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By: Jason M. Noel, PharmD, BCPP

  • Associate Professor, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland

Inflamma to heart arrhythmia 4 year old buy discount metoprolol 50mg line ry diseases of the genitalia (ovaritis blood pressure yoga ramdev metoprolol 100 mg mastercard, parametritis with sensation of prolapse); climacteric complaints (flushes blood pressure kit walgreens discount metoprolol 25mg free shipping, outbreaks of sweating) low pressure pulse jet bag filter buy metoprolol 25 mg with visa. Indications: Stimulative effect in enzymic disturbances or disturbances, of the protein metabolism. Rapidly acting remedy for seizures and cramp; conditions of collapse with hypothermia, imperceptible pulse, precordial anxiety; deglutition cramp and phrenospasms, spasmodic asthmatic coughs. Affects muscular and connective tissue; exhaustion accompanied by pain is typical. Pains and injuries in the musculature and ligamen to us apparatus (also rheumatism in soft tissues); tendovaginitis. Respira to ry disorders of the cells, as well as adjuvant in diabetes mellitus; further, in precancerous conditions and neoplasm phases. The main remedy for general de to xification as well as for oxygenation of glandular and muscular tissues. Degeneratively and to xically induced diseases of the cardiac muscle; myocardial insufficiency, post-infectious weakness of the cardiac muscle, athlete’s heart. Aphthae, eczema, dyspepsia, chronic gastroenteritis; haemorrhoids, burning, bluish red. Action on mucosa and skin, especially at the transitional region between the two (mouth, nose, urethra, vulva and anus) exanthema, especially on the forehead at the hairline; malodorous perspiration, splinter pains, tendency to haemorrhages, chronic nephritis. Neuralgia, attacks in circumscribed areas; paresthesia, paresis of the legs, oxaluria, hyperemesis, great excitation; all symp to ms worsened by thinking of them (see Ambra Injeel). Physical and mental exhaustion, poor memory, debilitating hyperhidrosis, painless diarrhoea; worsening of condition through cold, improvement by warmth. Conditions of nervous exhaustion with lumbago, notalgia, myalgia and arthralgia; neurasthenia; migraine, worsening of condition through heat and mental effort. Related closely to the haema to genic system: anaemia, leukaemia and also in anaemic headaches, following loss of blood, conditions of exhaustion. Chronic recurring infections of the renal pelvis and of the efferent urinary tracts. Chronic gastritis (chronic catarrh due to alcoholism); burning, painful haemorrhoids; hot flushes and sweats; tendency to haemorrhages. Disturbances of the intermediary uric acid metabolism; experimentally also for gout. Fever with a hot, dry skin, intense internal cold (“like ice in the veins“) and rigor. Indications: Therapeutical damage during or after long-term glucocorticoid medication. Experimentally also for disfunction of the anterior lobe of hypophysis or of the cortex of the suprarenal gland. More or less painful spherical, benign, firm small nodules in the mammae, mainly diffuse/multiple, in the form of pellets in the mammary gland, with typical premenstrual worsening of the disorder. Prostitis, prostatic adenoma, dysuria, strangury, as part of the other antihomo to xic therapy also for prostatic carcinoma. Disorders occurring after consumption of animal fats (particularly lard), cholesterolemia. Connective tissue blocking effect, adiposis, acne vulgaris; seborrhoea; acute and chronic eczema, biliary colic, blepharitis, hordeolums, chalazions. Disorders arising from homo to xins, released through loss of weight, including, for example, to o rapid slimming, fasting, dehydrating treatment, as a result of the massive deposition of adipose tissue (deposition phase) in the Iymphatic ducts and blood stream (intermediary decomposition to xins). Coronary diseases, especially accompanied by or after rheumatism; arrhythmia, tachycardia (with hyperthyroldlsm); endocarditis rheumatica). As adrenaline or epinephrine is contained in several allopathic remedies, however, Adrenalin-Injeel and forte are included here. Known side effects of epinephrine or adrenaline should be pointed out again here: palpitations, anginal disorders, disturbances of the ventricular rhythm, hyperglycaemia. Cramp, pains, vomiting followed by great exhaustion, milk is not to lerated (brought up immediately by children). Sensitivity to cool air, sensation of a lump being situated in epigastrium, chorea minor, tics, conditions of excitation; restlessness of the mo to r area; irritation, prickling and burning sensation of the skin. Remedy for disorders of the liver and gall-bladder; adjuvant for skin diseases; crural ulcers. Conditions of exhaustion, general weakness, hyperemesis gravidarum, dysmenorrhoea, fluor albus, disorders accompanying hysterop to sis (“the cinchona of the female reproductive system”). Digestive disorders, with eructation and pyrosis, in patients consuming large amounts of meat. Morning diarrhoea, incontinentia ani (involuntary passage of s to ols); plethora abdominalis. Great debility and exhaustion as well as irritability; dryness of the skin and mucosa; fluor albus. Hyperexcitability, nervous sparmodic cough, vertigo, lack of concentration and poor memory, all symp to ms worsened by thinking of them (see Acidum oxalicum-Injeel). Hay fever, pertussis, summer diarrhoea; helminthiasis with nervous, irritative conditions. Agranulocy to sis, leukopenia, endocardial, myocardial or pericardial impairment and renal damage, particularly when these are, or have been, associated with a rheumatic attack. This “precursor” of the local anesthetic procaine (p-amino-2’-diethylaminobenzoate) can, by resorptive means via the skin (benzocaine in the corresponding ointments), or via the mucosa (benzocaine in analgesic lozenges or dragees for painful oral and pharangeal infections, or in the treatment of gastritis with or without ulcer, involving the administration of liquid remedies, after which the patient is required to change position frequently), give rise to in to xication (formation of methaemoglobin). The Contra-Indications of local anesthetics in systemic and parenteral application are serious transfusion disorders and acute cardiac insufficiency. At higher dosages they may lead to bradycardia and disturbances of the rhythm of myocardial activity; possibly also to stupor and cramp. In addition, it should be pointed out that benzocaine can also cause eczema to us drug rashes, and in surface anesthesia, when a certain to tal dosage is exceeded, benzocaine can cause cerebral in to xication with disturbances of consciousness, aphnea or also signs of central nervous irritation, such as impairment of hearing, equilibrium and sight, as well as emesis and cramp; sometimes also in to xication of the myocardium (leading to acute, sometimes fatal, circula to ry failure). Circula to ry disorders, coronary disorders of the circulation, spasmodic bronchitis. Remedy for debility, chronic rhinitis, possibly with nasal haemorrhage (when washing); congestive catarrh. Coughs and catarrh, especially in hepatic disorders; pain in the heels, sciatica, worse when patient is seated. Hot flushes, particularly of the upper half of the body; facial flushes, angina pec to ris. Conditions of tension and cramp of the striped and smooth musculature; hypersensitivity of the senses. Koch (for literature see above), anthraquinone regenerates blocked cellular respiration enzymes by “burning away” accumulated to xins, (amines, etc. Ulceration of the skin with intense unbearable burning sensation, bluish violet to blackish blisters releasing purulent, malodorous, irritating fluid; possible tendency to gangrenous phlegmons, septicemia, swelling of the Iymph glands, parotitis septica, especially on the right side; gastro-enteritis, malodorous diarrhoea, whitlows, furuncles, carbuncles, erysipelas, acne vulgaris; acts well in association with Pyrogenium-Injeel. Bronchiolitis; bronchial asthma with circula to ry insufficiency and oedema, pulmonary emphysema, dyspnea. Gastritis (chalky-white coating of the to ngue); kera to sis (especially on the soles of the feet); rhagades; warts; eruptions with honey-yellow crusts; disorders worsened by cold bathing/washing but also by heat; the patient is fretful and morose throughout the day. In such cases pretreatment should first be given with antihomo to xic agents (Cactus compositum, Cralonin, Angio-Injeel, etc. Pale oedema, urticaria; stabbing, burning pains; development of cysts (right ovary); conjunctivitis, meningitic irritation, nephritis after scarlet fever; erysipelas (especially in the face); angina to nsillaris (right); serous discharges in pleuritis, etc. Side effects: Injeel forte: After subcutaneous injection, reddening of the skin may occur at the site of injection. Apomorphine hydrochloride exerts a stimulating action on the medullary centers, particularly on the vomiting and breathing centers. Chronic swelling of the Iymph glands, appendicitis and conditions of irritation; experimentally in chronic constipation. For supportive treatment of patients with carcinoma (catalytic effect on enzyme systems). Due to its high content of sodium hydrogen carbonate (approximately 3 g per litre of Dunaris source), it causes alkalinisation of acid tumour tissue. Attacks of asthma or irritating coughing immediately after falling asleep; hay fever.

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Disorders of the circulation (Haemodermal deposition or impregnation or degeneration phase) See angina pec to blood pressure 200 120 metoprolol 100 mg with mastercard ris blood pressure medication alcohol cheap metoprolol 25 mg fast delivery, claudication blood pressure chart for senior citizens generic metoprolol 100 mg on line, intermittent blood pressure medication long term effects buy metoprolol us, endarteritis obliterans, haemorrhoids, cardiac insufficiency, menopause, varicose veins, etc. Disturbance of circulation, peripheral (Haemodermal impregnation or deposition phases) (Main remedy: Aesculus compositum) Arteria-Heel 8-10 drops at 8 a. Aesculus compositum (in place of the aforementioned 10 drops 3-6 times daily) Lymphomyosot (drops, ampoules) for arteriosclerotic circula to ry disorders Selenium-Homaccord for cerebral circula to ry disorders Cardiacum-Heel for coronary circula to ry disorders Injection therapy Circulo-Injeel alternating with Cralonin drops as well as with Cor suis-Injeel (coronary vessels), Placenta suis-Injeel, Arteria suis lnjeel and possibly Aorta suis-Injeel once weekly i. Placenta compositum (constitutional therapy) once to twice weekly Bacterium proteus-Injeel (forte) (nosode as intermediate remedy) Coenzyme compositum (improvement of the enzyme systems) once weekly i. Disturbance of development (Mental) in children (Neurodermal impregnation and possibly degeneration phases) (main remedy: Nervoheel) Lymphomyosot at 8 a. Traumeel S tablets (regeneration of the sulphide enzymes) Galium Heel to be exchanged for Hormeel S (weekly). Injection therapy Cerebrum compositum (improvement of the cerebral function) and possibly Tonsilla compositum (Iymphatic circulation) for functional disorders of the liver, also Hepar compositum alternately i. Medorrhinum-Injeel (forte) and Stramonium-Injeel (forte) for fear of darkness Bacterium proteus-Injeel (forte) for bad-tempered children with paroxysms of rage Pertussis-Nosode-Injeel (forte) for whooping cough in the case his to ry Struma-Nosode-Injeel (forte) for symp to ms of myxoedema. Diverticulitis (En to dermal deposition, possibly degeneration, phase with transition to neoplasm phase) (Main remedy: Veratrum-Homaccord) Veratrum-Homaccord 8-10 drops at 8 a. Injection therapy Nux vomica-Homaccord, Veratrum-Homaccord and Galium-Heel alternating or mixed i. Bacterium coli-Injeel (forte), Salmonella typhi-Injeel and Salmonella paratyphi B-Injeel (forte), at intervals also Pyrogenium-Injeel and Su to xol-Injeel (forte) for nosode therapy. Coxsackie Virus-A9 or B4-Injeel (forte) in residual conditions of diseases of the gastro intestinal tract (resistance to therapy). Mucosa compositum (remedy for affections of the mucous membranes for intermediate injections). Strict prohibition of alcohol and su to xins, also nicotine should be scrupulously avoided. Down’s syndrome (General cellular degeneration phase – trisomy) Natrium-Homaccord 8-10 drops at 7 a. Galium-Heel as intermediate remedy once to twice daily (in the morning upon rising and in the evening upon retiring). Injection therapy Tonico-Injeel with Hypothalamus suis-Injeel and Glandula thyreoidea suis-Injeel on Mondays s. Neuro-Injeel ampoules with Cerebrum suis-Injeel and Glandula thymi suis-Injeel on Thursday s. In place of this treatment a transfer can also be made repeatedly at intervals to Cerebrum compositum (brain functions) and Testis compositum (for boys) or Ovarium compositum (girls) as well as to intermediate doses from the collective pack of catalysts of the citric acid cycle, Cystein-Injeel etc. Dumping syndrome (post-gastrec to my) (Organodermal impregnation phase) (Main remedy: Duodenoheel) Selenium-Homaccord 8-10 drops at 8 a. Anacardium-Homaccord (specific) Diarrheel S (diarrhoea) Traumeel S tablets (regeneration of the sulphide enzymes) Hepeel (improvement of the hepatic functions) Injection therapy Hepeel and Erigotheel on Mondays i. Ventriculus suis-Injeel, Hepar suis-Injeel, Sympathicus suis-Injeel once weekly i. Duodenitis (En to dermal reaction or impregnation phase) Duodenoheel 1 tablet 3 times daily Diarrheel S (meteorism) Injection therapy Erigotheel initially daily i. Mucosa compositum (constitutional therapy) See also ulcers, duodenal and ventricular. Dupuytren’s contracture (Mesenchymal impregnation or degeneration phase) (Main remedy: Graphites-Homaccord) Graphites-Homaccord 8-10 drops at 8 a. Traumeel S ointment to be massaged in twice daily; possibly also Calendula-Salbe-Heel S ointment or Hamamelis-Salbe-Heel S ointment to be used in alternation (often better action). Injection therapy Traumeel S and Funiculus umbilicalis suis-Injeel and possibly Calcium fluoratum-Injeel forte once to twice weekly i. Dysentery (En to dermal reaction phase) (Main remedies: Diarrheel S, Veratrum-Homaccord) Diarrheel S 1 tablet half-hourly to hourly, in addition Veratrum-Homaccord 8-10 drops at 8 a. Nux vomica-Homaccord for after-treatment Injection therapy Veratrum-Homaccord, Traumeel S and Nux vomica-Homaccord alternating or mixed i. Mercurius cyanatus-Injeel for dysentery with collapse, Colon suis-Injeel for after-treatment once weekly i. Mucosa compositum (after-treatment) Dysmenorrhoea (Germinodermal impregnation phase) (Main remedy: Spascupreel) Gynacoheel 8-10 drops at 8 a. Initially, and in serious disorders, 1/4 to 1/2 hourly alternating, according to the treatment only once each daily; Spascupreel alone is sufficient in many cases, 1 tablet or 1 supposi to ry every 1/4 hour on several occasions. Trichomonaden-Fluor-Injeel and Sanguis suis-Injeel, possibly also Urinum gravidarum D200 as intermediate injection Ovarium compositum and Placenta compositum (for constitutional therapy alternating i. Hepeel (influence on the hepatic function) Diarrheel S (as alternating remedy), possibly alone 3-6 times daily Vomitusheel (nausea) as alternating remedy (drops or supposi to ries) Spascupreel for spasms Injection therapy Nux vomica-Homaccord, Veratrum-Homaccord and Spascupreel, possibly Hepeel mixed or alternating i. Dyspnoea (En to dermal or haemodermal impregnation phase) (Main remedy: Ignatia-Homaccord) Aurumheel N drops 8-10 drops at 8 a. Injection therapy Arnica-Injeel (forte) S, Naja tripudians-Injeel forte, Carbo vegetabilis-Injeel, Phosphorus-Injeel (forte) S, Veratrum-Injeel (forte) S and Ignatia-Injeel (forte) S as mixed injection i. Dystrophia adiposogenitalis (Hypothalamic dysfunction) (Mesenchymal deposition phase, based on an impregnation phase of the pituitary gland) (Main remedy: Hormeel S) Hormeel S 8-10 drops at 8 a. Lymphomyosot as mesenchymal purge at intervals, 8-10 drops 3 times daily Schwef-Heel 8-10 drops 3 times daily to stimulate the general de to xification function possibly the above preparations taken to gether 2-4-6 times daily. Traumeel S tablets (resorptive mercury and enzyme-regenerating sulphide effect) Aesculus compositum (regulation of the peripheral circulation) Injection therapy Hormeel S, Graphites-Homaccord, Hypophysis suis-Injeel and Funiculus umbilicalis suis-Injeel on Mondays i. Galium-Heel, Engys to l N and Traumeel S with Testis suis-Injeel (or Ovarium suis Injeel) on Thursdays i. Testis compositum (for men) or Ovarium compositum (for women) with Thyreoidea compositum and possibly Tonsilla compositum. For the regulation of the hepatic functions, also Solidago compositum S (alternating or mixed once to twice weekly i. Ecthyma (pyogenic skin infection) (Ec to dermal reaction phase) (Main remedy: Psorinoheel) Psorinoheel 8-10 drops at 8 a. Mercurius-Heel S at intervals in exchange for Traumeel S Injection therapy Traumeel S, Cutis suis Injeel, Funiculus umbilicalis suis-Injeel and Psorinoheel alternating or mixed once to twice weekly i. Eczema (Ec to dermal reaction phase) (Main remedy: Graphites-Homaccord) In general: Schwef-Heel 8-10 drops 3 times daily Belladonna-Homaccord in the acute stage 8-10 drops 3-6 times daily Graphites-Homaccord in chronic cases 8-10 drops 3 times daily Simultaneous hepatic therapy approximately according to the following prescription: Sulfur-Heel 1 tablet at 8 a. Petroleum-Injeel (forte) (in the palm of the hand, behind the ears) Bacillinum-Injeel, Serum ovile-Injeel (allergies) Ovum-Injeel and Medorrhinum-Injeel (eczema of the but to cks in infants) for nosode therapy Asthma-Nosode-Injeel (chronic eczema) Mercurius solubilis-Hahnemanni-Injeel (forte S), alternating with Traumeel S (weeping pustular eczema) Cistus canadensis-Injeel (kera to sis and fissures in the palm of the hand) Cro to n tiglium-Injeel (eczema scroti, pustules and vesicles) Manganum carbonicum-Injeel (chronic eczema) Corallium rubrum-Injeel (coral-red rash) Acidum nitricum-Injeel (forehead-hairline, backs of the hands) Curare-Injeel (forte S) (in the face and behind the ears) Acidum muriaticum-Injeel (forte) S and Bovista-Injeel (backs of the hands) Adeps suillus-Injeel (forte) for consumers of pork Cistus canadensis-Injeel, Mercurius bijodatus-Injeel (forte S) and Petroleum-Injeel (forte) for eczema of the palms of the hands Cutis compositum (constitutional therapy) and possibly Hepar compositum (improvement of hepatic function) once to twice weekly i. For eczema of the scalp, mixed injections of the following are indicated: Lachesis-Injeel (forte) S, Cicuta virosa-Injeel, Spongia-Injeel (forte), Vinca minor-Injeel, Hepar sulfuris-Injeel (forte) i. Eczema, ani (Ec to dermal reaction phase) (Main remedy: Paeonia-Heel) Abropernol 1 tablet at 8 a. Cruroheel S (in place of Abropernol) possibly the above preparations taken to gether 2-4-6 times daily. Trichomonaden-Fluor-Injeel (intermediate remedy), Aethiops antimonialis-Injeel /weeping eczema ani). Eczema, baker’s (Ec to dermal reaction phase) (Main remedy: Graphites-Homaccord) Graphites-Homaccord 8-10 drops at 8 a. Schwef-Heel as reagent at intervals, 8-10 drops 1-3 times daily Lymphomyosot as mesenchymal purge, 8-10 drops 3 times daily Sulfur-Heel for severe irritation, at intervals, 1 tablet on several occasions Injection therapy Cutis suis Injeel, Glandula suprarenalis suis-Injeel and Hypophysis suis-Injeel with Traumeel S on Mondays i. Manganum carbonicum-Injeel and Sepia-Injeel (forte) for chronic eczema Graphites-Homaccord, Psorinoheel, Engys to l N and Funiculus umbilicalis suis-Injeel, possibly also Hepar suis-Injeel on Thursdays i. See also dermatitis, derma to ses, pemphigus, cradle cap, pityriasis versicolor, neurodermatitis, etc. Eczema of the audi to ry meatus (Ec to dermal reaction phase) (Main remedy: Lamioflur) Abropernol 1 tablet at 8 a. Traumeel S tablets (anti-inflamma to ry, antisuppurative action), Psorinoheel (chronic cases), Traumeel S ointment externally Injection therapy Traumeel S, alternating i. Ductus auricularis externus suis-Injeel, Cutis suis Injeel and Hepar suis-Injeel i. Cutis compositum (action on the constitution) and Acidum formicicum-Injeel (or D200) for progressive au to -sanguis therapy.

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Furthermore blood pressure 150100 cheap metoprolol 50mg fast delivery, there was a plea for greater discussion and debate within the community of experts on the risks of experiments prehypertension the rationale for early drug therapy discount metoprolol 25mg amex, as well as substantial efforts to heart attack enzyme test purchase metoprolol 25mg without a prescription raise awareness arrhythmia consultants of greater washington quality metoprolol 100 mg. Important was the observation that influenza is only one field which must deal with these issues: other viruses, bacteria 29 and parasites are also subject to concerns. There were more debates: in the autumn of 2013, both supporters and opponents of gain-of-function research approached the European Commission with open letters. The Netherlands Royal Academy of Arts and Sciences organised a debate on gain-of function in June 2014. It was emphasised that all researchers (for or against gain-of function) are devoted and driven people trying to solve important problems. There was a strong plea for an open discussion on these kinds of issues, not only within science, but also between scientists and the public. In this debate it became clear that the individual responsibility of scientists will not cease to be an important aspect for dealing with gain-of-function research. This responsibility can be strengthened by ethical review boards and codes of conduct. However, as standards need to be defined and as self 31 regulation may fail, regulation will always be necessary. This period of suspension is meant fi to launch a deliberative process to assess the potential risks and benefits associated with a subset of life sciences research known as figain-of-functionfi studies. With an ultimate goal of better understanding disease pathways, gain-of function studies aim to increase the ability of infectious agents to cause disease by 32 enhancing its pathogenicity or by increasing its transmissibilityfi. Incidents in major American labora to ries– although with other pathogens – may also have given the White House cause to take these rigorous measures. Many relevant issues were treated, such as scientific interest, benefits and risks, and safety. Earlier doubts about whether it was wise to use the concept of gain-of-function to describe the fiexperiments of concern‘ were repeated here. Another observation is that biosecurity issues got relatively little attention in the debates (see Box 2. It seems that the debate had shifted to scientific and biosafety arguments for and against such research. Questions on the possible dual use of this research were not very prominent in this debate, and neither 34 in a similar debate in Hannover. This is important because the gain-of-function debate started with questions on the possible dual use of these research experiments. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and chief of infectious diseases at the Veterans Affairs Palo Al to Health Care System in Palo Al to, California. He is also co-direc to r of the Center for International Security and Cooperation and senior fellow at the Freeman Spogli Institute for International Studies at Stanford University. Relman‘s primary research focus is the human indigenous microbiota (microbiome), and in particular, the nature and mechanisms of variation in patterns of microbial diversity and function within the human body, and the basis of microbial community resilience. He has become one of the most prominent participants in the gain-of-function debate. This can be illustrated with his contribution to a Hastings Centre Report: fiWe should also remember that research funders often issue calls for research proposals and write contracts that address requests for specified products. An example is the National Institutes of Health–sponsored Centers of Excellence in Influenza Research contract with Erasmus University that funded the deliberate construction of a highly pathogenic strain of avian influenza virus with enhanced transmissibility among mammals. First, certain kinds of experiments may have predictable outcomes that demand special scrutiny before they are undertaken and may deserve to be declared unethical and morally forbidden. For example, experiments that are designed and likely to yield novel biological agents with high degrees of transmissibility and high levels of virulence or resistance to all available countermeasures may incur highly consequential risks for much of the world‘s population. Typically, to o, there are substantial delays before the benefits might be realized. The undertaking of experiments with high potential for significant harm to large populations and limited or much-delayed benefit threatens to violate fundamental principles of justice. Government of a funding pause for certain gain-of function studies on three pathogenic respira to ry viruses, and of a more deliberative process for risk-benefit assessments, is a welcome step in focusing serious attention 35 on these issues. The shift to biosafety and more scientific arguments means that the debate more and more deals with questions such as: What knowledge is gained with these experimentsfi One reason for this shift may be that the use of the concept figain-of-functionfi for the disputed experiments has been to o broad and unspecified. As noted above, gain of-function research refers to many experiments in present day life sciences. Because of that it is understandable that life scientists are looking for scientific arguments to defend their research. But this shift seems also welcomed by the scientists who perform the disputed experiments, because it relocates the debate to a field (science, biosafety) where they are the experts and where they can argue using their professional expertise. Here the debate revolves around claims that the research results are in the shorter or longer term beneficial to science and to human and animal health, while opponents state that the studies are of no use to society and even dangerous. It is beyond dispute that these are very important issues that need to be dealt with. Paradoxically, it is doubtful that this debate on scientific and biosafety issues would have taken place if it had not been initiated by the biosecurity debate on both H5N1 experiments. The shift to biosafety and scientific arguments in the debate should not imply that biosecurity is seen as less relevant. If the political and social context is one of the fac to rs in determining the dual use character of a biological agent or an experiment – as it is proposed in the Report of the Royal Netherlands Academy of Arts and 37 Sciences – it can be easily observed that this context has not changed dramatically since the start of the H5N1 debate in 2011. Security experts could even defend the view that the threat level for a terrorist attack is now greater than a few years ago. Of course, it should also be acknowledged that the threat of a deliberate biological attack is a minor one within the broader spectrum of possible threats. Nevertheless it is important to pay attention to such questions as: what is the likelihood of the experiments being misused, for example by terroristsfi How realistic is the risk that terrorists or others will want to misuse the research results and can actually do sofi The problem is of course that it is very difficult to answer these and comparable questions, even for security experts. Many life scientists are inclined to play down or deny the possible misuse of their research. And on the other hand there are security experts who reason from worst case scenarios. And that brings us back to the lessons learned that already have been presented above. Raising awareness among life scientists of the possible misuse of their research; ii. More attention for the ethical, legal and social responsibilities of scientists; iii. More attention for the international character of biosecurity and dual use research; v. References 1 National Science Advisory Board for Biosecurity Findings and Recommendations March 29fi30, 2012, osp. Department of Health and Human Services Funding Decisions about Research Proposals with the Potential for Generating Highly Pathogenic Avian Influenza H5N1 Viruses that are Transmissible among Mammals by Respira to ry Droplets‘ (February 2013). They then collected a nasal wash from each infected ferret and inoculated another ferret after a few days. His research team found that only 5 mutations, 3 by reverse genetics and 2 by repeated transmission, were enough to produce this result. Malta 2011 10 By asking for a biosecurity review the edi to rial boards were following a policy procedure established in 2003 by various key life science journals: fi there is information that, although we cannot now capture it with lists or definitions, presents enough risk of use by terrorists that it should not be published. How and by what processes it might be identified will continue to challenge us. Department of Health and Human Services Funding Decisions about Research Proposals with the Potential for Generating Highly Pathogenic Avian Influenza H5N1 Viruses that are Transmissible among Mammals by Respira to ry Droplets‘. The report states that the public should be able to trust researchers and others involved to assess whether their results can be misused. The responsibility for making that assessment lies primarily with researchers and other parties in the knowledge chain. However, as most of them are no security experts, they should have the opportunity to request for advice on potential bio-security aspects of their research proposal or research results. This ability to advise on research with potential dual-use aspects requires knowledge and expertise in multiple areas (the science involved, labora to ry security, and national and international threat analyses). Report of a Debate between Prof Giorgio Palu and Prof Simon Wain-Hobson‘.

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