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Sometimes we want to fungus gnats weed purchase generic fulvicin from india converse with another person; sometimes we want to fungus gnats mosquito dunks buy fulvicin 250mg with visa have that conversation sexually zeasorb antifungal treatment discount fulvicin 250mg without a prescription. In still other contexts or moods, we will not want to talk with anyone at all, but spend time alone. We might want to avoid intercourse, of both types, with human beings, those hordes from whose noisy prattle we try to escape by running off to Montana-not an "ultimate retreat," but a blessed haven, a sanctuary. For Solomon to call masturbation "empty" or inferior in the face of such facts about the importance of context to human sexuality in its many forms is to confess that he did not understand the implications of his own crucial qualification. Indeed, it is jolting to behold him, in an argument reminiscent of religious objections to contraception (viz. A man pleasing himself by masturbating is not taking advantage of economically and socially less powerful women; he is not refurbishing the infrastructure of his fragile ego at the expense of womankind. He is, instead, flouting cultural standards of masculinity that instruct him that he must perform sexually with women in order to be a man. Stoltenberg does not merely condemn masturbating with pornography (35­36, 42­43, 49­50). Further, mental sexual objectification makes its own contribution to violence against women (54­55). He supposes that when a man fantasizes sexually about women, he reduces them from persons to objects. Further, when a man thinks of women as things, he has given himself carte blanche in his behavior toward them, including violence: regarding an object, "you can do anything to it you want" (55). There are innumerable lifeless objects to which I would never lay a hand, because other people value them, and I value these people, or because I myself dearly value the objects. Her smile, the way she moves down the stairs, the bounce of her tush, the sexy thoughts in her own mind, her lusty yearning for me-these are mere parts of her. But fantasizing or imagining them while masturbating, or driving my car, or having coffee, need not amount to, indeed is the opposite of, my reducing her to plastic. These are fantasies about people, not things, and they remain people during the fantasy. My fantasy of her (having a) fantasy of me (or of her having a fantasy of my [having a] fantasy of her) is structurally too sophisticated to be called crude objectification. The fantasizer makes himself in his consciousness both subject and object and imagines his partner as both subject and object. Finnis immediately mentions, creating the impression that these sexual activities are his primary targets, that "in masturbating, as in being. Being married is, we can grant, often conducive or contributes to the value of sexual activity. Even so, what is objectionable about sexual activity between two single consenting adults who care about and enjoy pleasing each other? No: the friends might only be seeking pleasure for its own sake, as often occurs in sodomy and masturbation. What if the friends say that they do have a common good, their friendship, the same way a married couple has the common good that is their marriage? Finnis tries to explain, and in doing so reveals the crux of his sexual philosophy: the common good of friends who are not and cannot be married (man and man, man and boy, woman and woman) has nothing to do with their having children by each other, and their reproductive organs cannot make them a biological (and therefore a personal) unit. Finnis began with the Kantian intuition that sexual activity involves treating the body instrumentally, and he concludes with the Kantish intuition that sex in marriage avoids disintegrity since the couple is a biological "unit," or insofar as "the orgasmic union of the reproductive organs of husband and wife really unites them biologically. The psychic falling apart each person would undergo in nonmarital sex is prevented in marital sex by their joining into one; this bolstering of the self against a metaphysical hurricane is gained by the tempestuous orgasm, of all things. After all, if marriage has the "double blessing" of procreation and friendship, the same double blessing is available to heterosexual friends. Would Finnis want to claim, in reply, that if these friends are committed to each other and plan to, or do, have children with each other, they are in effect married and hence their sexual interactions are fine? No genuine commitment (or love, or union) exists without a formal compact; a promise too easily fled is no promise at all. For Roger Scruton, another conservative who condemns masturbation, the ephemeral self is in continual danger of being exposed as a fraud: "In my [sexual] desire [for you] I am gripped by the illusion of a transcendental unity behind the opacity of [your] flesh.

At the same time fungus gnats lawn discount fulvicin 250mg, the ratio of the average price of generic products to antifungal ointment discount fulvicin 250mg line originator products decreased rapidly over the course of the study period (figure F-6) antifungal lacquer buy genuine fulvicin line. Four years after patent expiration, the generic price was just 20 percent of the originator price. Manufacturers continue to increase the real price of their drugs as their share of the market in unit volume falls. The real price increases dampen the rapid decline in unit sales that follows generic competition. Because the sample of drugs did not include injectable and infusible products, however, the rate must be adjusted for the probable impact of these hospital products on the rate of loss of sales. Generic substitution is much more common in hospitals, where strong formularies and centralized pharmacies can control prescribing and dispensing more thoroughly, and where the incentives are strong to purchase the least expensive version of a drug for hospitalized patients. About 23 percent of all ethical pharmaceutical sales are to hospitals, which would imply that about 14 percent of sales overall are for these products. Table F-5 shows the resulting estimates of year-to-year changes in sales relative to the year of patent expiration. Table F-5-Change in Originator Brand Revenues for Drugs Losing Patent Protection, 1984-87 Rate of change excluding injectable and infusible drugsb (percent) Rate of change in injectable and infusible drugsc (percent) 1. Appendix G Estimating the Cost of Producing and Selling New Chemical Entities 1981-83, the cost of manufacturing, marketing and distribution in each year following market approval must be subtracted from net revenues. Precise estimation of such costs is impossible from published financial statements because companies produce a variety of products but report costs on a consolidated basis across all operations. Additional investments may be necessary as time goes on, especially if the drug is one that has a high unit volume. Product campaigning refers to the scheduling of production runs of different products on the same equipment and using the same facility. Campaign production generally reduces fixed facility costs because it allows different products to share the same facility and equipment and reduces down time of equipment. Costs are incurred in preparing the facility and equipment for new production runs, but the overall manufacturing process is generally cheaper when dedicated facilities do not have to be built. The cost of sharing plant and equipment among different biotechnology drugs is much higher because of the more stringent U. The sales-weighted average ratio of cost of goods sold to total company sales for the sample of firms was 0. New methods for assigning costs to different products have been proposed but are not fully diffused into company practice (92,93,94,95). Z the six firms are Marion Merrell Dow (1989-90), Merck (1988-90), Schering-Plough (1989-91), Syntex (1989-91), Upjohn (1988-90), and Eli Lilly (1987-89). The potential for cont amination is greater with biological products than with synthetic compounds, and containment areas may be necessary. One biotechnology executive recently submitted a statement in congressional hearings that a dedicated bulk biopharmaceutical facility would cost approximately $25 million (31). The drugs approved in the period 1981-83 included only a very few biotechnology drugs, so the special manufacturing problems with these products were not present. A recent bulk pharmaceutical plant for TenorminTm, an antihypertension drug, cost $60 million to construct (382). Because of the uncertainty associated with this estimate we examined the impact on the estimated returns on R&D of an average expenditure for plant and equipment of $35 million. The administrative and marketing cost estimates include charges for depreciation on facilities used in these functions. In addition, the cost of sales includes any charges for depreciation on manufacturing facilities in excess of the depreciation that would be charged for the $25-million facility. Also, manufacturers of drugs in finished form often buy their bulk chemicals from fine chemical producers. Thus, the estimate of cost of goods sold contains an implicit rental charge for the value of the manufacturing facilities used to produce bulk chemicals purchased from other producers. Therefore, if the capital expenditures on plant and equipment were in reality higher than $25 million, the extra costs would be at least partially captured in residual depreciation charges and cost of materials embedded in the cost-of-sales estimates. One firm (Eli Lilly) reported over a 3-year period that 67 percent of marketing and administrative costs were for marketing. If this one firm is representative of the industry, administrative costs would be 11.

Selection of citations by an unsympathetic outsider can be dismissed as biased antifungal yogurt generic 250mg fulvicin with amex, and anyway piling on the anecdotes never amounts to fungus bob buy fulvicin 250mg with visa proof fungus gnats thuricide generic fulvicin 250 mg with amex. One columnist20 meditates on "demystifying the dick size complex," al- 118 Michael E. Levin though his ultimate point is that you will never meet anyone "cute" or "hot" if "they only send you a picture of their dick. Indeed, liberationist steps to domesticate homosexual habits underscore the salience of sex. But a typical publication aimed at a typical heterosexual readership-a newsmagazine or daily newspaper-contains no pictures of couples having intercourse or discussions of genitalia. Singles bars-the seeming heterosexual counterpart-are less central to heterosexual life than gay bars are to homosexual life. While men may frequent them mainly in the hope of finding sex partners, female habituйs are mainly looking for Mr. Right; above all, there are no facilities for sex on the premises, as there are in many homosexual venues. However, the hope of such encounters is not the premise for most heterosexual social events. Anthony Trollope lived openly with a woman (his wife), yet wrote novels on topics other than sex. The Principia Mathematica of Bertrand Russell (a notorious heterosexual womanizer) and Alfred North Whitehead (another "out" heterosexual) runs over two thousand pages yet never mentions anything long, hard, or throbbing. Rembrandt never tried to hide his taste for women, and produced many images of his son Titus, but seems to have been uninterested in heterosexual pornography. Because pride usually rests on an achievement or some outstanding personal quality, what ho- Against Homosexual Liberation 119 mosexuals qua homosexuals are supposed to be proud of is quite unclear. If it is the accomplishments of some homosexuals throughout history, as in "Rudolf Nureyev was gay, and so am I,"23 the typical heterosexual has more to be proud of: Aristotle, Einstein, and Bach were also straight. More than this, sameness of sexual orientation is far too tenuous a connection to sustain vicarious bragging. Aesthetic distaste is not the only reason to deplore homosexual preoccupation with sex and attendant fixations on youth and appearance. These concerns indicate time preferences too high to sustain civilization-not merely the high-tech world of the modern West, but any tolerable social order. Resources must be accumulated, goods produced, and investments allowed to ripen, all of which require deferral of gratification. Whenever a hunter patiently sharpens a spear to bring down larger game than he could attack with a stick, he forgoes present consumption. This exchange of the present for a lightly discounted future comes naturally to heterosexuals, imposed on them as it is by the fact of children. Heterosexuals must take an interest in what things will be like a generation or two hence, since that is the world their descendants (carrying their genes) will inhabit; homosexuals, without issue, feel no pressure to share this interest. Relatively long-term horizons seem intrinsic to heterosexuality itself; homosexuality is more present-oriented. Liberationists periodically seize on his theory to bolster alternatives to ordinary sexual morality, whether free love (marriage is a prison; Samoans can teach us how to relax) or, in the present instance, homophilia. In this connection psychoanalytic diagnoses are deployed to intimidate traditionalists: any foe of any sexual revolution must be "sick"-uptight, frigid, envious, or a secret self-hating homosexual. There is no evidence whatever that law and technology (the indicia of civilization) correlate with neurosis. Indeed, since social institutions are summations over individual preferences, bour- 120 Michael E. Levin geois sexual arrangements would long since have been discarded if they genuinely frustrated the mass of humanity. Nor did Freud appreciate that, since community-wide cooperative channeling of sexual energy into nonsexual tasks tends to enhance the inclusive fitness of community members, there has almost certainly been selection for willingness to sublimate. Far from seething with frustration that life is not one extended orgy, the average heterosexual would be less happy if it were. The joy of sexual anarchy is not a good that is, regretfully, outweighed by the advantages of order; given the opportunity by some cosmic intervener to act on homosexual time preferences, heterosexuals, including heterosexual men, would probably find them uncongenial and recur to the old ways. In the midst of an endless roundelay of copulation, men as well as women would find themselves falling in love, experiencing jealousy, desiring exclusivity, and inventing marriage. This return to a biological orientation brings up perhaps the strongest objection to cultural transformation, namely its sheer impossibility.

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Clinical trials of germ line therapy would have to antifungal wash fulvicin 250 mg otc demonstrate fungus wine purchase fulvicin no prescription, moreover fungus gnats grow room fulvicin 250 mg, that the inserted gene had no demonstrable effect during embryonic and fetal development. Providing evidence of safety in humans without being able to target gene insertion is difficult to imagine. Germ line gene therapy might be useful for conditions where damage accumulated during embryonic or fetal development, or if multiple organ systems had to be corrected. Germ line therapy would require techniques to insert genes into sperm or egg cells that currently do not exist (or into cells that produce them), or use of in vitro fertilization followed by treatment of early embryos. Prospective parents could more simply and safely choose to implant embryos that would not develop a disease, rather than treating embryos destined to do so. This alternative would not be available in one very unusual situation-if both parents had a recessive genetic disease. Both parents would carry double copies of a defective gene in this case, and so every embryo would likewise have a double dose of a gene defect and would thus be affected. These technical factors combine with a lack of consensus that germ line therapy is ethically acceptable to make germ line gene therapy unlikely in the foreseeable future, although it might resurface in the more distant future. Most genetic diseases have only palliative treatments, or only partially effective ones. The optimists foresaw that the problem of getting cells into specific target cells and in specified chromosomal locations would be solved. A tamed virus, perhaps inhaled or injected, would have to home in on those stem cells. In addition, the introduction would have to be sufficiently controlled 50 that when many millions of cells were treated, the gene insertion did not induce mutations leading to cancer or cause other unwanted side effects. Once stem cells were treated, it might not be necessary to continually administer drugs. In this sense, it would be more akin to organ transplantation or 130 I Pharmaceutical R&D: Costs, Risks and Rewards vaccination than to most drug treatments. Onetime treatment is an appealing prospect for diseases such as diabetes, where it would obviate daily injections of insulin. Fluctuations in drug levels often fail to synchronize with normal regulatory controls. This is particularly important for hormones and other substances produced in response to environmental changes. Skeptics note the technical difficulties in targeting specific cell types, in getting genes into identified chromosomal sites, and in the high costs of clinical trials and safety testing. Gene therapy might be useful for cancer therapy, fatal genetic diseases of childhood, and other extremely serious conditions lacking better therapy. Some of those surveyed acknowledged that these revolutionary treatments were imminent, but questioned whether they would prove economically viable on a grand scale. If the number of affected individuals is small and the treatment is expensive to develop and to administer, the clinical advantages of a one-time treatment could prove a commercial disadvantage. The costs of R&D might fall on a small number of patients and single doses, limiting access and boosting the unit price. The range of disorders that can be approached by gene therapy will not broaden appreciably until better cell targeting and chromosome-site targeting are possible, and these make well take a decade of research to develop, if they develop at all. The cost of the clinical trials has to date been funded directly by the National Institutes of Health, although this may change as more firms become involved in gene therapy development. At least three small biotechnology companies were founded with gene therapy as part of their business plan, but these are viewed as long-term investments and the companies are now concentrating on research and new methods. They aspire to turn a profit from marketable therapeutic products in the next several years. These small startup companies have been joined by eight or more larger pharmaceutical firms pursuing gene therapy technology. Even if they cannot sell gene therapy itself, however, they may be able to sell reagents for gene transfer to other researchers. Gene transfer methods are widely applicable beyond gene therapy, and so this market, while not comparable to a major therapeutic agent, might nonetheless sustain a small firm during its formative years. Current work includes collaborative agreements with larger pharmaceutical firms, that fired small exploratory research efforts. This strategy of making "antisense" sequences to block the production of proteins is being explored by several pharmaceutical companies for its possible therapeutic value. Drugs uncovered by chance clinical observations or systematic refinement of folk remedies early in the century have given way to pharmaceutical firms with thousands of scienThe dominant strategy of modern pharmaceutitific workers pursuing drug research.

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