medicare Advantage spending in 2019.Projected growth in Medicare Advantage spendingGrowth in Medicare how much does propecia cost per month Advantage enrollment explains half of the projected growth in Medicare Advantage spending between 2021 and 2029, after adjusting for inflation. Between 2021 and 2029, federal spending on payments to Medicare Advantage plans is projected to increase by $316 billion, from $348 billion to $664 billion. After accounting how much does propecia cost per month for inflation (which represents $108 billion of this increase), the remaining $208 billion is explained by growth in payments per person ($105 billion, or 50 percent) and growth in enrollment ($104 billion, or 50 percent) (Figure 1).Figure 1.

Growth in Medicare Advantage Enrollment Explains Half of the Projected Increase in Medicare Advantage Spending through 2029Notably, the rebate portion of Medicare Advantage payments, which must be used to cover the cost of additional benefits not available to traditional Medicare beneficiaries, is projected to grow between 2021 and 2029. Rebates account for about 10 percent of Click This Link Medicare Advantage payments in 2021 ($35 billion of $348 billion) and are projected to rise to 12 percent ($80 billion of $664 billion) in how much does propecia cost per month 2029.Medicare spending is projected to grow faster for Medicare Advantage enrollees than traditional Medicare beneficiaries. Spending per person in Medicare Advantage is projected to grow 5.3 percent a year on average between 2021 and 2029, an amount which is similar across plan types (based on KFF analysis of data from the 2020 Medicare Trustees Report). The projected growth in Medicare Advantage spending per person is somewhat higher than the 4.4 percent average annual growth projected for beneficiaries in traditional Medicare (see how much does propecia cost per month Methodology for details on data and methods).According to the Medicare actuaries, the higher projected growth in Medicare payments per Medicare Advantage enrollee are in part explained by faster projected growth in the rebate portion of the payment. Rebates are projected to grow nearly 8 percent a year on average, which the actuaries attribute to âassumed increases in quality bonus payments and increases in benchmarks.âIt is also possible that the faster expected increase in spending per person in Medicare Advantage compared to traditional Medicare through 2029 is due in part to an assumption that sicker and higher cost beneficiaries, such as those dually eligible for Medicare and Medicaid, will enroll in Medicare Advantage at a higher rate than in traditional Medicare.

For example, the number of Medicare Advantage enrollees in special needs plans (SNPs), which included just over half of all dually how much does propecia cost per month eligible beneficiaries in Medicare Advantage in 2019, is expected to increase slightly by 2029. However, the change is relatively small, and even if it represents only half of the total increase in Medicare Advantage enrollment by dually eligible beneficiaries, it suggests the projected increase in spending per Medicare Advantage enrollee is being driven by other factors, such as Medicare Advantage payment methodology. Additionally, starting in 2021, all Medicare beneficiaries with end-stage renal disease (ESRD) are eligible to enroll in a Medicare Advantage plan. Though beneficiaries with ESRD have substantially higher costs than the average Medicare beneficiary, they represent less than 1 percent of all Medicare beneficiaries, and so increased enrollment by beneficiaries with ESRD is likely to explain a relatively small portion of the growth in per-person spending in Medicare Advantage.Alternative projections for Medicare Advantage spendingIf Medicare Advantage spending per person was 2 percent less a year than projected, similar to the simulated effect of recommended payment changes from MedPAC, total Medicare spending how much does propecia cost per month would be $82 billion lower through 2029. MedPAC has proposed changes to how Medicare Advantage benchmarks are calculated and estimate these changes would result in a 2 percent reduction in Medicare Advantage payments in a single year.

Applying this payment reduction to the projected Medicare Advantage payments per enrollee in each year between 2022 and 2029, total Medicare Advantage spending would how much does propecia cost per month be $82 billion lower through 2029 (Figure 2). The decrease is approximately 1 percent of total Medicare benefit spending over these years (and 2 percent of Medicare Advantage spending).Even with the reduction in aggregate spending under this scenario where Medicare Advantage payments are reduced by 2 percent per year, projected Medicare spending per Medicare Advantage enrollee would still be higher and grow faster than projected spending per person in traditional Medicare. MedPAC expects implementing changes to the benchmark policy that result in a 2 percent reduction in payments in a how much does propecia cost per month given year would have only a modest effect on access to plans with lower cost sharing and reduced Part B and D premiums. For example, in their simulations, the vast majority (over 95 percent) of Medicare beneficiaries would continue to have access to Medicare Advantage plans that offer reduced cost sharing and Part B and/or D premium reductions. The number of plan sponsors and plan choices how much does propecia cost per month would vary across geographic areas, as they do under current policy, but would be somewhat reduced.

In the quartile of counties with the lowest traditional Medicare spending per person, MedPAC estimates an average of 5 plan sponsors would offer 12 different plans (compared to 6 plans sponsors who offered 22 different plans in 2020). In the quartile of counties how much does propecia cost per month with the highest spending per person in traditional Medicare, an average of 8 plan sponsors would offer 22 different Medicare Advantage plans (compared to the same number of sponsors who offered 27 plans in 2020).Under an alternative, illustrative scenario, where Medicare Advantage spending per person grew at the same rate as is projected for traditional Medicare, spending would be $183 billion lower between 2021 and 2029. For this scenario, we calculated the difference in projected Medicare spending if Medicare payments per person to Medicare Advantage plans grew at the same rate as spending per person in traditional Medicare (4.4 percent) between 2021 and 2029, rather than the higher 5.3 percent growth rate projection. While this approach is not directly pegged to how much does propecia cost per month a specific policy proposal, it illustrates the potential for savings, of, for example, a cap on the growth in total Medicare Advantage payments per enrollee. To adjust to such a cap, plans could find additional efficiencies in the coverage of Part A and B services, reduce supplemental benefits, restrict the future growth in supplemental benefits, lower administrative costs, reduce profits, or some combination of each.

Limiting the growth in Medicare payment per Medicare Advantage enrollee directly or indirectly could also be achieved through other payment reforms.Under the scenario where per-person spending growth in Medicare Advantage and traditional Medicare is equivalent, total Medicare Advantage spending over 2021 to 2029 would be $183 billion lower (Figure 2). For context, the savings under this scenario represents 4 percent of how much does propecia cost per month projected Medicare Advantage spending over this time period (and 2 percent of total Medicare benefit spending). That compares to an expected reduction in Medicare Advantage spending of 8.9 percent between 2010 and 2019 due to changes in the Affordable Care Act (based on CBOâs estimate of the health care law and its March 2009 baseline). While spending per person would grow at the same rate in both Medicare Advantage and traditional Medicare under this scenario, payments per Medicare Advantage enrollee would be higher than spending per beneficiary in traditional Medicare because of higher projected how much does propecia cost per month spending per person in Medicare Advantage in 2021. Comparing the two alternative scenarios, the reduction in Medicare Advantage spending is similar in the initial years of the time period.

However, the Medicare savings accrue more rapidly under the scenario where growth in payments per Medicare Advantage enrollee is equal to how much does propecia cost per month the rate of growth in spending per person in traditional Medicare. This is because savings from lower growth compound over time. (Toggle between the two scenarios to see the year-by-year savings under each scenario in Figure 3).These estimates assume no changes to projected enrollment, which may occur if supplemental benefits, cost sharing, how much does propecia cost per month or other features of Medicare Advantage plans change in response to lower payments from the federal government. However, while it is not possible to know exactly how plans will respond to lower payments, previous analyses of past payment changes demonstrate that plans have found savings elsewhere in order to maintain rebate dollars to fund supplemental benefits that may appeal to enrollees. For example, MedPAC examined the response of Medicare Advantage plans that lost bonus status between 2018 and 2019 and found how much does propecia cost per month that these plans reduced their profits and administrative costs, and had lower growth in their projected Part A and B costs compared to other plans.

This allowed the plans to continue to provide similar levels of supplemental benefits. Further, despite predictions by CBO, Medicare actuaries, and others that enrollment in Medicare Advantage would fall following the reductions in payment to Medicare Advantage plans enacted as part of the Affordable Care Act, enrollment never declined and has instead risen rapidly how much does propecia cost per month. Plans offer more generous supplemental benefits in 2021 than at any other point in the programâs history and Medicare Advantage markets are robust, with the average Medicare beneficiary having more than 30 Medicare Advantage plans to choose from in 2021. ConclusionHistorically, one goal of the Medicare Advantage program was to leverage the efficiencies of managed care to reduce Medicare spending. However, the program has never generated savings relative to how much does propecia cost per month traditional Medicare.

In fact, the opposite is true. As a result, Medicare Advantage plans have been able to offer an increasingly how much does propecia cost per month robust set of extra benefits not available to beneficiaries in traditional Medicare. The annual cost of the rebate dollars used to pay for the extra benefits â $1,680 per Medicare Advantage enrollee for non-employer, non-SNP plans in 2021 â more than offset any savings that Medicare Advantage plans generate by bidding below the benchmark set by CMS for covering Part A and B services. The extra benefits improve coverage for beneficiaries who choose Medicare Advantage plans how much does propecia cost per month and have likely contributed to the substantial increase in Medicare Advantage enrollment. But the higher payments have also led to higher Medicare spending than would have occurred under traditional Medicare and higher Medicare Part B premiums paid by all beneficiaries, including those in traditional Medicare.Our analysis finds that Medicare Advantage payments per enrollee in 2019 were approximately 103 percent of spending per person for comparable beneficiaries covered by traditional Medicare, consistent with estimates based on data submitted by private plans as part of the bidding process and concurrent projections by CMS of future spending in traditional Medicare.

MedPACâs most recent analysis of the relationship between Medicare Advantage payments and spending in traditional Medicare suggests that the difference has widened, with 2021 payments per Medicare Advantage enrollee estimated to total how much does propecia cost per month 104 percent of spending in traditional Medicare. That trend is in part attributed to the rise in the rebate component of Medicare Advantage payments, which increased 14 percent between 2020 and 2021. While part of the increase in rebates stems from a decrease in how much private plans bid to provide coverage of Part A and B services, other features of the Medicare Advantage payment methodology, including the quality bonus program payments and how much does propecia cost per month benchmark policy contribute to both the recent and projected growth in rebates, and in turn, total Medicare Advantage spending. For example, under the quality bonus program, payments from the federal government to Medicare Advantage plans will total $11.6 billion in 2021, at least a portion of which was paid as the rebate.MedPAC recently recommended changes to how plan payments are calculated, observing that because most plans currently bid well below the cost of providing Part A and B services in traditional Medicare, there is an opportunity for the Medicare program to share in these efficiencies. Their simulations indicate that a 2 percent reduction in payments would not significantly how much does propecia cost per month affect access to private plans or supplemental benefits.

A reduction in Medicare Advantage payments consistent with the simulated effect of MedPACâs recommendations, would result in Medicare program payments per enrollee that would remain higher and still grow faster than spending under traditional Medicare. Alternatively, bringing Medicare Advantage spending growth in line with projected growth in traditional Medicare would achieve more than twice as much savings. Under that scenario, the absolute level of payments per enrollee to private plans would still be higher than spending per person for beneficiaries in traditional how much does propecia cost per month Medicare. Reduced federal payments could mean Medicare Advantage enrollees see fewer extra benefits and higher cost sharing and premiums compared to today (but still lower costs than compared to traditional Medicare without supplemental coverage), but plans could also reduce profits or administrative costs to make up the difference. Further, savings of this magnitude how much does propecia cost per month would be less than half of those included in the Affordable Care Act, which were followed by a period of robust Medicare Advantage growth.Over the next decade, Medicare Advantage enrollment is expected to continue to grow.

As more Medicare beneficiaries enroll in private plans, differences in Medicare payments across Medicare Advantage and traditional Medicare will lead to even higher Medicare spending, and more generous benefits for beneficiaries in Medicare Advantage than traditional Medicare. That higher spending increases Part B premiums paid by all Medicare beneficiaries, including those who are not in a Medicare Advantage plan, and how much does propecia cost per month contribute to the financing challenges facing the Medicare HI Trust Fund. Further, these projections raise questions of equity between Medicare Advantage and traditional Medicare because the faster growth in spending per Medicare Advantage enrollee, compared to traditional Medicare beneficiaries, is in part due to rising rebates to private plans, which cover the cost of benefits not available to traditional Medicare beneficiaries. Although taking steps to address the fiscal challenges facing Medicare are not front and center in current Medicare policy discussions, policymakers may soon be on the lookout for options how much does propecia cost per month to achieve Medicare savings to fund other spending priorities or extend the solvency of the Medicare HI Trust Fund. This analysis suggests that reducing the difference in payments between Medicare Advantage and traditional Medicare would generate savings, with the potential for reductions in extra benefits for Medicare Advantage enrollees.This work was supported in part by Arnold Ventures.

We value how much does propecia cost per month our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities. Methodology.

What side effects may I notice from Propecia?

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

breast enlargement or tenderness
skin rash
sexual difficulties (less sexual desire or ability to get an erection)
small amount of semen released during sex

This list may not describe all possible side effects.

Propecia ejaculation

A vein propecia ejaculation of formIn footballing vernacular (and Iâm an ardent student) a âvein of formâ means a good run. For whatever reason âsomethingâ gelled, continues to gel and there are no reasons to see an end to the gelling. The reasons can be purely sporting (the mix of players, the 3-5-2 vs the 4-2-3-1 formation) or related to the aura a winning side builds, respect (timidity and fear perhaps) induced by the seeming insuperability of the side propecia ejaculation.

But, what does this mean now and in the long term?. The bottom propecia ejaculation line is that outcomes (results) breed outcomes, an area under scrutiny in this issue. From causation to interpretation, our papers illustrate this more articulately than my ungainly analogy manages.Prematurity.

Decodifying outcomesThis issue is rich with detail on research and perspectives on the developmental trajectories of preterm babies equally relevant for non-neonatologists as those whose day jobs are NICU-based. ÂBut isnât this old propecia ejaculation hat?. Â I hear you protestâ¦ Emphatically ânoâ, as the surface has only really been scratched especially in the previously-considered-risk-free late preterm and early groups.

Neora Alterman and colleaguesâ analysis of educational outcome by degree of prematurity in babies recruited in propecia ejaculation the UK Millennium Cohort Study included 12â081 children assessed at 11 years by parental report. The overall prevalence of SEN of 11.2% and, by GA subgroup, was inversely associated with gestational age. At <32 weeks the prevalence of 27.4% with an adjusted relative risk of 2.9 (95% CI 2.0 to 4.1).

Those born at early term (37â38 weeks), a much larger propecia ejaculation contributor numerically at a population level, were at higher risk of SEN (aRR=1.33. 95%âCI 1.11 to 1.59). Think about propecia ejaculation this the next time you reassure the parents of a 38âweek gestation baby that âthereâs no need for follow-up as we donât see problems at this ageâ.Neil Marlow puts the population attributable risks in perspective, argues the case for health-educational linkage and for looking beyond the (letâs be honest) rather crude dichotomy of the SEN label.Lex Doyle and colleagues reviews of outcome data in extremely preterm babies over time using data from various sources.

The Victoria cohort studies from 1991, the Victoria Cerebral Palsy (CP) register and other comparable studies. Progress has been slow and erratic propecia ejaculation. Progress in CP but the academic performance gap worsened.

Without refinements to ante- and postnatal identification and intervention this discussion will simply continue. See pages 842, 833 propecia ejaculation and 834MicrocephalyItâs well known that microcephaly (<2âSD below the mean) of any degree is predictive of later developmental, hearing and visual problems with a clear dose response association. The Zika-related epidemic microcephaly epidemic in the mid 2010s focused on the most severely affected babies but the population attributable risks of more subtle damage both at an individual level and outside the Brazil and Caribbean epicentres.

The findings from two national surveillance studies estimating the degree of Zika propecia related congenital microcephaly from the Australian and Canadian Paediatric Surveillance Unit/Programmes by Carolos Nunezâs and Shaun Morrisâ groups respectively go some way to propecia ejaculation answering this. Data from the 2016â18 (Australia) and 2016â2019 (Canada) estimate similar incidences of microcephaly (1.12 and 0.45 babies/ 10â000 births) with extremely few being Zika related.A high proportion of babies in both studies had associated dysmorphology and, sadly but unsurprisingly, fared badly. In a knightâs move thinking way, thereâs an additional lesson here.

Despite the low incidence so far propecia ejaculation outside South and Central America, we canât completely count on the geographical and meteorological fastidiousness of the aedes aegyptae mosquito. Remember how easily Yellow fever and Dengue sneaked into the US from South East Asia some decades ago the aedes larvae vector crossing the oceans nestling in pools of water in the base of untreated rubber tyres. Aedes is simply a metaphor of the way in which our fates/outcomes are all interconnected and that Global health (and no one needs reminding as the propecia continues to ebb, flow and confound and ice caps melt) isnât about low propecia ejaculation and middle income countries alone.

See page 849Parenteral nutritionFar from being the finished article, parenteral nutrition continues to evolve. In a âVoices from historyâ piece, Rachel Pybus and John Puntis outline its heritage from William Harveyâs discovery of circulation in the 17th century to a period of awakening in the wake of, in 1949, work by the Medical Research Council showing that the components of proteins (digested casein, amino acids and polypeptides), could be administered intravenously. The idea gained traction and popularity during the 1970s with breakthrough ideas in the means of adding the âother componentsâ, lipids and to this day is finding new uses in areas unimaginable in the heady propecia ejaculation post war era.

The mother refused consent for the swab as she did not display the classical propecia ejaculation symptoms. The second patient presented to a tertiary hospital with high temperatures and joint pain and met the hospital criteria for hair loss treatment testing. The mother refused consent for the swab, though agreed to isolate with the family for 2 weeks.

The child was treated with suspected hair loss treatment precautions while an inpatient.In the first case, the child would not have met criteria for testing propecia ejaculation due to symptoms alone and only required the test for admission, though the patient was quickly well enough for discharge, and there was no ongoing consequence for nursing care, precautions or bed management. In the second case, despite the child having a temperature and requiring admission, the mother refused consent for the hair loss treatment swab as she did not want to distress her son. The fever mandated the child being treated as a possible case of hair loss treatment, which led to a clear impact on staff caring for the child, bed management as well as the contacts of the patient.We know, as defined by our legal bodies, we can over-rule parents withholding consent if lack of intervention would propecia ejaculation result in death or severe permanent disfigurement.

Clearly, this is not the case in these instances, though in times of a global propecia, the arguable moral and social obligations to carry out appropriate screening are not being met. Such obligations are not normally enforceable, but the picture becomes complicated with the existence of UK hair loss treatment laws and penalties for failing to comply.The solution to this situation of consenting for hair loss treatment swabs is probably exploring the reasons why consent is withheld. Parents may simply be worried about the procedure, hence time and gentle explanation propecia ejaculation may be all that is needed.

However, while awaiting a result, the child and family may need to isolate and this could result in loss of school time, loss of parental earnings and impact the psychosocial well-being of families. Another influencing factor may be the fear of a positive result, and this may lead propecia ejaculation to the problems just described.Both these cases were discussed in an ethics committee meeting. While there is no clear answer, clearly we should not be refusing treatment based on a refusal of screening, especially in children.

There is a need for published guidance for these instances, but also clear and transparent criteria, augmented by good communication, for patients and parents to understand the necessity and importance of hair loss treatment testing.Ethics statementsPatient consent for publicationNot required..

A vein Buy cialis in montreal of formIn how much does propecia cost per month footballing vernacular (and Iâm an ardent student) a âvein of formâ means a good run. For whatever reason âsomethingâ gelled, continues to gel and there are no reasons to see an end to the gelling. The reasons can be purely sporting (the mix of players, the 3-5-2 vs the 4-2-3-1 formation) or related to the aura how much does propecia cost per month a winning side builds, respect (timidity and fear perhaps) induced by the seeming insuperability of the side. But, what does this mean now and in the long term?. The bottom how much does propecia cost per month line is that outcomes (results) breed outcomes, an area under scrutiny in this issue.

From causation to interpretation, our papers illustrate this more articulately than my ungainly analogy manages.Prematurity. Decodifying outcomesThis issue is rich with detail on research and perspectives on the developmental trajectories of preterm babies equally relevant for non-neonatologists as those whose day jobs are NICU-based. ÂBut isnât this how much does propecia cost per month old hat?. Â I hear you protestâ¦ Emphatically ânoâ, as the surface has only really been scratched especially in the previously-considered-risk-free late preterm and early groups. Neora Alterman how much does propecia cost per month and colleaguesâ analysis of educational outcome by degree of prematurity in babies recruited in the UK Millennium Cohort Study included 12â081 children assessed at 11 years by parental report.

The overall prevalence of SEN of 11.2% and, by GA subgroup, was inversely associated with gestational age. At <32 weeks the prevalence of 27.4% with an adjusted relative risk of 2.9 (95% CI 2.0 to 4.1). Those born at early term (37â38 weeks), a much larger contributor numerically at how much does propecia cost per month a population level, were at higher risk of SEN (aRR=1.33. 95%âCI 1.11 to 1.59). Think about this the next time you reassure the parents of a 38âweek gestation baby that âthereâs no need for follow-up as we donât see problems at this ageâ.Neil Marlow puts the population attributable risks in perspective, argues the case for health-educational linkage and for looking beyond the (letâs be honest) rather crude dichotomy of the SEN label.Lex Doyle and how much does propecia cost per month colleagues reviews of outcome data in extremely preterm babies over time using data from various sources.

The Victoria cohort studies from 1991, the Victoria Cerebral Palsy (CP) register and other comparable studies. Progress has how much does propecia cost per month been slow and erratic. Progress in CP but the academic performance gap worsened. Without refinements to ante- and postnatal identification and intervention this discussion will simply continue. See pages 842, 833 and 834MicrocephalyItâs well known that microcephaly how much does propecia cost per month (<2âSD below the mean) of any degree is predictive of later developmental, hearing and visual problems with a clear dose response association.

The Zika-related epidemic microcephaly epidemic in the mid 2010s focused on the most severely affected babies but the population attributable risks of more subtle damage both at an individual level and outside the Brazil and Caribbean epicentres. The findings from two national surveillance studies estimating the degree of Zika propecia related congenital microcephaly from the Australian and Canadian Paediatric Surveillance Unit/Programmes by Carolos how much does propecia cost per month Nunezâs and Shaun Morrisâ groups respectively go some way to answering this. Data from the 2016â18 (Australia) and 2016â2019 (Canada) estimate similar incidences of microcephaly (1.12 and 0.45 babies/ 10â000 births) with extremely few being Zika related.A high proportion of babies in both studies had associated dysmorphology and, sadly but unsurprisingly, fared badly. In a knightâs move thinking way, thereâs an additional lesson here. Despite the low incidence so far outside South and Central America, we canât completely count on the geographical and meteorological fastidiousness of the how much does propecia cost per month aedes aegyptae mosquito.

Remember how easily Yellow fever and Dengue sneaked into the US from South East Asia some decades ago the aedes larvae vector crossing the oceans nestling in pools of water in the base of untreated rubber tyres. Aedes is simply a metaphor of the way in which our fates/outcomes are all interconnected and that Global health (and no one needs reminding as the propecia continues to ebb, flow and confound and ice caps melt) isnât about low and middle income how much does propecia cost per month countries alone. See page 849Parenteral nutritionFar from being the finished article, parenteral nutrition continues to evolve. In a âVoices from historyâ piece, Rachel Pybus and John Puntis outline its heritage from William Harveyâs discovery of circulation in the 17th century to a period of awakening in the wake of, in 1949, work by the Medical Research Council showing that the components of proteins (digested casein, amino acids and polypeptides), could be administered intravenously. The idea gained traction and popularity during the how much does propecia cost per month 1970s with breakthrough ideas in the means of adding the âother componentsâ, lipids and to this day is finding new uses in areas unimaginable in the heady post war era.

See page 921Consent can be a difficult issue, especially in childrenâs health. We describe two cases where our current propecia has caused a novel issue in this area.A child with a complex background presented how much does propecia cost per month with croup to their local district general hospital. While there was no suspicion of hair loss treatment , hospital policy dictated all admissions to the ward should be screened for hair loss treatment, regardless of presentation. The mother refused consent for the swab as she did not display how much does propecia cost per month the classical symptoms. The second patient presented to a tertiary hospital with high temperatures and joint pain and met the hospital criteria for hair loss treatment testing.

The mother refused consent for the swab, though agreed to isolate with the family for 2 weeks. The child was treated how much does propecia cost per month with suspected hair loss treatment precautions while an inpatient.In the first case, the child would not have met criteria for testing due to symptoms alone and only required the test for admission, though the patient was quickly well enough for discharge, and there was no ongoing consequence for nursing care, precautions or bed management. In the second case, despite the child having a temperature and requiring admission, the mother refused consent for the hair loss treatment swab as she did not want to distress her son. The fever mandated the child being treated as a possible case of hair loss treatment, which led to a clear impact on staff caring for the child, bed management how much does propecia cost per month as well as the contacts of the patient.We know, as defined by our legal bodies, we can over-rule parents withholding consent if lack of intervention would result in death or severe permanent disfigurement. Clearly, this is not the case in these instances, though in times of a global propecia, the arguable moral and social obligations to carry out appropriate screening are not being met.

Such obligations are not normally enforceable, but the picture becomes complicated with the existence of UK hair loss treatment laws and penalties for failing to comply.The solution to this situation of consenting for hair loss treatment swabs is probably exploring the reasons why consent is withheld. Parents may simply be worried about the procedure, hence time and gentle explanation may be all that is needed how much does propecia cost per month. However, while awaiting a result, the child and family may need to isolate and this could result in loss of school time, loss of parental earnings and impact the psychosocial well-being of families. Another influencing factor how much does propecia cost per month may be the fear of a positive result, and this may lead to the problems just described.Both these cases were discussed in an ethics committee meeting. While there is no clear answer, clearly we should not be refusing treatment based on a refusal of screening, especially in children.

Where to buy cheap propecia

How about where to buy cheap propecia that wedding shower that you went to? price of propecia in canada. Your girlsâ weekend?. Do you have plans to watch the Husker game with people?. Even where to buy cheap propecia if itâs only like one other person?. Did you have your kidsâ friends over to play in the basement?.

I ask you these questions because though they may be low-risk to you, they are high-risk to me. Because my colleagues and I cannot take care of all of where to buy cheap propecia you currently needing to be admitted to the hospital. Youâre right. Most people with hair loss treatment do just fine. But, a number of people where to buy cheap propecia do not.

And if our health care workforce keeps getting stretched to the limits AND many of them keep needing time to quarantine due to hair loss treatment or positive exposures, then we are ALL going to be in a really dark(er) place. For example, my institution usually runs 2 general hair loss treatment teams. We are up to 6-7 teams with plans to increase where to buy cheap propecia to 10. You know what that also means?. We will run out of space for non-hair loss treatment patients too.

And we where to buy cheap propecia may not have enough people to take care of these folks.Please. Please. Rethink interacting with people outside of your home. I know this exhausting where to buy cheap propecia. Iâm tired.

I miss my old life. Youâre right where to buy cheap propecia. I donât have older kids that need human interaction with others. But please help. I jokingly compare hair loss treatment to an where to buy cheap propecia STD.

The person you are with may seem âsafe,â but you never know where they have been. And though thatâs rather funny, itâs scarily true. Asymptomatic carriers and or people that are positive but donât have symptoms yet are a real problem where to buy cheap propecia. Donât think negative hair loss treatment test excuses what youâve done or clears you!. You can still turn positive a day or two later, having exposed people in the meantime.

Ugh.Please donât where to buy cheap propecia assume this isnât about you and that Iâm directing this to someone else not you. Donât assume youâre doing enough. We all ARENâT doing enough. Take a step back and assume you arenât where to buy cheap propecia doing enough. How you could have done better?.

How can you do better starting right now?. I beg you all to make decisions for your where to buy cheap propecia health care providers. My colleagues and I are making sacrifices for you. Please make a sacrifice for us.Allison Ashford is a hospitalist.With the holidays approaching, how can we celebrate with loved ones while reducing risks?. The hair loss treatment propecia is nowhere near over, where to buy cheap propecia increasing the risk of transmission during one of the busiest travel and social-gathering periods of the year.

The Texas Medical Association (TMA) unveils two new tools from doctors to help people make safe holiday plans. New podcastTrish Perl, MD, and TMA public health staff member Meredith Vinez address how to reduce your risk for hair loss treatment during the holiday season, in the latest episode of the TMAâs Practice Well podcasts. Dr. Perl is a member of both TMAâs hair loss treatment Task Force and Committee on Infectious Diseases, and chief of the infectious diseases division at UT Southwestern Medical Center in Dallas.âThis is the new normal, and until we really see that we have something like a treatment or other measures that are going to prevent transmission, this is going to be our new normal,â Dr. Perl says in the podcast.

That means everyone should balance healthy practices with pursuing holiday traditions.Dr. Perl discusses the dangers of hair loss treatment fatigue, and how wearing face masks, maintaining good hygiene (washing hands frequently), and social distancing can help stop the spread of the propecia. Citing their own family situations, she and Ms. Vinez discuss what people should do if they decide to travel for the holidays, the safest way to travel, and the risks of visiting elderly relatives. The episode also covers how to deal with relatives who arenât taking hair loss treatment seriously, low risk holiday activities for the kids, potential tweaks to the traditional holiday to family dinners, and how to give back to the community this season.

Some of their suggestions include hosting outdoor family gatherings, using disposable plates and utensils, and serving guests rather than passing a bowl of food with a single serving spoon.Dr. Perl concluded with this reminder. ÂStay safe, and everybody remember your three wâs. Wear your mask, watch your distance, and wash your hands!. Â To listen to the holiday podcast and other episodes of TMAâs Practice Well podcast, visit us on our website, Apple Podcasts, Spotify, iHeartRadio and Podbean.

For you and for me.I need you all to take a minute and think of the last time that you weblink interacted how much does propecia cost per month in-person with someone who does not live in your home. Did you see a friend this weekend?. Did you go to the store?. Did you go inside how much does propecia cost per month the gas station?.

Did family come in from out of state?. How about that wedding shower that you went to?. Your how much does propecia cost per month girlsâ weekend?. Do you have plans to watch the Husker game with people?.

Even if itâs only like one other person?. Did you have your kidsâ friends how much does propecia cost per month over to play in the basement?. I ask you these questions because though they may be low-risk to you, they are high-risk to me. Because my colleagues and I cannot take care of all of you currently needing to be admitted to the hospital.

Youâre right how much does propecia cost per month. Most people with hair loss treatment do just fine. But, a number of people do not. And if our health care workforce keeps getting stretched to the limits AND many of them keep needing time to quarantine due to hair loss treatment or positive exposures, then we are ALL going to be in a really dark(er) place how much does propecia cost per month.

For example, my institution usually runs 2 general hair loss treatment teams. We are up to 6-7 teams with plans to increase to 10. You know what how much does propecia cost per month that also means?. We will run out of space for non-hair loss treatment patients too.

And we may not have enough people to take care of these folks.Please. Please. Rethink interacting with people outside of your home. I know this exhausting.

Iâm tired. I miss my old life. Youâre right. I donât have older kids that need human interaction with others.

But please help. I jokingly compare hair loss treatment to an STD. The person you are with may seem âsafe,â but you never know where they have been. And though thatâs rather funny, itâs scarily true.

Asymptomatic carriers and or people that are positive but donât have symptoms yet are a real problem. Donât think negative hair loss treatment test excuses what youâve done or clears you!. You can still turn positive a day or two later, having exposed people in the meantime. Ugh.Please donât assume this isnât about you and that Iâm directing this to someone else not you.

Donât assume youâre doing enough. We all ARENâT doing enough. Take a step back and assume you arenât doing enough. How you could have done better?.

How can you do better starting right now?. I beg you all to make decisions for your health care providers. My colleagues and I are making sacrifices for you. Please make a sacrifice for us.Allison Ashford is a hospitalist.With the holidays approaching, how can we celebrate with loved ones while reducing risks?.

The hair loss treatment propecia is nowhere near over, increasing the risk of transmission during one of the busiest travel and social-gathering periods of the year. The Texas Medical Association (TMA) unveils two new tools from doctors to help people make safe holiday plans. New podcastTrish Perl, MD, and TMA public health staff member Meredith Vinez address how to reduce your risk for hair loss treatment during the holiday season, in the latest episode of the TMAâs Practice Well podcasts. Dr.

Perl is a member of both TMAâs hair loss treatment Task Force and Committee on Infectious Diseases, and chief of the infectious diseases division at UT Southwestern Medical Center in Dallas.âThis is the new normal, and until we really see that we have something like a treatment or other measures that are going to prevent transmission, this is going to be our new normal,â Dr. Perl says in the podcast. That means everyone should balance healthy practices with pursuing holiday traditions.Dr. Perl discusses the dangers of hair loss treatment fatigue, and how wearing face masks, maintaining good hygiene (washing hands frequently), and social distancing can help stop the spread of the propecia.

Citing their own family situations, she and Ms. Vinez discuss what people should do if they decide to travel for the holidays, the safest way to travel, and the risks of visiting elderly relatives. The episode also covers how to deal with relatives who arenât taking hair loss treatment seriously, low risk holiday activities for the kids, potential tweaks to the traditional holiday to family dinners, and how to give back to the community this season.

Propecia over the counter

IntroductionLa Peste (Camus 1947) has served propecia over the counter as a basis for several critical works, including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and propecia over the counter Payne 2017). Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994).

Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The hair loss treatment propecia has increased general interest about historical and propecia over the counter fictional epidemics. La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, propecia over the counter especially among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020.

Bate 2020. Vandekerckhove 2020 propecia over the counter. Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from propecia over the counter our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us from establishing too close resemblances between both situations.Furthermore, it will not be strange if hair loss treatment serves as a frame for fictional works in the near future.

Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest propecia in the last century, the so-called propecia over the counter âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels such as Katherine A Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018. Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018).

By contrast, we may think that hair loss treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading of La Peste, we point out in this essay different aspects of living under an epidemic propecia over the counter that can be identified both in Camusâs work and in our current situation. We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of hair loss treatment, as Camus does concerning Oranâs rulers. However, what propecia over the counter we want to foreground is La Pesteâs intrinsic value, its suitability to be read now and after hair loss treatment has passed, when Camusâs novel endures as a solid art work and hair loss treatment remains only as a defeated plight.MethodsWe confronted our own experiences about hair loss treatment with a conventional reading of La Peste. A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of hair loss treatment.

In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to integrate propecia over the counter the information collected. Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people of our town to expect the propecia over the counter events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.

(Camus 2002, Part I)By referring from the beginning to âthe people of our townâ, Camus is already suggesting an idea which is repeated all along the novel, and which may be well understood by us as hair loss treatmentâs witnesses. Epidemics affect the community as a whole, they are present in everybodyâs mind and their joys and sorrows are not individual, but collective. For example (and we are anticipating Part II), propecia over the counter the narrator says:But, once the gates were closed, they all noticed that they were in the same boat, including the narrator himself, and that they had to adjust to the fact. (Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all.

(Camus 2002, Part III)This distinction propecia over the counter is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours and those who remain behaving selfishly. Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, Part III)Being collective issues does propecia over the counter not mean that epidemics always enhance auism and solidarity. As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020).

Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning hair loss treatment, some authors have described a greater impact of the propecia in propecia over the counter those countries with higher levels of individualism (Maaravi et al. 2021. Ozkan et al. 2021).

However, this finding should be complemented with other national culturesâ aspects before concluding that collectivism itself exerts a protective role against epidemics. Concerning this, it has been shown how âpower distanceâ frequently intersects with collectivism, being only a few countries in which the last one coexists with a small distance to power, namely with a capacity to disobey the power authority (Gupta, Shoja, and Mikalef 2021). Moreover, those countries classically classified as âcollectivistâ (China, Japan, South Korea, India, Vietnam, etc.) are also characterised by high levels of power distance, and their citizens have been quite often forced to adhere to hair loss treatment restrictions and punished if not (Gupta, Shoja, and Mikalef 2021). Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9).

For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide. It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business. (Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods.

By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and hair loss treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC. N.d.a, ECDC. N.d, Pollitzer 1954). Concerning hair loss, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

In Camusâs novel, the animalâs link to the epidemic seemed very clear since the beginning:Things got to the point where Infodoc (the agency for information and documentation, â all you need to know on any subjectâ) announced in its free radio news programme that 6,231 rats had been collected and burned in a single day, the 25th. This figure, which gave a clear meaning to the daily spectacle that everyone in town had in front of their eyes, disconcerted them even more. (Camus 2002, Part I)This accuracy in figures is familiar to us. People nowadays have become very used to the statistical aspects of the propecia, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks.

(Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?. Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them. These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic.

We synthesise them in Table 1, coupled with a hair loss treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste. Each topic is accompanied by two examples from the novel and one concerning hair loss treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that hair loss treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.

2008). It is well known that media tries to attract spectatorsâ attention by making the news more appealing. However, they deal with the risk of expanding unreliable information, which may be pernicious for the public opinion. Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about hair loss treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al.

2020). Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost. (Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated.

Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin. (Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.

(Camus 2002, Part I)By then, Oranians continue rejecting the epidemic as an actual threat, completely immersed in that phase that dominates the beginning of all epidemics and is characterised by âdenial and disbeliefâ (Wigand, Becker, and Steger 2020, 443):A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. [â¦] The people of our town were no more guilty than anyone else, they merely forgot to be modest and thought that everything was still possible for them, which implied that pestilence was impossible. They continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine.

(Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic. While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic. As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing.

(Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one. As in La Peste, during hair loss treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.

Two outbuildings hastily cleared of other patients, their windows sealed up and the whole surrounded by a cordon sanitaire. (Camus 2002, Part I)He illustrates the need of frankness, the preference for clarity in language, which is often the clarity in thinking:No. I phoned Richard to say we needed comprehensive measures, not fine words, and that either we must set up a real barrier to the epidemic, or nothing at all. (Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to hair loss treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time.

[â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation. (Camus 2002, Part II)In hair loss treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual propecia, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again. This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby.

However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons. As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.

Cited by Haroutunian 1964, 312 (translation is ours)), and that âthere is not love to human life but with despair about human life.â (Camus 1958, 112â5. Cited by Haroutunian 1964, 312â3 (translation is ours)).People nowadays deal with resignation relying on daily life pleasures (being not allowed to make further plans or trips) and in company from the nearest ones (as they cannot gather with relatives living far away). Second, they observe the beginning of vaccination campaigns as a first step of the final stage, and summer 2021, reflecting what happened with summer 2020, has been fixed as a temporal horizon. This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the propecia.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then.

Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day. ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during hair loss treatment have rejected to be named as that. The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation.

There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence. (Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of hair loss treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.

That the plague bacillus affecting Oran is different from previous variants:â¦the microbe differed very slightly from the bacillus of plague as traditionally defined. (Camus 2002, Part II)Related to hair loss treatment new variants, they represent a challenge because of two main reasons. Their higher transmissibility and/or severity and their higher propensity to skip the effect of natural or treatment-induced immunity. Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al.

2021). In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one. However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it.

In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus. However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the hair loss treatment propecia.

Vaccination campaigns have started all over the world, and three types of hair loss treatments are being applied in the European Union, after their respective statements of efficacy and security (Baden et al. 2021. Polack et al. 2020. Voysey et al.

2021), while a fourth treatment has just recently been approved (EMA 2021a). Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al. 2021.

Polack et al. 2020), while others use a viral vector (Bos et al. 2020. Voysey et al. 2021).

They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al. 2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al.

2021. Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease. (Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion.

All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced. (Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in hair loss treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).

Camus knew how acutely increasing demands and hygienic requirements affect funeral habits during epidemics:Everything really happened with the greatest speed and the minimum of risk. (Camus 2002, Part III)Like many other processes during epidemics, the burial process becomes a protocol. When protocolised, everything seems to work well and rapidly. But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before.

Irony.The whole thing was well organized and the Prefect expressed his satisfaction. He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index. No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time.

For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-. (Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.

He does not pursue any other goal than doing his duty, thus humour (as a response to dire situations) stands out from him when he observes others celebrating irrelevant achievements, such as the Prefect with his burial protocol. In the field of medical ethics, Lengers has highlighted the importance of Camusâs perspective when considering âthe immediacy of life rather than abstract valuesâ (Lengers 1994, 250). Rieux himself is quite sure that his solid commitment is not âabstractâ, and, even if he falls into abstraction, the importance relies on protecting human lives and not in the name given to that task:Was it truly an abstraction, spending his days in the hospital where the plague was working overtime, bringing the number of victims up to five hundred on average per week?. Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it.

(Camus 2002, Part II)Farewells during hair loss treatment may have not been particularly pleasant for some families. Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well. Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which hair loss treatment has not evaded.

s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague. [â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.

(Camus 2002, Part III)The effects of the plague over the economic system are one of our recurrent topics (table 1). The plague in Oran, as it forces to close the city, impacts all trading exchanges. In addition, it forbids travellers from arriving to the city, with the economic influence that that entails:This plague was the ruination of tourism. (Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In hair loss treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant.

In theory, in the opinion of experts, this was a good sign. The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during hair loss treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978). In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed.

(Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates. The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.

Rats and figures. In this moment, the first ones reappear and the second ones seem to be declining:He had seen two live rats come into his house through the street door. Neighbours had informed him that the creatures were also reappearing in their houses. Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week.

They showed a decline in the disease. (Camus 2002, Part IV)Part VGiven that we continue facing hair loss treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ. hair loss treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate.

The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope. [â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

As we said, a more important role of scientific aspects is observed in hair loss treatment if compared with La Peste (an expected fact if considered that Camusâs story is an artistic work, that he skips sometimes the most complex scientific issues of the plague and that health sciences have evolved substantially during last decades). Oranians, in fact, achieve the end of the epidemic not through clearly identified scientific responses but with certain randomness:All one could do was to observe that the sickness seemed to be going as it had arrived. The strategy being used against it had not changed. It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives.

In a sense, its role was completed. (Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth. Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air.

Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following themâ¦ (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again. At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.

It was a cat, the first that had been seen since the spring. It stopped for a moment in the middle of the road, hesitated, licked its paw, quickly passed it across its right ear, then carried on its silent way and vanished into the night. Tarrou smiled. The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce.

However, when Camus speaks directly about normality, he highlights more appealing habits. He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafÃ©s. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ. In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so.

But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile. (Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to hair loss treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the propecia.In La Peste, love is also seen as a simple good to be fully recovered after the plague.

While Rieux goes through the ârebornâ Oran, it is loversâ gatherings what he highlights. Unlike them, everyone who, during the epidemic, sought for goals different from love (such as faith or money, for instance) remain lost when the epidemic has ended:For all the people who, on the contrary, had looked beyond man to something that they could not even imagine, there had been no reply. (Camus 2002, Part V)And this is because lovers, as the narrator says:If they had found that they wanted, it was because they had asked for the only thing that depended on them. (Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?.

Ââ So the papers say. A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already. Â Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches. He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â).

We have also got used, during hair loss treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ. Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during hair loss treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.

We want rulers to be less aware of their own image and to stress truthfulness as a goal, even if this is a hard requirement not only for them, but for every single person. Language is essential in this issue, we think, since it is prone to be twisted and to become untrue. The old asthmatic man illustrates it with his âThereâll be speechesâ and his âOur deadâ¦â, but this is not the only time in the novel in which Camus brings out the topic. For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms.

(Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionalsâ¦ and, if we extend the scope, to every single citizen. Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during hair loss treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come. When hair loss treatment will have passed, it will be time for us as well to review our life during these months.

For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..

IntroductionLa Peste (Camus 1947) has served as how much does propecia cost per month a basis for several critical works, including some in the field of medical humanities (Bozzaro a fantastic read 2018. Deudon 1988. Tuffuor and Payne how much does propecia cost per month 2017).

Frequently interpreted as an allegory of Nazism (with the plague as a symbol of the German occupation of France) (Finel-Honigman 1978. Haroutunian 1964), it has also received philosophical readings beyond the sociopolitical context in which it was written (Lengers 1994). Other scholars, on the other hand, have centred their analyses on its literary aspects (Steel 2016).The hair loss treatment propecia has increased general interest about historical and fictional epidemics how much does propecia cost per month.

La Peste, as one of the most famous literary works about this topic, has been revisited by many readers during recent months, leading to an unexpected growth in sales in certain countries (Wilsher 2020. Zaretsky 2020). Apart from that, commentaries about the novel, especially among health sciences scholars, have emerged with how much does propecia cost per month a renewed interest (Banerjee et al.

2020. Bate 2020. Vandekerckhove 2020 how much does propecia cost per month.

Wigand, Becker, and Steger 2020). This sudden curiosity is easy to understand if we consider both La Pesteâs literary value, and peopleâs desire to discover real or fictional situations similar to theirs. Indeed, Oran inhabitantsâ experiences are not quite far from our own, even if geographical, chronological and, specially, scientific factors (two different diseases occurring at two different stages in the history of medical development) prevent us how much does propecia cost per month from establishing too close resemblances between both situations.Furthermore, it will not be strange if hair loss treatment serves as a frame for fictional works in the near future.

Other narrative plays were based on historical epidemics, such as Daniel Defoeâs A Journal of the Plague Year or Giovanni Boccaccioâs Decameron (Wigand, Becker, and Steger 2020. Withington 2020). The biggest propecia in the last century, the so-called âSpanish Influenzaâ, has been described as not very fruitful in this sense, even if it produced famous novels how much does propecia cost per month such as Katherine A Porterâs Pale Horse, Pale Rider or John OâHaraâs The Doctor Son (Honigsbaum 2018.

Hovanec 2011). The overlapping with another disaster like World War I has been argued as one of the reasons explaining this scarce production of fictional works (Honigsbaum 2018). By contrast, we may think that hair loss treatment is having a global impact hardly overshadowed by other events, and that it will leave a significant mark on the collective memory.Drawing on the reading how much does propecia cost per month of La Peste, we point out in this essay different aspects of living under an epidemic that can be identified both in Camusâs work and in our current situation.

We propose a trip throughout the novel, from its early beginning in Part I, when the Oranians are not aware of the threat to come, to its end in Part V, when they are relieved of the epidemic after several months of ravaging disasters.We think this journey along La Peste may be interesting both to health professionals and to the lay person, since all of them will be able to see themselves reflected in the characters from the novel. We do not skip critique of some aspects related to the authoritiesâ management of hair loss treatment, as Camus does concerning Oranâs rulers. However, what we want to foreground is La Pesteâs intrinsic value, its suitability to how much does propecia cost per month be read now and after hair loss treatment has passed, when Camusâs novel endures as a solid art work and hair loss treatment remains only as a defeated plight.MethodsWe confronted our own experiences about hair loss treatment with a conventional reading of La Peste.

A first reading of the novel was used to establish associations between those aspects which more saliently reminded us of hair loss treatment. In a second reading, we searched for some examples to illustrate those aspects and tried to detect new associations. Subsequent readings of certain parts were done to integrate the information collected how much does propecia cost per month.

Neither specific methods of literary analysis, nor systematic searches in the novel were applied. Selected paragraphs and ideas from Part I to Part V were prepared in a draft copy, and this manuscript was written afterwards.Part ISome phrases in the novel could be transposed word by word to our situation. This one pertaining to its start, for instance, may make us remember the first months of 2020:By now, it will be easy to accept that nothing could lead the people how much does propecia cost per month of our town to expect the events that took place in the spring of that year and which, as we later understood, were like the forerunners of the series of grave happenings that this history intends to describe.

(Camus 2002, Part II)Later, he will insist in this opposition between the concepts of âindividualâ, which used to prevail before the epidemic, and âcollectiveâ:One might say that the first effect of this sudden and brutal attack of the disease was to force the citizens of our town to act as though they had no individual feelings. (Camus 2002, Part II)There were no longer any individual destinies, but a collective history that was the plague, and feelings shared by all. (Camus 2002, Part III)This distinction is not trivial, since the story will display a strong confrontation between those who get involved and help their neighbours and how much does propecia cost per month those who remain behaving selfishly.

Related to this, Claudia Bozzaro has pointed out that the main topic in La Peste is solidarity and auistic love (Bozzaro 2018). We may add that the disease is so attached to peopleâs lives that the epidemic becomes the new everyday life:In the morning, they would return to the pestilence, that is to say, to routine. (Camus 2002, how much does propecia cost per month Part III)Being collective issues does not mean that epidemics always enhance auism and solidarity.

As said by Wigand et al, they frequently produce ambivalent reactions, and one of them is the opposition between auism and maximised profit (Wigand, Becker, and Steger 2020). Therefore, the dichotomy between individualism and collectivism, a central point in the characterisation of national cultures (Hofstede 2015), could play a role in epidemics. In fact, concerning hair loss treatment, some authors have described a greater how much does propecia cost per month impact of the propecia in those countries with higher levels of individualism (Maaravi et al.

Thus, it is important to consider that individualism is not always opposed to âlook after each otherâ (Ozkan et al. 2021, 9). For instance, the European region, seen as a whole as highly âindividualisticâ, holds some of the most advanced welfare protection systems worldwide.

It is worth considering too that collectivism may hide sometimes a hard institutional authority or a lack in civil freedoms.Coming back to La Peste, we may think that Camusâs Oranians are not particularly âcollectivistâ. Their initial description highlights that they are mainly interested in their own businesses and affairs:Our fellow-citizens work a good deal, but always in order to make money. They are especially interested in trade and first of all, as they say, they are engaged in doing business.

(Camus 2002, Part I)And later, we see some of them trying selfishly to leave the city by illegal methods. By contrast, we observe in the novel some examples of more âcollectivisticâ attitudes, such as the discipline of those quarantined at the football pitch, and, over all, the main charactersâ behaviour, which is generally driven by auism and common goals.Turning to another topic, the plague in Oran and hair loss treatment are similar regarding their animal origin. This is not rare since many infectious diseases pass to humans through contact with animal vectors, being rodents, especially rats (through rat fleas), the most common carriers of plague bacteria (CDC.

N.d.a, ECDC. N.d, Pollitzer 1954). Concerning hair loss, even if further research about its origin is needed, the most recent investigations conducted in China by the WHO establish a zoonotic transmission as the most probable pathway (Joint WHO-China Study Team 2021).

People nowadays have become very used to the statistical aspects of the propecia, due to the continuous updates in epidemiological parameters launched by the media and the authorities. Camus was aware about the relevance of figures in epidemics, which always entail:â¦required registration and statistical tasks. (Camus 2002, Part II)Because of this, the novel is scattered with numbers, most of them concerning the daily death toll, but others mentioning the number of rats picked up, as we have seen, or combining the number of deaths with the time passed since the start of the epidemic:â Will there be an autumn of plague?.

Professor B answers. Â Noâ â, â One hundred and twenty-four dead. The total for the ninety-fourth day of the plague.â (Camus 2002, Part II)We permit ourselves to introduce here a list of recurring topics in La Peste, since the salience of statistical information is one of them.

These topics, some of which will be treated later, appear several times in the novel, in various contexts and stages in the evolution of the epidemic. We synthesise them in Table 1, coupled with a hair loss treatment parallel example extracted from online press. This ease to find a current example for each topic suggests that they are not exclusive of plague or of Camusâs mindset, but shared by most epidemics.View this table:Table 1 Recurring topics in La Peste.

Each topic is accompanied by two examples from the novel and one concerning hair loss treatment, extracted from online press.Talking about journalism and the media (one of the topics above), we might say that hair loss treatmentâs coverage is frequently too optimistic when managing good news and too alarming when approaching the bad. Mediaâs âexaggeratedâ approach to health issues is not new. It was already a concern for medical journalsâ editors a century ago (Reiling 2013) and it continues to be it for these professionals in recent times (Barbour et al.

Related to the intention of âgarnishingâ the news, Aslam et al. (2020) have described that 82% of more than 100â000 pieces of information about hair loss treatment appearing in media from different countries carried an emotional, either negative (52%) or positive (30%) component, with only 18% of them considered as âneutralâ (Aslam et al. 2020).

Some evidence about this tendency to make news more emotional was described in former epidemics. For instance, a study conducted in Singapore in 2009 during the H1N1 crisis showed how press releases by the Ministry of Health were substantially transformed when passed to the media, by increasing their emotional appeal and by changing their dominant frame or their tone (Lee and Basnyat 2013). In La Peste, this superficial way of managing information by the media is also observed:The newspapers followed the order that they had been given, to be optimistic at any cost.

(Camus 2002, Part IV)At the first stages of the epidemic in Oran, journalists proclaim the end of the dead ratsâ invasion as something to be celebrated. Dr Rieux, the character through which Camus symbolises caution (and comparable nowadays to trustful scientists, well-informed journalists or sensible authorities), exposes then his own angle, quite far from suggesting optimism:The vendors of the evening papers were shouting that the invasion of rats had ended. But Rieux found his patient lying half out of bed, one hand on his belly and the other around his neck, convulsively vomiting reddish bile into a rubbish bin.

(Camus 2002, Part I)Camus, who worked as a journalist for many years, insists afterwards on this cursory interest that some media devote to the epidemic, more eager to grab the noise than the relevant issues beneath it:The press, which had had so much to say about the business of the rats, fell silent. This is because rats die in the street and people in their bedrooms. And newspapers are only concerned with the street.

Why should they have thought about the plague, which negates the future, negates journeys and debate?. They considered themselves free and no one will ever be free as long as there is plague, pestilence and famine. (Camus 2002, Part I)Probably to avoid citizens' disapproval, among other reasons, the Oranian Prefecture (health authority in Camus' novel) does not want to go too far when judging the relevance of the epidemic.

While not directly exposed, we can guess in this fragment the tone of the Prefectâs message, his intention to convey confidence despite his own doubts:These cases were not specific enough to be really disturbing and there was no doubt that the population would remain calm. None the less, for reasons of caution which everyone could understand, the Prefect was taking some preventive measures. If they were interpreted and applied in the proper way, these measures were such that they would put a definite stop to any threat of epidemic.

As a result, the Prefect did not for a moment doubt that the citizens under his charge would co-operate in the most zealous manner with what he was doing. (Camus 2002, Part I)The relevant role acquired by health authorities during epidemics is another topic listed in our table. Language use, on the other hand, is an issue linkable both with the media topic and with this one.

As in La Peste, during hair loss treatment we have seen some public figures using words not always truthfully, carrying out a careful selection of words that serves to the goal of conveying certain interests in each moment. Dr Rieux refers in Part I to this language manipulation by the authorities:The measures that had been taken were insufficient, that was quite clear. As for the â specially equipped wardsâ, he knew what they were.

(Camus 2002, Part I)At the end of this part, his fears about the inadequacy of not taking strict measures are confirmed. Oranian hospitals become overwhelmed, as they are now in many places worldwide due to hair loss treatment.Part IILeft behind the phases of âdenial and disbeliefâ and of âfear and panicâ, it appears among the Oranians the âacceptance paired with resignationâ (Wigand, Becker, and Steger 2020, 443):Then we knew that our separation was going to last, and that we ought to try to come to terms with time. [â¦] In particular, all of the people in our town very soon gave up, even in public, whatever habit they may have acquired of estimating the length of their separation.

(Camus 2002, Part II)In hair loss treatment as well, even if border closure has not been so immovable as in Oran, many people have seen themselves separated from their loved ones and some of them have not yet had the possibility of reunion. This is why, in the actual propecia, the idea of temporal horizons has emerged like it appeared in Camusâs epidemic. In Spain, the general lockdown in March and April 2020 made people establish the summer as their temporal horizon, a time in which they could resume their former habits and see their relatives again.

This became partially true, and people were allowed in summer to travel inside the country and to some other countries nearby. However, there existed some reluctance to visit ill or aged relatives, due to the fear of infecting them, and some families living in distant countries were not able to get together. Moreover, autumn brought an increase in the number of cases (âthe second waveâ) and countries returned to limit their internal and external movements.Bringing all this together, many people nowadays have opted to discard temporal horizons.

As Oranians, they have noted that the epidemic follows its own rhythm and it is useless to fight against it. Nonetheless, it is in human nature not to resign, so abandoning temporal horizons does not mean to give up longing for the recovery of normal life. This vision, neither maintaining vain hopes nor resigning, is in line with Camusâs philosophy, an author who wrote that âhope, contrary to what it is usually thought, is the same to resignation.â (Camus 1939, 83.

This preference for summers has an unavoidable metaphorical nuance, and their linking to joy, long trips and life in the streets may be the reason for which we choose them to be opposed to the lockdown and restrictions of the propecia.We alluded previously to the manipulation of language, and figures, as relevant as they are, they are not free from manipulation either. Tarrou, a close friend to Dr Rieux, points out in this part of the novel how this occurred:Once more, Tarrou was the person who gave the most accurate picture of our life as it was then. Naturally he was following the course of the plague in general, accurately observing that a turning point in the epidemic was marked by the radio no longer announcing some hundreds of deaths per week, but 92, 107 and 120 deaths a day.

ÂThe newspapers and the authorities are engaged in a battle of wits with the plague. They think that they are scoring points against it, because 130 is a lower figure than 910.â (Camus 2002, Part II)Tarrou collaborates with the health teams formed to tackle the plague. Regarding these volunteers and workers, Camus refuses to consider them as heroes, as many essential workers during hair loss treatment have rejected to be named as that.

The writer thinks their actions are the natural behaviour of good people, not heroism but âa logical consequenceâ:The whole question was to prevent the largest possible number of people from dying and suffering a definitive separation. There was only one way to do this, which was to fight the plague. There was nothing admirable about this truth, it simply followed as a logical consequence.

(Camus 2002, Part II)We consider suitable to talk here about two issues which represent, nowadays, a great part of hair loss treatment fears and hopes, respectively. New genetic variants and treatments. Medical achievements are another recurrent issue included in table 1, and we write about them here because it is in Part II where Camus writes for the first time about treatments, and where it insists on an idea aforementioned in Part I.

Public health professionals are determining which is the actual threat of all the new variants discovered, such as those first characterised in the UK (Public Health England 2020), South Africa (Tegally et al. 2021) or Brazil (Fujino et al. 2021).

In La Peste, Dr Rieux is always suspecting that the current bacteria they are dealing with is different from the one in previous epidemics of plague. Since several genetic variations for the bacillus Yersinia pestis have been characterised (Cui et al. 2012), it could be possible that the epidemic in Oran originated from a new one.

However, we should not forget that we are analysing a literary work, and that scientific accuracy is not a necessary goal in it. In fact, Rieuxâs reluctances have to do more with clinical aspects than with microbiological ones. He doubts since the beginning, relying exclusively on the symptoms observed, and continues doing it after the laboratory analysis:I was able to have an analysis made in which the laboratory thinks it can detect the plague bacillus.

However, to be precise, we must say that certain specific modifications of the microbe do not coincide with the classic description of plague. (Camus 2002, Part II)Camus is consistent with this idea and many times he mentions the bacillus to highlight its oddity. Insisting on the literary condition of the work, and among other possible explanations, he is maybe declaring that that in the novel is not a common (biological, natural) bacteria, but the Nazism bacteria.Turning to treatments, they constitute the principal resource that the global community has to defeat the hair loss treatment propecia.

2020. Voysey et al. 2021), while a fourth treatment has just recently been approved (EMA 2021a).

Although some concerns regarding the safety of two of these treatments have been raised recently (EMA 2021b. EMA 2021c), vaccination plans are going ahead, being adapted according to the state of knowledge at each moment. Some of these treatments are mRNA-based (Baden et al.

2021. Polack et al. 2020), while others use a viral vector (Bos et al.

They are mainly two-shot treatments, with one exception (Bos et al. 2020), and complete immunity is thought to be acquired 2âweeks after the last shot (CDC. N.d.b, Voysey et al.

2021). Other countries such as China or Russia, on the other hand, were extremely early in starting their vaccination campaigns, and are distributing among their citizens different treatments than the aforementioned (Logunov et al. 2021.

Zhang et al. 2021).Even if at least three types of plague treatments had been created by the time the novel takes place (Sun 2016), treatments do not play an important role in La Peste, in which therapeutic measures (the serum) are more important than prophylactic ones. Few times in the novel the narrator refers to prophylactic inoculations:There was still no possibility of vaccinating with preventive serum except in families already affected by the disease.

(Camus 2002, Part II)Deudon has pointed out that Camus mixes up therapeutic serum and treatment (Deudon 1988), and in fact there exists a certain amount of confusion. All along the novel, the narrator focuses on the prophylactic goals of the serum, which is applied to people already infected (Othonâs son, Tarrou, Grandâ¦). However, both in the example above (which can be understood as vaccinating household contacts or already affected individuals) and in others, the differences between treating and vaccinating are not clear:After the morning admissions which he was in charge of himself, the patients were vaccinated and the swellings lanced.

(Camus 2002, Part II)In any case, this is another situation in which Camus stands aside from scientific matters, which are to him less relevant in his novel than philosophical or literary ones. The distance existing between the relevance of treatments in hair loss treatment and the superficial manner with which Camus treats the topic in La Peste exemplifies this.Part IIIIn part III, the plagueâs ravages become tougher. The narrator turns his focus to burials and their disturbance, a frequent topic in epidemicsâ narrative (table 1).

But this perfect mechanism is the Prefectureâs goal, not Rieuxâs. He reveals in this moment an aspect in his character barely shown before. Irony.The whole thing was well organized and the Prefect expressed his satisfaction.

He even told Rieux that, when all was said and done, this was preferable to hearses driven by black slaves which one read about in the chronicles of earlier plagues. Â Yes,â Rieux said. Â The burial is the same, but we keep a card index.

No one can deny that we have made progress.â (Camus 2002, Part III)Even if this characteristic may seem new in Dr Rieux, we must bear in mind that he is the story narrator, and the narration is ironic from time to time. For instance, speaking precisely about the burials:The relatives were invited to sign a register âwhich just showed the difference that there may be between men and, for example, dogs. You can keep check of human beings-.

(Camus 2002, Part III)In Camusâs philosophy, the absurd is a core issue. According to Lengers, Rieux is ironic because he is a kind of Sisyphus who has understood the absurdity of plague (Lengers 1994). The response to the absurd is to rebel (Camus 2013), and Rieux does it by helping his fellow humans without questioning anything.

Yes, there was an element of abstraction and unreality in misfortune. But when an abstraction starts to kill you, you have to get to work on it. (Camus 2002, Part II)Farewells during hair loss treatment may have not been particularly pleasant for some families.

Neither those dying at nursing homes nor in hospitals could be accompanied by their families as previously, due to corpses management protocols, restrictions of external visitors and hygienic measures in general. However, as weeks passed by, certain efforts were made to ease this issue, allowing people to visit their dying beloved sticking to strict preventive measures. On the other hand, the number of people attending funeral masses and cemeteries was also limited, which affected the conventional development of ceremonies as well.

Hospitals had to deal with daily tolls of deaths never seen before, and the overcrowding of mortuaries made us see rows of coffins placed in unusual spaces, such as ice rinks (transformation of facilities is another topic in table 1).We turn now to two other points which hair loss treatment has not evaded. s among essential workers and epidemicsâ economic consequences. The author links burials with s among essential workers because gravediggers constitute one of the most affected professions, and connects this fact with the economic recession because unemployment is behind the large availability of workers to replace the dead gravediggers:Many of the male nurses and the gravediggers, who were at first official, then casual, died of the plague.

[â¦] The most surprising thing was that there was never a shortage of men to do the job, for as long as the epidemic lasted. [â¦] When the plague really took hold of the town, its very immoderation had one quite convenient outcome, because it disrupted the whole of economic life and so created quite a large number of unemployed. [â¦] Poverty always triumphed over fear, to the extent that work was always paid according to the risk involved.

(Camus 2002, Part II)Oranians, who, as we saw, were very worried about making money, are especially affected by an event which jeopardises it. In hair loss treatment, for one reason or for another, most of the countries are suffering economic consequences, since the impact on normal life from the epidemic (another recurrent topic) means also an impact on the normal development of trading activities.Part IVIn Part IV we witness the first signals of a stabilisation of the epidemic:It seemed that the plague had settled comfortably into its peak and was carrying out its daily murders with the precision and regularity of a good civil servant. In theory, in the opinion of experts, this was a good sign.

The graph of the progress of the plague, starting with its constant rise, followed by this long plateau, seemed quite reassuring. (Camus 2002, Part IV)At this time, we consider interesting to expand the topic about the transformation of facilities. We mentioned the case of ice rinks during hair loss treatment, and we bring up now the use of a football pitch as a quarantine camp in Camusâs novel, a scene which has reminded some scholars of the metaphor of Nazism and concentration camps (Finel-Honigman 1978).

In Spain, among other measures, a fairground was enabled as a field hospital during the first wave, and it is plausible that many devices created with other purposes were used in tasks attached to healthcare provision during those weeks, as occurred in Oranâs pitch with the loudspeakers:Then the loudspeakers, which in better times had served to introduce the teams or to declare the results of games, announced in a tinny voice that the internees should go back to their tents so that the evening meal could be distributed. (Camus 2002, Part IV)Related to this episode, we can also highlight the opposition between science and humanism that Camus does. The author alerts us about the dangers of a dehumanised science, of choosing procedures perfectly efficient regardless of their lack in human dignity:The men held out their hands, two ladles were plunged into two of the pots and emerged to unload their contents onto two tin plates.

The car drove on and the process was repeated at the next tent.â Itâs scientific,â Tarrou told the administrator.â Yes,â he replied with satisfaction, as they shook hands. Â Itâs scientific.â (Camus 2002, Part IV)Several cases with favourable outcomes mark Part IV final moments and prepare the reader for the end of the epidemic. To describe these signs of recovering, the narrator turns back to two elements with a main role in the novel.

Behind the walls of other houses there was a hustle and bustle that had not been heard for months. Rieux waited for the general statistics to be published, as they were at the start of each week. They showed a decline in the disease.

(Camus 2002, Part IV)Part VGiven that we continue facing hair loss treatment, and that forecasts about its end are not easy, we cannot compare ourselves with the Oranians once they have reached the end of the epidemic, what occurs in this part. However, we can analyse our current situation, characterised by a widespread, though cautious, confidence motivated by the beginning of vaccination campaigns, referring it to the events narrated in Part V.Even more than the Oranians, since we feel further than them from the end of the problem, we are cautious about not to anticipate celebrations. From time to time, however, we lend ourselves to dream relying on what the narrator calls âa great, unadmitted hopeâ.

hair loss treatment took us by surprise and everyone wants to âreorganiseâ their life, as Oranians do, but patience is an indispensable component to succeed, as fictional and historical epidemics show us.Although this sudden decline in the disease was unexpected, the towns-people were in no hurry to celebrate. The preceding months, though they had increased the desire for liberation, had also taught them prudence and accustomed them to count less and less on a rapid end to the epidemic. However, this new development was the subject of every conversation and, in the depths of peopleâs hearts, there was a great, unadmitted hope.

[â¦] One of the signs that a return to a time of good health was secretly expected (though no one admitted the fact) was that from this moment on people readily spoke, with apparent indifference, about how life would be reorganized after the plague. (Camus 2002, Part V)We put our hope on vaccination. Social distancing and other hygienic measures have proved to be effective, but treatments would bring us a more durable solution without compromising so hardly many economic activities and social habits.

It had been ineffective yesterday, and now it was apparently successful. One merely had the feeling that the disease had exhausted itself, or perhaps that it was retiring after achieving all its objectives. In a sense, its role was completed.

(Camus 2002, Part V)They receive the announcement made by the Prefecture of reopening the townâs gates in 2âweeks time with enthusiasm. Dealing with concrete dates gives them certainty, helps them fix the temporal horizons we wrote about. This is also the case when they are told that preventive measures would be lifted in 1âmonth.

Camus shows us then how the main characters are touched as well by this positive atmosphere:That evening Tarrou and Rieux, Rambert and the rest, walked in the midst of the crowd, and they too felt they were treading on air. Long after leaving the boulevards Tarrou and Rieux could still hear the sounds of happiness following themâ¦ (Camus 2002, Part V)Then, Tarrou points out a sign of recovery coming from the animal world. In a direct zoological chain, infected fleas have vanished from rats, which have been able again to multiply across the city, making the cats abandon their hiding places and to go hunting after them again.

At the final step of this chain, Tarrou sees the human being. He remembers the old man who used to spit to the cats beneath his window:At a time when the noise grew louder and more joyful, Tarrou stopped. A shape was running lightly across the dark street.

The little old man, too, would be happy. (Camus 2002, Part V)Unpleasant things as a town with rats running across its streets, or a man spending his time spitting on a group of cats, constitute normality as much as the reopening of gates or the reboot of commerce. However, when Camus speaks directly about normality, he highlights more appealing habits.

He proposes common leisure activities (restaurants, theatres) as symbols of human life, since he opposes them to Cottardâs life, which has become that of a âwild animalâ:At least in appearance he [ Cottard ] retired from the world and from one day to the next started to live like a wild animal. He no longer appeared in restaurants, at the theatre or in his favourite cafÃ©s. (Camus 2002, Part V)We do not disclose why Cottardâs reaction to the end of the epidemic is different from most of the Oraniansâ.

In any case, the narrator insists later on the assimilation between common pleasures and normality:â Perhaps,â Cottard said, â Perhaps so. But what do you call a return to normal life?. Â â New films in the cinema,â said Tarrou with a smile.

(Camus 2002, Part V)Cinema, as well as theatre, live music and many other cultural events have been cancelled or obliged to modify their activities due to hair loss treatment. Several bars and restaurants have closed, and spending time in those who remain open has become an activity which many people tend to avoid, fearing contagion. Thus, normality in our understanding is linked as well to these simple and pleasant habits, and the complete achievement of them will probably signify for us the desired defeat of the propecia.In La Peste, love is also seen as a simple good to be fully recovered after the plague.

(Camus 2002, Part V)We have spoken before about language manipulation, hypocrisy and public figuresâ roles during epidemics. Camus, during Dr Rieuxâs last visit to the old asthmatic man, makes this frank and humble character criticise, with a point of irony, the authoritiesâ attitude concerning tributes to the dead:â Tell me, doctor, is it true that theyâre going to put up a monument to the victims of the plague?. Ââ So the papers say.

A pillar or a plaque.ââ I knew it!. And thereâll be speeches.âThe old man gave a strangled laugh.â I can hear them already. Â Our deadâ¦â Then theyâll go and have dinner.â (Camus 2002, Part V)The old man illustrates wisely the authoritiesâ propensity for making speeches.

He knows that most of them usually prefer grandiloquence rather than common words, and seizes perfectly their tone when he imitates them (âOur deadâ¦â). We have also got used, during hair loss treatment, to these types of messages. We have also heard about âour old peopleâ, âour youthâ, âour essential workersâ and even âour deadâ.

Behind this tone, however, there could be an intention to hide errors, or to falsely convey carefulness. Honest rulers do not usually need nice words. They just want them to be accurate.We have seen as well some tributes to the victims during hair loss treatment, some of which we can doubt whether they serve to victimsâ relief or to authoritiesâ promotion.

For instance, he does so when he equates silence (nothing can be thought as further from wordiness) with truth:It is at the moment of misfortune that one becomes accustomed to truth, that is to say to silence. (Camus 2002, Part II)or when he makes a solid statement against false words:â¦I understood that all the misfortunes of mankind came from not stating things in clear terms. (Camus 2002, Part IV)The old asthmatic, in fact, while praising the deceased Tarrou, remarks that he used to admire him because âhe didnât talk just for the sake of it.â (Camus 2002, Part V).Related to this topic, what the old asthmatic says about political authorities may be transposed in our case to other public figures, such as scholars and researchers, media leaders, businessmen and women, health professionalsâ¦ and, if we extend the scope, to every single citizen.

Because hypocrisy, language manipulation and the fact of putting individual interests ahead of collective welfare fit badly with collective issues such as epidemics. Hopefully, also examples to the contrary have been observed during hair loss treatment.The story ends with the fireworks in Oran and the depiction of Dr Rieuxâs last feelings. While he is satisfied because of his medical performance and his activity as a witness of the plague, he is concerned about future disasters to come.

When hair loss treatment will have passed, it will be time for us as well to review our life during these months. For now, we are just looking forward to achieving our particular âpart Vâ.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions.

Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

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