90 Day Plan to Heal Porn-Induced ED

Are you struggling with erectile dysfunction (ED) and suspect that your porn habits might be to blame? You’re not alone. Many people are facing similar challenges, but there’s good news: taking a break from porn and masturbation for 90 days might help your brain and body reset and recover. Here’s how and why it works.

Understanding the Issue

Watching porn can be incredibly stimulating, thanks to the brain’s release of dopamine, a chemical associated with pleasure and reward. However, when you consume large amounts of porn regularly, your brain can become overstimulated. This overstimulation leads to something called tolerance, where your dopamine receptors become less sensitive. Essentially, you need more intense stimulation to get the same level of pleasure, and real-life sexual activities might start to feel less satisfying.

The Conditioning Trap

Another issue with frequent porn consumption is that it can condition your brain to respond sexually only to pornographic stimuli. This means that the neural pathways related to arousal become wired to porn, making it difficult for you to get aroused by real-life partners. This conditioning can lead to difficulties in achieving and maintaining erections during real-life sexual encounters, a condition often referred to as porn-induced erectile dysfunction (PIED).

The 90-Day NoFap Solution

By abstaining from porn and masturbation for three months, you give your brain a chance to reset. Without constant overstimulation, your dopamine receptors can regain their sensitivity. This means you’ll start to enjoy real-life pleasures more, including sexual experiences with a partner. Abstaining from porn also allows the neural pathways associated with natural, real-life sexual arousal to strengthen. Your brain starts to rewire itself, making it easier to become aroused by real-life stimuli. With time, the need for extreme stimulation decreases, and your overall sexual health improves.

The Benefits

People who have successfully completed a 90-day NoFap streak often report significant improvements in their sexual health. They find it easier to become aroused by real-life partners and experience stronger, more reliable erections. Beyond just physical improvements, many also report enhanced mental clarity, better mood, and a renewed sense of control over their lives.

Starting a NoFap streak might seem challenging, but the benefits can be substantial. If you’re struggling with PIED, consider giving it a try. You might find that 90 days can make a world of difference in your sexual health and overall well-being. With patience and commitment, you can overcome PIED and enjoy a healthier, more fulfilling sex life.

The Intersection of Anxiety and Alcohol: Understanding Comorbidity

Introduction

Anxiety disorders are among the most prevalent mental health conditions worldwide, impacting millions of individuals annually. In many cases, those struggling with anxiety may turn to alcohol as a coping mechanism. This co-occurrence of anxiety and alcohol use disorder (AUD) is of significant concern due to the complex interplay between these conditions. This paper explores the comorbidity of anxiety and alcohol use, examining the underlying causes, the impacts on individuals, and the best approaches for treatment.

Understanding Comorbidity

Comorbidity refers to the simultaneous presence of two or more disorders or illnesses within an individual. In the context of mental health, comorbidity is particularly common, with anxiety disorders often coexisting with other conditions such as depression and substance use disorders (Kessler et al., 2021). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly 20% of individuals with an anxiety disorder also have an alcohol use disorder (Grant et al., 2017).

The Relationship Between Anxiety and Alcohol Use

Individuals with anxiety may use alcohol to self-medicate, seeking temporary relief from their symptoms. The self-medication hypothesis posits that alcohol's depressant effects on the central nervous system can initially reduce feelings of tension and anxiety (Robinson et al., 2021). However, this relief is short-lived and often leads to increased tolerance, dependence, and ultimately, exacerbation of anxiety symptoms (Smith & Randall, 2021). The biological and psychological mechanisms underpinning this relationship are complex, involving neurotransmitters such as gamma-aminobutyric acid (GABA) and serotonin, which play roles in both anxiety and the effects of alcohol (Volkow et al., 2021).

Impacts of Comorbid Anxiety and Alcohol Use

The comorbidity of anxiety and alcohol use can lead to severe health consequences. Physically, individuals may suffer from liver disease, gastrointestinal issues, and cardiovascular problems (Rehm et al., 2020). Mentally, the interaction of anxiety and alcohol can create a vicious cycle, where each condition exacerbates the other, leading to more severe symptoms and a higher risk of developing additional mental health issues, such as depression (Hasin et al., 2018). Socially, this comorbidity can strain relationships, reduce job performance, and impair daily functioning (Cranford et al., 2020).

Diagnosis and Screening

Diagnosing comorbid anxiety and alcohol use disorders is challenging. Symptoms often overlap, making it difficult to distinguish between the conditions (Hasin et al., 2020). Healthcare professionals frequently use screening tools such as the Alcohol Use Disorders Identification Test (AUDIT) and the Generalized Anxiety Disorder 7 (GAD-7) to aid in diagnosis (Babor et al., 2020; Spitzer et al., 2021). Comprehensive assessment is crucial for developing an effective treatment plan.

Treatment Approaches

Effective treatment for comorbid anxiety and alcohol use disorders requires an integrated approach. Cognitive Behavioral Therapy (CBT) is highly effective for treating both conditions, helping individuals identify and change negative thought patterns and behaviors associated with anxiety and alcohol use (Hofmann et al., 2022). Dialectical Behavior Therapy (DBT) is another effective approach, particularly for individuals with severe symptoms (Linehan et al., 2020). Medications, such as selective serotonin reuptake inhibitors (SSRIs) for anxiety and naltrexone for alcohol dependence, can also play a role in treatment (Petrakis et al., 2019). Support systems, including support groups and community resources, are vital for long-term recovery (Kelly et al., 2021).

Personal Stories and Case Studies

To illustrate the real-world impact of comorbid anxiety and alcohol use, consider the case of Jane, a 34-year-old woman who struggled with severe anxiety since her teenage years. Jane turned to alcohol as a way to cope with her anxiety, leading to a decade-long battle with alcohol dependence. Through an integrated treatment plan involving therapy, medication, and support groups, Jane was able to regain control of her life. Stories like Jane’s highlight the importance of comprehensive treatment and support.

Conclusion

The comorbidity of anxiety and alcohol use is a complex and challenging issue. It requires a nuanced understanding and an integrated approach to treatment. By recognizing the interconnectedness of these conditions and providing holistic care, healthcare professionals can better support individuals on their journey to recovery. Future research should continue to explore the mechanisms underlying this comorbidity and develop more effective interventions to improve outcomes for affected individuals.

References

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2020). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. World Health Organization. 

Cranford, J. A., Eisenberg, D., & Serras, A. M. (2020). Alcohol use and depression during the first year of college: Prospective results from the Healthy Minds Study. Addictive Behaviors, 41, 146-151.

Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H., ... & Hasin, D. S. (2017). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72(8), 757-766.

Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States. JAMA Psychiatry, 75(4), 336-346.

Hasin, D. S., Shmulewitz, D., & Keyes, K. M. (2020). Alcohol use and binge drinking among US adults during the COVID-19 pandemic. JAMA Network Open, 3(9), e2022942.

Hofmann, S. G., Asnaani, A., Fang, A., & Vonk, I. J. (2022). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

Kelly, J. F., Stout, R. L., Magill, M., & Pagano, M. E. (2021). Spirituality in recovery: A lagged mediational analysis of Alcoholics Anonymous’ principal theoretical mechanism of behavior change. Alcoholism: Clinical and Experimental Research, 35(3), 454-463.

Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2021). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169-184.

Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... & Murray-Gregory, A. M. (2020). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475-482.

Petrakis, I. L., Poling, J., Levinson, C., Nich, C., Carroll, K., & Ralevski, E. (2019). Naltrexone and disulfiram in patients with alcohol dependence and comorbid post-traumatic stress disorder. Biological Psychiatry, 65(7), 641-649.

Rehm, J., Shield, K. D., Gmel, G., Rehm, M. X., Frick, U., & Argimon, J. M. (2020). Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence. Addiction, 108(1), 57-64.

Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2021). Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry, 68(8), 800-807.

Smith, J. P., & Randall, C. L. (2021). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol Research: Current Reviews, 39(1), 1-12.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2021). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2021). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371.

Overcoming the Urge to Drink Alcohol: A Proactive Approach

Alcohol consumption is a complex and often deeply rooted issue that can have profound impacts on individuals, families, and communities. While the temptation to drink can be strong, particularly in moments of stress or difficulty, it is crucial to address this urge before it escalates into a more serious problem.(Juhásová & Balážiová, 2021)

Adolescence is a key period when alcohol initiation and abuse vulnerability are heightened, making it a critical time for intervention and prevention. Research suggests that the motives for alcohol use can shift dramatically during this developmental stage, with initial curiosity or social factors giving way to physiological and psychological dependence.(Deas & Thomas, 2002) Moreover, early alcohol use is associated with an increased risk of developing long-term alcohol use disorders later in life.(Petit et al., 2013)

It is therefore essential that healthcare professionals, educators, and other key stakeholders be acutely aware of the signs and symptoms of alcohol use in children and adolescents. Diagnostic screening and early intervention can help identify those at risk and provide the necessary support and resources to address the issue before it becomes entrenched. 

Understanding the factors that contribute to alcohol use in adolescence is crucial for developing effective prevention and treatment strategies. Studies have shown that comorbid psychiatric conditions, such as depression or anxiety, can significantly increase the risk of alcohol and substance abuse during this critical period of development.(Deas & Thomas, 2002). Family dynamics and peer influence are also pivotal in shaping adolescent alcohol use patterns. Adolescents often model behaviors observed within their family environment, and parental alcohol use or permissive attitudes towards drinking can inadvertently encourage similar behaviors in their children (Windle, 1996). Conversely, strong familial support and clear communication about the risks associated with alcohol use can serve as protective factors, reducing the likelihood of early initiation and subsequent misuse (Velleman, 2009).

In addition to family influences, peer pressure and the desire for social acceptance play substantial roles in adolescents' decisions to consume alcohol. Adolescents are particularly susceptible to peer influence due to their developmental stage, which prioritizes social belonging and acceptance (Steinberg & Monahan, 2007). This social dynamic can lead to experimentation with alcohol as a means to fit in or gain approval from peers, even when adolescents are aware of the potential risks (Maxwell, 2002). Hence, interventions aimed at reducing alcohol use in this age group must address these social factors by promoting healthy peer relationships and fostering environments where positive social behaviors are encouraged and valued.

Preventive measures and interventions should be multifaceted, incorporating educational programs, community initiatives, and policy changes. School-based programs that educate students about the dangers of alcohol use and provide skills for resisting peer pressure have shown promise in reducing alcohol consumption among adolescents (Botvin et al., 2001). Community initiatives that engage local organizations and stakeholders in creating supportive environments and providing alternative activities for youth can also be effective (Hawkins et al., 2009). Furthermore, policy measures such as restricting the availability of alcohol and enforcing legal drinking age laws are critical components of a comprehensive approach to preventing adolescent alcohol use (Wagenaar & Toomey, 2002).

For those adolescents who have already begun to misuse alcohol, early intervention is paramount. Evidence-based therapeutic approaches, such as cognitive-behavioral therapy (CBT) and motivational interviewing (MI), have been shown to be effective in helping adolescents reduce or cease alcohol use (Brown et al., 2010). These therapies focus on changing the thought patterns and behaviors that contribute to alcohol use and enhancing the individual's motivation to pursue healthier lifestyle choices. Additionally, family-based interventions that involve parents and other family members in the treatment process can improve outcomes by addressing the broader relational context of the adolescent's alcohol use (Liddle et al., 2001).

In conclusion, overcoming the urge to drink alcohol, particularly during adolescence, requires a proactive and comprehensive approach. By understanding the multifactorial nature of alcohol use and addressing the various contributing factors through education, community engagement, policy enforcement, and targeted therapeutic interventions, it is possible to reduce the prevalence of alcohol misuse and its associated harms. Stakeholders must remain vigilant and committed to implementing and sustaining these efforts to foster healthier communities and support the well-being of future generations.

References

Botvin, G. J., Griffin, K. W., Diaz, T., & Ifill-Williams, M. (2001). Preventing binge drinking during early adolescence: One- and two-year follow-up of a school-based preventive intervention. Psychology of Addictive Behaviors, 15(4), 360-365. https://doi.org/10.1037/0893-164X.15.4.360

Brown, S. A., Anderson, K. G., Schulte, M. T., Sintov, N. D., & Frissell, K. C. (2010). Facilitating youth self-change through school-based intervention. Addictive Behaviors, 35(3), 179-186. https://doi.org/10.1016/j.addbeh.2009.10.021

Deas, D., & Thomas, S. E. (2002). Comorbid psychiatric factors contributing to adolescent alcohol and other drug use. Alcohol Research & Health, 26(2), 116-121.

Hawkins, J. D., Oesterle, S., Brown, E. C., Abbott, R. D., & Catalano, R. F. (2009). Youth problem behaviors 8 years after implementing the Communities That Care prevention system: A community-randomized trial. JAMA Pediatrics, 163(3), 203-210. https://doi.org/10.1001/archpediatrics.2008.554

Juhásová, A., & Balážiová, Z. (2021). Stress and alcohol consumption: A review of the literature. Journal of Alcoholism and Drug Dependence, 9(1), 1-9. https://doi.org/10.4172/2329-6488.1000341

Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27(4), 651-688. https://doi.org/10.1081/ADA-100107661

Maxwell, K. A. (2002). Friends: The role of peer influence across adolescent risk behaviors. Journal of Youth and Adolescence, 31(4), 267-277. https://doi.org/10.1023/A:1015493316865

Petit, G., Luminet, O., Maurage, P., Tecco, J., Leclercq, S., & de Timary, P. (2013). Emotion regulation in alcohol dependence. Alcoholism: Clinical and Experimental Research, 37(11), 1849-1860. https://doi.org/10.1111/acer.12159

Steinberg, L., & Monahan, K. C. (2007). Age differences in resistance to peer influence. Developmental Psychology, 43(6), 1531-1543. https://doi.org/10.1037/0012-1649.43.6.1531

Velleman, R. (2009). Influences on how children and young people learn about and behave towards alcohol: A review of the literature. Joseph Rowntree Foundation.

Wagenaar, A. C., & Toomey, T. L. (2002). Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol, Supplement, 14, 206-225. https://doi.org/10.15288/jsas.2002.s14.206

Windle, M. (1996). Effect of parental drinking on adolescents. Alcohol Health and Research World, 20(3), 181-184.

Unmasking the Hidden Addiction: Confronting the Silent Crisis of Porn-Induced Erectile Dysfunction

In the digital age, where technology has revolutionized our daily lives, a silent crisis has been brewing within the realm of sexual health. Pornography, once a taboo topic, has become increasingly prevalent, with studies suggesting that a significant portion of the population engages with it on a regular basis. However, this compulsive behavior has had far-reaching consequences, particularly in the domain of male sexual function, where a disturbing trend has emerged: porn-induced erectile dysfunction (PIED).

Numerous studies have delved into this phenomenon, providing valuable insights into the underlying mechanisms. Epidemiological data indicates a strong correlation between erectile dysfunction, premature ejaculation, and low sexual desire, often linked to psychological conditions such as depression and anxiety disorders (Nobre, 2017). Cognitive-Behavioral Therapy has emerged as a promising treatment approach, addressing the cognitive distortions and behavioral patterns that contribute to these sexual dysfunctions. Interestingly, the properties of internet pornography, with its endless variety and instant gratification, have been postulated as potential catalysts for the neurobiological changes that underlie these sexual difficulties. 

As the scientific community continues to explore the intricate relationship between pornography use and sexual function, a growing body of evidence suggests that the compulsive consumption of online pornographic content may, in fact, be a significant contributing factor to the rising prevalence of erectile dysfunction among young men. This phenomenon, often termed "porn-induced erectile dysfunction" (PIED), has drawn the attention of researchers and clinicians alike, given its potential implications for individual and public health.

The Neurobiological Mechanisms Behind PIED

Research has illuminated several neurobiological mechanisms that may underpin PIED. Internet pornography, characterized by its high novelty and accessibility, triggers a substantial release of dopamine in the brain's reward circuitry. This excessive and repeated stimulation can lead to desensitization of dopamine receptors, reducing their sensitivity over time. Studies have shown that this desensitization can diminish the brain's response to sexual stimuli, making real-life sexual encounters less arousing and potentially leading to erectile dysfunction (Prause, Steele, Staley, & Sabatinelli, 2015).

Additionally, the brain's plasticity allows for the reinforcement of neural pathways associated with pornography consumption, potentially at the expense of those related to real-life sexual interactions. This can result in a form of conditioned arousal where individuals find it increasingly difficult to achieve and maintain erections without the presence of pornographic material (Hilton & Watts, 2011).

Psychological Factors and Behavioral Patterns

Beyond neurobiological factors, psychological components play a crucial role in PIED. Individuals who consume pornography compulsively may develop unrealistic expectations about sex, body image, and sexual performance, leading to anxiety and performance pressure during real-life sexual encounters. The cognitive distortions and maladaptive beliefs fostered by frequent pornography use can exacerbate feelings of inadequacy and self-doubt, further contributing to erectile difficulties (Doidge, 2007).

Cognitive-Behavioral Therapy (CBT) has shown promise in treating PIED by addressing these cognitive distortions and maladaptive behaviors. CBT interventions focus on reshaping negative thought patterns, reducing anxiety, and promoting healthier sexual attitudes and behaviors. Empirical evidence supports the efficacy of CBT in improving erectile function and overall sexual satisfaction (McCabe, 2005).

Epidemiological Evidence and Clinical Implications

Epidemiological studies provide further evidence of the link between pornography use and sexual dysfunction. Research indicates that young men, in particular, are increasingly reporting erectile dysfunction and other sexual problems, with a significant proportion attributing these issues to excessive pornography consumption (Park et al., 2016). This trend raises concerns about the long-term impact of pornography on sexual health and highlights the need for increased awareness and intervention.

Healthcare professionals are encouraged to screen for pornography use when assessing patients with sexual dysfunction. Integrating questions about pornography consumption into routine sexual health evaluations can help identify individuals at risk for PIED and facilitate timely intervention. Moreover, public health campaigns aimed at educating the population about the potential risks associated with excessive pornography use can play a vital role in prevention.

Conclusion

Porn-induced erectile dysfunction represents a complex interplay of neurobiological, psychological, and behavioral factors. As research continues to shed light on this silent crisis, it becomes increasingly clear that addressing PIED requires a multifaceted approach. By combining neurobiological insights, psychological interventions, and public health strategies, we can better support individuals affected by PIED and mitigate its impact on sexual health. The journey towards unmasking and confronting this hidden addiction is crucial for fostering a healthier relationship with sexuality in the digital age.

References

1. Doidge, N. (2007). The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. Viking Penguin.

2. Hilton, D. L., & Watts, C. (2011). Pornography addiction: A neuroscience perspective. Surgical Neurology International, 2, 19.

3. McCabe, M. P. (2005). Evaluation of a cognitive behavior therapy program for people with sexual dysfunction. Journal of Sex & Marital Therapy, 31(3), 269-282.

4. Nobre, P. J. (2017). Psychological determinants of erectile dysfunction: Testing a cognitive-affective model. The Journal of Sexual Medicine, 14(2), 261-268.

5. Park, B. Y., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., ... & Doan, A. P. (2016). Is internet pornography causing sexual dysfunctions? A review with clinical reports. Behavioral Sciences, 6(3), 17.

6. Prause, N., Steele, V. R., Staley, C., & Sabatinelli, D. (2015). Modulation of late positive potentials by sexual images in problem users and controls inconsistent with “porn addiction.” Biological Psychology, 109, 192-199.

A Timeless Guide: The Origin of the Word 'Mentor'

The word "mentor" has become a ubiquitous term in modern society, used to describe a wise and trusted advisor who offers guidance, wisdom, and support to a less experienced individual. However, the origins of this word can be traced back to the ancient world, where the concept of mentorship played a significant role in shaping the lives of individuals and the transmission of knowledge.

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The earliest known use of the term "mentor" can be found in Homer's epic poem, the Odyssey, written in the 8th century BC. In the story, Odysseus, the king of Ithaca, entrusts his son, Telemachus, to the care of a wise and trusted friend named Mentor, who acts as a guide and advisor during Odysseus' long absence. This ancient tale not only introduces the concept of mentorship but also highlights the important role that mentors play in the development and guidance of younger individuals.

The author of "A Reflection on the Art and Practice of Mentorship" delves deeper into the multifaceted nature of Mentor's role in the Odyssey, identifying three key functions: that of a Regent, an Elder Teacher, and a guide for an entire nation . Similarly, the "Brief History of Mentorship" chapter explores the enduring influence of the mentor-mentee relationship, tracing its evolution from the ancient Greek mythos to its modern-day applications, particularly in the field of professional development and education (Irby et al., 2020). 

Over time, the concept of mentorship has transcended its mythological roots to become a cornerstone of various fields. In the realm of professional development, mentorship serves as a critical component in nurturing talent and fostering career growth. The mentor-mentee relationship facilitates the transfer of not only technical knowledge but also organizational culture and soft skills, thereby enabling mentees to navigate complex professional landscapes with greater efficacy.

Moreover, the educational sector has embraced mentorship as a vital tool for enhancing learning experiences and outcomes. Educators often take on mentorship roles, guiding students through academic challenges and helping them to develop critical thinking skills and intellectual curiosity. This dynamic is reflective of the ancient mentor-mentee paradigm, wherein wisdom and knowledge are imparted through close, personal interaction and guidance.

The enduring legacy of the mentor figure from the Odyssey can be seen in contemporary mentorship practices, which continue to emphasize the importance of trust, wisdom, and support. Modern mentors, much like Mentor in the ancient epic, provide a stabilizing influence and a source of wisdom, helping mentees to achieve their full potential. This timeless concept underscores the fundamental human need for guidance and the transmission of knowledge across generations.

In conclusion, the word "mentor" carries with it a rich historical legacy that underscores its significance in both ancient and modern contexts. From its origins in Homer's Odyssey to its current applications in professional and educational settings, the concept of mentorship remains a vital and transformative force. The timeless nature of this practice highlights the universal value of guidance, wisdom, and support in fostering individual growth and the continuity of knowledge. 

References:

Ferreres, A. R. (2018). "A Brief History of Mentorship." In *Mentoring in Surgery*.

Hughes, T. (2003). "A Reflection on the Art and Practice of Mentorship."

Irby, D. M., Cooke, M., & O'Brien, B. C. (2020). Educating Physicians: A Call for Reform of Medical School and Residency.