Respectful Insolence

Suzanne Somers annoys me.

She annoys me because, despite the fact that her statements and activities over the last 25 years reveal her to be probably no more intelligent than the character that she played on Three’s Company, she still feels the need to spread misinformation about diet and medicine in several books that she has written. Indeed, my annoyance at her was manifested very early in the history of this blog, when I mentioned her in the context of testimonials for alternative medicine treatments for breast cancer. The reason? In 2001, Somers was diagnosed with breast cancer. She underwent standard lumpectomy and radiation therapy but made a great show of eschewing chemotherapy (it is unclear if she underwent axillary lymph node sampling or dissection), opting instead for Iscador, an extract of mistletoe, which is touted by alties to “boost the immune system,” a standard vague, unmeasured (and probably unmeasurable) claim common to many alternative medicine therapies. In any case, blissfully for me, not much has been heard from her for a while.

Until now.

Yes, she has a new book out, if you can call it that, and it seems to be no better in the quality of its medical information than a Kevin Trudeau screed. Most unusually, in contrast to the credulity demonstrated by the Chicago Tribune over alternative cancer therapy, a major news magazine has taken Somers to task for pushing dubious claims and even more dubious medicine. Pat Wingert and Barbara Kantrowitz have written a lovely takedown of Somers’ woo published online in Newsweek as an article entitled A Blowup Over “Bioidenticals.” I had been aware of Somers’ pushing of bogus pseudoscience with respect to her choosing Mistletoe extract over chemotherapy as an adjuvant treatment of her breast cancer. Indeed, I used her as an example of how breast cancer testimonials are usually meaningless because most of these patients have had lumpectomies and surgery alone cures most cancers. (Chemotherapy is the “icing on the cake” that decreases the rate of recurrence below an already rather low number.) I further pointed out that most patients who opt for alternative medicines over adjuvant chemotherapy, like Somers, usually end up crediting their alternative medicine rather than good old fashioned surgical steel with their cure. However, I must confess to you, my readers, that I was totally (and quite happily) unaware of Somers’ book from a couple years ago, The Sexy Years, in which she promoted so-called “bioidentical hormones” as “natural” alternatives to hormone replacement therapy and a veritable fountain of youth that would forestall the ravages of the aging process. Nor was I aware of Somers’ latest incursion into the world of woo, Ageless, which sounds like more of the same. I almost wish that Wingert and Kantrowitz hadn’t informed me:

Oct. 31, 2006 – We have to admire Suzanne Somers’s persistence. She doesn’t give up–even when virtually the entire medical community is lined up against her. Three years ago, Somers wrote a best-selling book called “The Sexy Years” in which she promoted so-called bioidentical hormones as a more natural alternative to hormones produced by drug companies for menopausal women. Somers, now 60, claimed that these individually prepared doses of estrogen and other hormones, sold via the Internet or by compounding pharmacies, made her look and feel half her age. As the popularity of bioidenticals soared, major medical organizations like the American College of Obstetricians and Gynecologists grew so alarmed that they mounted publicity campaigns to convince Somers’s readers that these alternative treatments, which are usually custom made for each patient, haven’t been proven safe or more effective than traditional hormone therapy for symptoms like hot flashes.

Heh. It’s not quite a Respectful Insolence™-level takedown, but it’s probably about as pointed as we can expect from a major news magazine. After all, this is a blog, and I can pretty much say whatever I want without editing. Columnists for major news magazines aren’t allowed the leeway that I am. (If I ever wrote anything or a popular journal, you can expect that my commentary would be more–shall we say?–“measured” in my commentary, too.) Particularly amusing is the way that Somers has managed to piss off even some advocates of so-called “bioidenticals”:

Inside, she calls bioidenticals “the juice of youth” and also promotes the questionable dosage advice of a former actress and “independent researcher” named T.S. Wiley (whose academic credentials are limited to a bachelor’s degree in anthropology) who thinks menopausal women should have as much estrogen in their bodies as 20-year-olds. Now, even some of the pro-bioidentical doctors Somers quotes in her books are screaming foul. “Many of the claims throughout the book are scientifically unproven and dangerous,” three of these doctors assert in a letter sent a few weeks ago to Somers’s publisher, Crown. “By mixing quotes from qualified physicians … with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk.”

No kidding.

It’s utterly ridiculous to think that menopausal women “should have as much estrogen as 20-year olds.” If that were the case, then there probably wouldn’t be such a thing as menopause. In fact, all of this is no different than Ponce de Leon looking for the fountain of youth, because Somers seems to believe that taking these “bioidentical” hormones will keep her young indefinitely. As another irony, it never ceases to amaze me how people who castigate conventional medicine for going “against nature” are more than willing to ingest lots of one type of synthetic hormone that is synthesized to be identical to what their body produces, just as their bodies are naturally decreasing the levels of that hormone. Don’t get me wrong; I realize that menopause symptoms can be quite debilitating in some women. I see them artificially induced in my breast cancer patients on Tamoxifen therapy. Indeed, early in my career, one of the first breast cancer patients that I took care of as a newly minted attending had to stop her Tamoxifen because she just couldn’t stand the menopausal side effects. There’s no doubt at all that estrogenic hormones, whether “bioidentical” or modified or synthetic estrogen analogs, can greatly alleviate the symptoms of menopause. Unfortunately, the other benefits claimed for HRT (cardiovascular protection, for example) were cast in grave doubt in 2002 when the Women’s Health Initiative showed more heart attacks and more clots in women on a commonly used form of HRT, leading to medical science quite righty backing off from advocating HRT for almost every menopausal woman. There is at present no data to suggest that “bioidentical” hormone therapy in any way avoids the problems associated with the combination tested in the Women’s Health Initiative. Unfortunately, this example of medical science showing that what we previously thought about HRT was probably wrong had unintended consequences:

Much of the demand can be traced to continuing confusion over the troubling conclusions of the federally funded Women’s Health Initiative. In 2002 one arm of the study was halted early because researchers found that women taking the estrogen and progesterone in a widely used form of hormone therapy had more heart attacks, strokes, blood clots and breast cancer than women on a placebo. This was the opposite of what most doctors expected to hear. For decades, they had been recommending hormones to prevent future heart, bone and memory troubles. Their patients were equally stunned and many lost faith in their physicians and Big Pharma. Sales of FDA-approved hormones plummeted, inadvertently opening the door to bioidenticals.

One problem is that the whole term “bioidentical” is pretty meaningless in biological terms. All it means is that the hormones are synthesized to be “identical” to the natural hormones made by the body. That’s it. Of course, it is the natural estrogen that women’s own bodies make that can stimulate breast epithelial cells to grow and cause breast cancer, and it does it just as well as any synthetic hormone–better, in fact, because it’s always there before menopause. Indeed, one risk factor for breast cancer is prolonged unopposed estrogen exposure unbroken by pregnancy. Thus, if a woman starts menstruating early and stops late, and never has a child, she will be at increased risk, and it’s long been known that increased exposure to estrogens results in an increased risk of breast cancer later in life. Also, some of these drugs have been around for a long time and are FDA-approved, which makes me wonder about the whole “natural” part of Somers’ claims. In Suzanne Somers’ world, though, more than anything else, what “bioidentical” really seems to mean is that it’s not something made by big pharma or that it’s “personalized” for each patient. (Never mind that many “bioidentical” hormones are made by the same pharmaceutical companies that make other hormones used in HRT.) Moreover, Suzanne Somers advocates an approach in which made-to-order treatments are made by pharmacies with dosages determined by the results of blood tests. Sounds nice and neat, right? “Tailored” and “personalized” doses, who could argue with that? The problem is, there really isn’t much science to support this, nor is it known if there is a “safe” dose of estrogen for use over the many years that Somers recommends taking this “personalized” HRT, nor is this method recommended by the majority of doctors who treat women’s menopausal symptoms. Certainly using saliva tests to “measure” her hormone levels is very unreliable.

Of course, none of the criticism from her former admirers phases Somers in the least:

Somers adamantly defends her book and bioidenticals. “From a woman’s standpoint, this is the first time we’ve gotten some relief in a non-drug way,” she says in an interview with NEWSWEEK. And the criticism from major medical groups? “Doctors are embarrassed that they don’t know about this,” Somers says. “When doctors don’t have an answer, they like to pooh-pooh it.” As for the letter to her publishers, she accuses those doctors of trying to get publicity for themselves. “Women at this point trust me more than someone they don’t know,” she says. She urges all doctors to study up on bioidenticals. “Learn more, go deeper,” she says. “If I can learn it, they can learn it.”

Apparently Somers is stupid enough to trot out the old “doctors-don’t-know” ploy, as if she knows more about HRT from reading on the Internet than doctors and scientists who have spent years studying it and who actually prescribe it. Then, as is the tendency of woos to do when attacked, she questions the motivations of those criticizing her, rather than substantively addressing their criticisms.

From the point of view of being a cancer surgeon, though, what really irritates me about this is that Somers reportedly had an estrogen receptor-positive breast cancer, yet she’s taking a lot of estrogen and advocating the same for postmenopausal women. Whether they are “bioidentical” or not, taking large amounts of estrogens after having been treated for an ER(+) breast cancer without the input of a medical oncologist is a very bad idea. A prior history of breast cancer is almost an absolute contraindication to HRT. Indeed, HRT is only used in menopausal women with breast cancer for the most severe and debilitating menopausal symptoms, only after all non-estrogen treatments have failed, and only then with a great deal of angst and trepidation on the part of the physicians prescribing it. Fortunately for Somers, assuming she had stage I breast cancer, without her chemotherapy she could expect a 90% chance of survival from surgery and radiation alone, as Dr. Moran and I have pointed out for breast cancer testimonials in general. Even if taking her “bioidentical” estrogen were to increase her chance of cancer recurrence by, say, 25%, it would still leave a nearly 2/3 chance that her cancer won’t recur. Somers has very likely increased the odds of her breast cancer recurring, but it is still more likely than not that it won’t. However, her hormone advocacy is nonetheless not without its price; Somers has had to undergo a hysterectomy for postmenopausal uterine bleeding, which was likely to have been a consequence of her prolonged ingestion of large doses of estrogens. My concern is that other women with breast cancer who may read Somers’ book and follow her lead in taking “bioidentical” estrogen to “rejuvenate” themselves may not be so lucky in avoiding cancer recurrence.

Another thing that irritates me about Somers is the thing that irritates me about many alties: Namely, the claim that their favorite woo is not a “drug” or is somehow accomplished “without drugs.” In the case of bioidentical hormones, this is a load of bovine feces, as Kantrowitz and Wingert explain:

Somers says these custom-made treatments are natural and not really drugs. That’s just not true. Bioidenticals may start out as wild yams or soybeans, but by the time this plant matter has been converted into hormone therapy, it is in fact a drug. All of these products–whether or not they’re approved by the FDA–are chemicals synthesized in a lab. Another thing you should know: there are only a few labs in the world that synthesize these hormones. Everyone–from small compounding pharmacies to big pharmaceutical companies–gets their ingredients from the same places.

Another thing that’s rather ironic is that the same women who are so concerned with “natural” ways and who view the “old” way of HRT of being another example of the medicalization of a normal condition, a turning of a natural bodily process into a “disease” that needs to be “treated” are the same ones who will flock to “bioidentical” hormones, even though they are drugs made by pharmaceutical companies. Let me be very clear: If a compound, whether “bioidentical,” whether it comes from an herb, or whether made by a pharmaceutical company, has a measurable physiological or biological effect when introduced into the human body by ingestion, injection, inhalation, or through the skin, it is a drug. Period. If an herb causes a measurable physiologic effect, it is a drug. If herbal remedies weren’t drugs, Abel Pharmboy would have to find another subject to do his research on.

Satisfyingly (to me, anyway), the article finishes with what has been in essence the theme of this blog since the very beginning:

Since the health initiative, women have become much more skeptical about claims from pharmaceutical companies–and that’s a good thing. Now we should apply that same skepticism to claims for alternative therapies.

As I’ve said time and time again, if there is one principle I hope to impart on this blog, it is that the claims of conventional medicine and alternative medicine should be evaluated in the same way and that they should be held to the same standard of scientific and clinical evidence. I do not differentiate between the two when considering evidence, nor should you. Indeed, if you ever see it argued or implied that “alternative medicine” should be held to a different standard of evidence, you should wonder why the treatment in question shouldn’t be held to the same standard of evidence as any other medicine or treatment. (Better yet, ask the person making the claim; put them on the spot.) If someone like Suzanne Somers (or anyone else, for that matter) claims that her version of “bioidentical” hormones are an “elixir of youth” and are “safe,” I expect to see the same level of evidence backing up those claims that I would expect of a pharmaceutical company claiming that its latest cancer drug is major improvement in the treatment of cancer. Instead, what I get from Somers is pseudoscience, anecdotes, and woo.

I just hope her advice hasn’t led to any women with breast cancer recurring and dying.

Comments

  1. #1 Clark Bartram
    November 2, 2006

    So I guess I should stop using a Thighmaster to treat my prostate cancer?

  2. #2 Lab Cat
    November 2, 2006

    Thank you for this.

    I just heard about bioidentical hormones for the first time from my voice teacher. A lovely women but easily convinced by all the latest woo. At least now I can tell her what is wrong with it!

    This was after she recommended five tibetan rites as a way to get your day started. I do yoga and have done for years as a form of exercise and relaxation – the five tibetan rites are just a woo version of yoga. Sigh.

    She has also recommended reiki, acupuncture etc.

  3. #3 sophia8
    November 2, 2006

    Ms Somers certainly looks good for her age – but then, so does Cher.
    Those lips and cheekbones look like they get regularly Botoxed. Nobody has that amount of breast uplift without a lot of help from a brassiere, at the very least. And I can’t see her getting her hair looking so blond and curly by soaking it in lemon juice and tying it up in wet rags every night. If she’s so keen on all things “natural”, why does she slap on so much makeup?

  4. #4 Joe
    November 2, 2006

    This “bioidentical” stuff has bothered me for a while.

    1) When I worked with pharmacists, (30 years ago) they were opposed to “compounding” because of the lack of quality control and proof of efficacy. As for quality control- they did their best; but there was no check (QC lab analysis) to catch mistakes.

    B) I keep reading that they use phytosterols, which are not “identical” in my book. The local woos are now touting “bioequivalent” formulas. What are these women buying?

    Thanks for the post.

  5. #5 Steve Watson
    November 2, 2006

    Somers’ name surfaced in my personal pond recently as a speaker at a motivational seminar that was coming to town. While I realize there are significant exceptions, my cynical impression is that the whole “motivational industry” is top-heavy with people whose only discernible talent or achievement is self-promotion. I can’t imagine why I’d pay to hear someone like that tell me how to become a success in life.

  6. #6 Jen
    November 2, 2006

    Wow, she is a nut job. If someone is stupid enough to take their medical advice from Suzanne Sommers, well maybe…nevermind.

    For some, there desire to fight the aging process leads to seemingly irrational, (or at least strange) actions…like those people who are dedicated to calorie restriction. One of the biggest proponents of it died in his 70s from Lou Gerig’s disease…bet he wishes he had had the fries instead of the tofu.

  7. #7 Dr. Liz
    November 2, 2006

    If you read the beginning of the Ageless book, you will find Suzanne Somers is by her own admission, a testimonial for a very recent hysterectomy (which she blames on birth control pills, weight gain, and depression.

    She actually asked a talk show host, How do I look?”

    He should have answered, “I don’t know. I can’t see you under all that makeup.”

  8. #8 Cheryl
    November 2, 2006

    So, I am taking it you don’t agree with her methods??? What
    exactly is that you think woman should do??? Certainly, not what is prescribed at this point in time (Horses urine) At least she is putting it out there and boy are people responding. No one else seems to have any answers. I keep
    with my continued research on this very important subject.

  9. #9 Orac
    November 2, 2006

    At least she is putting it out there and boy are people responding.

    It is actually unfortunate that people are “responding” to Somers pseudoscientific, unsupported, and in some cases dangerous advice.

  10. #10 lisa
    November 2, 2006

    Let’s criticize Suzanne Somers’ book, not her looks, shall we? Thanks.

  11. #11 epador
    November 3, 2006

    Without her original looks, we wouldn’t even know or care who Suzanne Somers is or was. And she still tries to sell herself based on her looks. So Her Looks are unfortunately fair game.

  12. #12 sophia8
    November 3, 2006

    I wasn’t criticising her looks. I was criticising the atitude of her, and people like her, who tout “natural” medicines and use all kinds of UNnatural methods to stave off the totally natural processes of aging and looking old.

  13. #13 kitty
    November 3, 2006

    What exactly is that you think woman should do??? Certainly, not what is prescribed at this point in time (Horses urine) At least she is putting it out there and boy are people responding. No one else seems to have any answers. I keep with my continued research on this very important subject
    Premarin is not the only estrogen that is prescribed in this point of time. The same beta-17 estradiol that is used in “bioidentical” HRT, has been prescribed for some time both as pills (Estrace) or patch (Climara, Vivelle, Vivelle-dot). Similarly, “bioidentical” micronized progesterone has been prescribed for a while (e.g. Prometrium) to those with uterus. The thing is, there is no evidence that any of these hormones carry any less of a risk than “horse urine”. As long as you are aware of this and feel that for you benefits outweight the risks, you can choose estradiol over premarin and micronized progesterone over provera.

    For example I had spontaneous POF at 30-something so for me at this point of time (40-something) and with my osteopenia benefits still outweight the risks; and I tried different combinations and choose what makes me feel better. By the way, talking about “natural”, at some point I looked up specifically the percentage of increase of breast cancer risk with HRT vs normal periods: I wanted to compare my breast cancer risk with HRT with that of a “normal” woman my age who still has her periods. I found reference which listed 3% yearly increase for every year of normal periods vs 2.7% (or was it 2.3%?) yearly increase on HRT. So, it is essentially the same, even very slightly higher with normal periods. By the way, if I made a mistake and somebody has correct numbers, I’d be interested to know.

    disclaimer: I am not a doctor, I don’t even play one on TV, so don’t consider anything I say a medical advice. Of course, nobody in the right mind should take a medical advice from an anonymous blog poster (or from a movie star for that matter).

  14. #14 Cayte
    November 3, 2006

    A randomized study on mistletoe came out to weeks ago.
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17057389&query_hl=1&itool=pubmed_docsum

    I only checked the abstract but its not at the same ( admittedly low ) level of ditziness as quantum homeopathy. Thats why the public gets confused.

  15. #15 Robin Peters
    November 10, 2006

    I noticed some talk in this entry about “tailored” and “personalized” bioidentical treatments. Perhaps the real issue is that these women are finally getting the individual attention they really want, in the form of “tailored, personalized” treatments for the symptoms of menopause.

  16. #16 Neil Raden
    November 14, 2006

    Listen to an Oncologist

    Dr. Julie Taguchi MD, a clincal oncologist, presented a chart study last week at the annual ACAM conference. She has 60 cancer patients on the Wiley Protocol and has been following them for 3-5 years. Of the 60, there were only 2 recurrences, and they were along the scar line.

    Being a doctor doesn’t make you right. Why don’t you educate yourself to the facts before you dump your bile on them. What difference does it make if you don’t like Suzanne Somers? I just read today that scientists discovered something very interesting about the people in Qumran (the Dead Sea Scrolls) by examining their latrines. You can find good information anywhere.

    Now, Dr. Taguchi was the co-author of Wiley’s book Sex, Lies and Menopause. To dismiss Wiley as a “former actress” is not only the height of arrogance, it piss-poor journalism. Here is the worst part about this article and these two reporters who wrote it: I gave them all of the following information and they suppressed it to make Somers and Wiley look stupid, not to inform their readers, but to advance their agenda. Here is what I told them:

    ******************

    That was not what I’d call fair and balanced reporting. My first question is, have either of you read or even browsed Wiley’s books or made an attempt to contact any of the doctors that support the Wiley Protocol? Start here: http://www.thewileyprotocol.com

    Wiley was an actress thirty years ago. What were you thirty years ago? Would you like to be referred to as Barbara Kantrowitz, former babysitter or Pat Wingert former waitress? She is also a member of the New York Academy of Sciences, is a published scientist (check PubMed), teaches classes for which doctors receive CME’s, is published in two endocrinology textbooks that are used in medical schools, has authored two books of her own and owns a number of patents for the use of hormones in a variety applications, including cancer and she was a guest investigator in molecular biology at the Sansum Medical Research Foundation. Your use of quotation marks around “independent researcher” was condescending. What was Charles Darwin? What was Einstein when he worked at the Patent Office? Since when is independence a cause for sarcasm?

    Second, Suzanne’s problems for five years were under the care of Diana Schwartbein, one of the signers of the letter. She unfortunately didn’t meet Wiley until it was too late, but she’s glad she did in any case.

    There are thousands of women on the “Wiley Protocol,” and a respected oncologist is presenting her experience with over 60 patients, WITH CANCER, on the Wiley Protocol to a the American College for the Advancement of Medicine in Palm Springs tomorrow, November 1,

    Just because someone is blonde or used to be an actress doesn’t mean their findings aren’t as valued as a Harvard researcher who has been bought and sold by his/her grants. The way the media reports medicine is, well, sickening.
    **********

    As a result of this letter, Kantrowitz called Wiley and interviewed her, then proceded to write virtually the same poisonous article for the print edition of Newsweek.

    Your being a cancer surgeon means nothing to me, that’s just a job. If Wiley gave you a ten question quiz on hormones, you’d flunk it. If you’d actually like to learn something about hormones, down at the molecular level, you should get to know her.

  17. #17 Orac
    November 14, 2006

    I just read today that scientists discovered something very interesting about the people in Qumran (the Dead Sea Scrolls) by examining their latrines.

    An unintentionally appropriate comparison to Somers’ books.

    Your being a cancer surgeon means nothing to me, that’s just a job.

    That’s OK. Your being some dude shilling for Wiley on the Internet means nothing to me.

    As for your other suggestions, you should be very careful what you ask for; you might get it.

  18. #18 David
    November 15, 2006

    What is ultimately lacking in this arena is good education. We have have treated hundreds of patients in our facility and have had amazing results that are fully documented. There is excellent information on hormonebalance.org and hormonephysicians.com

  19. #19 HCN
    November 15, 2006

    Why should we read the documentation from your website… Can you give the cites in what journals they are published in, or even the links from http://www.pubmed.gov.

    Otherwise, it just looks like you are shilling for quack.

  20. #20 Joe
    December 2, 2006

    Interesting post by Neil Raden, shilling for TS Wiley- his wife. I’ve seen his, and his daughter’s, foolish posts before. They may be even more ignorant of medicine than Wiley.

  21. #21 HCN
    December 2, 2006

    Oh, he is even more amusing here:
    http://forums.randi.org/showthread.php?t=67706

  22. #22 Joe
    December 2, 2006

    @HCN, Yes, and also look at Wiley Watch
    http://www.wileywatch.org/
    She doesn’t even have the batchelor’s degree.

  23. #23 The Ridger
    December 2, 2006

    Of course, what’s “natural” is nothing. Menopause is Natural, and so is cancer. (Disclaimer: when I had cancer I had surgery and chemo. And drugs. It worked.) But “natural” is just lying down and dying when you get cancer. Extra estrogen from anywhere isn’t natural.

  24. #24 HCN
    December 2, 2006

    Joe, if you had checked out the JREF forum discussion I linked to, you would have noticed the presense of person who is responsible for Wileywatch — and the fact that Wiley’s BA in Anthropology is “pending” (can you guess what my username is there?).

    Yeah… I love “natural”. Cyanide is a perfectly “natural” ingredient in many fruit seeds. Yum.

  25. #25 Joe
    December 3, 2006

    @HCN Yup. Been there. That’s where I got the link. Wiley’s BA is, indeed, BS. I was responding to you, to inform everyone else. I was clumsy.

    jjm

  26. #26 HCN
    December 3, 2006

    Okay dokay… I understand now! All is good.

    It is especially interesting that there are competing doctors doing the same thing as Wiley, and they are also NOT to be trusted! I read somewhere that the real hormone medical academy, The Endocrine Society, have asked the FDA to look into the folks pushing “bioidenticals”:
    http://www.endo-society.org/news/press/2006/AMAAdoptsBHResolution.cfm

  27. #27 compound pharmacy
    May 28, 2008

    Compounding pharmacists play a vital role in their patients’ lives, providing customized medications ordered by prescribers, sometimes when all other options will not work. Compounded medications are prepared by pharmacists for individual patients, often with special needs.
    http://www.greatearthpharmacy.com

  28. #28 Joe
    May 28, 2008

    compound pharmacy wrote “Compounding pharmacists play a vital role in their patients’ lives …”

    In the case of BHRT, compounding pharmacists prey on people who have no need for them.

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.