seizure

A compound derived from marijuana decreases seizure frequency in children with Dravet syndrome, and there's nothing "miraculous" about it

oracknows — Fri, 26 May 2017 01:01:41 +0000

A compound derived from marijuana decreases seizure frequency in children with Dravet syndrome, and there's nothing "miraculous" about it

When I first started to take an interest in medical marijuana, I was struck by how much it reminded me of herbalism. Although herbalism is scientifically the most plausible of modalities commonly associated with "complementary and alternative medicine" (CAM), the use of herbal medicines still involve a number of problems, the biggest of which is what I like to call either the delivery problem or the bioavailability problem. In brief, herbs, when they work, are adulterated drugs. The active ingredient is often a relatively small, embedded in thousands of other constituents that make up herbs, and it’s very difficult to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition. To demonstrate the concept, I frequently point out that it’s much safer and more predictable to administer digoxin to a patient who needs its activity on the heart than it would be for the patient to chew on some foxglove leaves, given that the therapeutic window (the difference between the doses needed to produce therapeutic effects and the lowest dose that will cause significant toxicity) is narrow.

I have nothing against recreational marijuana use and have come around to the view that it should be legalized, taxed, and regulated, just like alcohol and tobacco. Unfortunately, medical marijuana has been co-opted as a "foot in the door" to try to legalize marijuana. The problem with this approach is that it necessitated massively overblown claims for marijuana's health benefits, up to and including claims that it is a great treatment for autism and that it can cure cancer. It isn't and can't. Nor does it stop exaggerated miraculous claims. Basically, the bottom line in terms of scientific evidence for medical marijuana is that it mostly doesn't do what it's claimed to be able to do.

None of this is to say that it might not have some value in some conditions. One condition for cannabinoids isolated from marijuana have shown some promise is in seizure disorders. That's why I learned with interest of a study published in the New England Journal of Medicine (NEJM). This study is a randomized, placebo-controlled clinical trial of a candidate drug isolated from marijuana on severe drug-resistant seizures in children that made the national news Wednesday night. To be honest, the study's gotten less press coverage than I thought it would, but it is an interesting study nonetheless. Medical marijuana proponents frequently misrepresent the skeptic position as being unalterably opposed to the idea that marijuana might have value as a medication. I can't speak for anyone else, but what I've always objected to are the exaggerated, evidence-free claims so many advocates make, and the veritable cult that has sprung up around it. I actually like evidence, which is why this study caught my attention. (Indeed, I would have written about it yesterday, except that the night before I fell asleep on the couch before I got one paragraph in.)

So let's look at the study by Dr. Orrin Devinsky, a neurologist at New York University Langone Medical Center, and colleagues, Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. The first thing I can't help but note is that this is not really medical marijuana, but rather an oral solution of cannabidiol (CBD), Investigational Medicinal Product GWP42003-P, manufactured by GW Pharmaceuticals under the trade name Epidiolex®. GWP42003-P is formulated from extracts prepared from Cannabis sativa L. plants that contain consistent levels of CBD as the principal phytocannabinoid. Extracts from these plants are processed to yield pure (>95%) CBD that contains less than 0.5% (w/w) THC. This pure CBD is subsequently dissolved in excipients with added sweetener and flavoring. So basically, it's a drug isolated from a plant, as many drugs are isolated from plants (and sometimes chemically modified).

Another thing that's important to note is that this trial was to test whether CBD was useful against drug-resistant seizures due to a specific genetic disorder, Dravet syndrome, also known as severe myoclonic epilepsy in infancy (SMEI). Dravet syndrome is due to a mutation in the voltage-gated sodium channel α1 subunit gene SCN1A, which encodes the pore-forming subunit of the NaV1.1 voltage-gated sodium. channel. There are currently more than 700 known SCN1A mutations, and 90% of them occur in DS patients. Two-thirds of these mutations give rise to truncations in the protein while the remaining third are missense mutations that are predicted to severely impair channel function. In patients with Dravet syndrome, the severity of the epilepsy can vary, but myoclonic seizures are the defining feature of Dravet syndrome, and can be massive, contributing to a mortality rate as high as 20% by age 20. The syndrome is also associated with developmental delay. The most devastating aspect of Dravet syndrome is that the epilepsy associated with it is among the most drug resistant forms, and most anti-epilepsy drugs provide inadequate relief.

This trial was pretty straightforward. Basically, it was a multi-institution phase II study carried out in the US and Europe with the following protocol, summarized by this flow sheet (click to embiggen)

The baseline characteristics of the two groups were well matched, ranging in age from 2 to 18, and patients had previously tried a median of 4 antiepileptic drugs, with a range from 0 to 26(!). Subjects were randomized to receive either placebo or CBD, and the primary end point measured was frequency of convulsive seizures. The CBD solution contained 100 mg/ml, and the placebo solution was identical except for the absence of CBD. Before the intervention began, there was a four week baseline period in which investigators trained caregivers to record daily seizure information. Then CBD or placebo was added to the subjects' regular anti-seizure regimen. This is actually a very important point that most reporting of the trial I've seen misses. This trial does not show that CBD has anti-seizure activity as a single agent, only that, when added to other regimens of anti-seizure medications, CBD can further decrease seizure frequency. We don't know from this trial whether CBD alone would be a useful treatment for Dravet syndrome seizures.

But back to the trial design. The dose was escalated up to 20 mg/kg per day with the use of a 14-day dosing regimen of twice daily administration. At the end of the treatment period, the cannabidiol and placebo solutions were tapered (10% each day) over a period of 10 days. After trial completion, all patients could enter a long-term open-label study. Each day, patients or caregivers recorded the number and type of seizures (tonic, clonic, tonic–clonic, or atonic) for the primary end point. Laboratory assessments were carried out at baseline and after 2, 4, 8, and 14 weeks of the trial regimen, as well as at the end of the taper period for those patients who did not enter the open-label extension study or who withdrew early and tapered the trial agent.

The results were encouraging. In the CBD group, the median frequency of seizures decreased from 12.4 to 5.9 per month, compared with a decrease from 14.9 to 14.1 in the placebo group. The percentage of patients with at least a 50% reduction on convulsive seizure frequency was 43% with CBD and 27% with placebo. The percentage of patients who became seizure-free was 5% in the CBD group, and 0% in the placebo group, but neither of these results achieved statistical significance (p=0.08 for both). I must admit that the way NBC reported Devinsky saying, ""Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial but neglecting to point out that the result didn't achieve statistical significance. I understand that there were some children who had dramatic remissions, but this observation does have to be put into context.

There were some adverse events due to the CBD, including diarrhea, vomiting, fatigue, fever, somnolence, and abnormal liver-function tests. There were more withdrawals from the trial in the cannabidiol group. Indeed, nine out of the 61 subjects in the CBD group withdrew from the study, compared to only three from the placebo group. Overall, serious adverse events were more common in the cannabidiol group than in the placebo group (16% vs. 5%)

One interesting aspect of this trial is that the mechanism of CBD against seizures in patients with Dravet syndrome is not known. The clinical manifestations of Dravet syndrome are due to a single gene, SCN1A. In an accompanying editorial, Dr. Samuel Berkovic notes:

A major aim in the field of the Dravet syndrome and other genetic encephalopathies is to develop precision therapies — treatments directed at the specific genetic defect. Because the Dravet syndrome has a single-gene basis, it is an attractive target for precision medicine. However, cannabidiol is not a precision treatment for the syndrome, because there is no established link of the cannabinoid receptors with the inhibitory interneuron pathology of the Dravet syndrome, and the response across the cohort of the current study was not uniform.

He also notes:

Devinsky et al. found a significantly greater reduction in seizure frequency among patients who received cannabidiol than among those who received placebo, and the seizure-free rate was 5% with the active drug as compared with 0% with placebo. Thus, anecdote has been confirmed by data, and one might ask whether a controlled trial was really necessary. The answer is absolutely yes. Perhaps counterintuitively, the rate of response to placebo in clinical trials is higher among children than among adults. Moreover, parents who go to enormous efforts to get cannabis for their children report a higher response rate than those who can easily obtain it. Cannabidiol is not without side effects. The dropout rate in the active-treatment group was appreciable, and common side effects included vomiting, loss of appetite, and diarrhea. With additional experience, perhaps these effects can be modified with dose adjustment and other strategies.

I would quibble again here. If you look at Table 3, you'll see that the difference between placebo and control didn't achieve statistical significance for reaching 100%, 75%, and 50% decreases in seizure frequency. Now, I'm not so dogmatic that I won't accept that this difference is probably real, failure to achieve a p-value less than 0.05 notwihstanding, but if you're going to use frequentist statistics and define statistically significant as 0.05, then you should at least be consistent. That quibble aside, I do agree with Dr. Berkovic that absolutely a clinical trial was indicated. I would also add a further quibble that "anecdote has been confirmed by data" is overstating it a bit, given the tiny percentage of patients who were seizure free. However, some patients do apparently have fairly dramatic responses.

Another interesting aspect is that, counterintuitively, seizure frequency did decrease in the placebo group by 13.3%, compared to the CBD group, where seizure frequency decreased by 38.9%. This should be a lesson as to why placebo controls are necessary, even for seemingly objective measures. Of course, given that these were either self-reported or caregiver-reported measures, they are not completely objective; so it is not surprising that there was a slight decrease in seizure frequency, even in the placebo control group.

Finally, I can't help but note that medical marijuana advocates, the ones who will be flogging this study as vindication that marijuana is a miracle drug (even though what this study shows is much more modest) tend also to be very much anti-pharma and pro-alternative medicine. That's why I want to draw attention to this part of the methods section:

The funding source, GW Pharmaceuticals, was responsible for the trial design (with input from investigators and other experts), trial management, site monitoring, trial pharmacovigilance, data analysis, and statistical analysis. GW Pharmaceuticals prepared and provided the active treatment and placebo. Trial procedures were reviewed at multisite investigator meetings. Services were used for clinical laboratory testing; bioanalytical laboratory testing; design of the case-report form; data management; trial-agent distribution, returns, and destruction; the interactive voice-response system; diagnosis of the Dravet syndrome and seizure classification; and translation of documents. The authors vouch for the accuracy and completeness of the reported data and analyses and for the adherence of the trial to the protocol (available with the full text of this article at NEJM.org). The authors affirm that they approved the final draft of the manuscript.

This is, of course, a not uncommon practice for a drug company doing a clinical trial upon which it wants to base an application for FDA approval for its drug, and that's exactly what GW Pharmaceuticals is doing. Nothing wrong with that. It's what a drug company needs to do, and GW Pharmaceuticals is a drug company. It's a good idea to be a little more skeptical about the results of this study than most medical marijuana advocates I've seen gloating over it as total vindication are doing. This is a positive study, but not as strongly positive as it's being spun, and there are issues with CBD and adverse events. As Dr. Berkovic puts it:

This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy. It requires replication. Future trials may answer further questions about the applicability of cannabinoids to the many other syndromes of childhood epilepsy and to treatment in adults. After an era dominated by anecdote and obfuscated by medicolegal issues and emotionally infused debate, more scientific studies are under way. Much more research is needed to understand the basic science, benefits, and risks of cannabinoids in epilepsy.

Correct. This is a study that demonstrates that one chemical that can be isolated from marijuana has promise as a treatment for the epilepsy assocaited with Dravet syndrome. The mechanism by which it appears to work is not clear, as the relationship between cannabinoid receptor and SCN1A is not clear. It's thus not clear whether this result is generalizable to other forms of seizure disorders, but it's worth investigating. In other words, CBD is just like any other drug. It appears to have reasonable activity against the epilepsy due to Dravet syndrome, but it also has significant side effects, just like a lot of other antiepileptic drugs. It's no miracle, but it could be a step forward, particularly if its study leads to a greater understanding of the role of cannabinoid receptors in seizure disorders.

oracknows Thu, 05/25/2017 - 21:01

Categories

Medicine

This a drug combination trial on a constituent of Cannabis sativa L. (not an "ingredient" of the plant because ingredients are items of cake mixes and sundry other inventions rather than nature-made products). What we don't know is whether the results would have been significantly different had the subjects not taken their "regular anti-seizure regimen" in addition to cannabidiol or placebo. We also don't know if that would extend to the adverse events, among which "diarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liver-function tests" were more frequent among those in the cannabidiol group compared to the placebo group. The fact that more subjects in the cannabidiol group withdrew from the trial than among those who received placebo is at least suggestive of adverse drug interactions. A further question (one I don't expect to be answered any time soon) is what, if any, medications could be dropped from a regular anti-seizure drug regimen without unacceptable harm to a patient with Dravet syndrome receiving cannabidiol?

This a drug combination trial on a constituent of Cannabis sativa L. (not an “ingredient” of the plant because ingredients are items of cake mixes and sundry other inventions rather than nature-made products).hat we don’t know is whether the results would have been significantly different had the subjects not taken their “regular anti-seizure regimen” in addition to cannabidiol or placebo.

Well, yes. Most clinical trials these days involve adding experimental therapeutic or placebo to the standard treatment regimen, mainly because in a disease as severe as Dravet syndrome it would be unethical to take patients off of their anti-seizure medications because the placebo group could be subjected to harm. This is particularly true in what are considered vulnerable populations, such as children. A follow up trial in which it is tested whether CBD can allow the dose of other anti-seizure drugs to be reduced would be a logical next step, but it would be tricky to design in an ethical fashion.

It is written,

The dropout rate in the active-treatment group was appreciable, and common side effects included vomiting, loss of appetite, and diarrhea.

MJD says,

Kudos to the brave parents and children in this study.

Q. If the drug proves to be effective, safe, and profitable, will the pharmaceutical company financially compensate those (i.e. test subjects) who sacrificed the most.

In my opinion, medical research subjects should be provided special compensation for their participation similar to our brave soldiers in the armed forces.

@MJD:
While I understand the sentiment behind wanting to richly compensate research participants, it is profoundly unethical to do so. At least when you're talking about reasonable compensation for time, validated parking, and so on. Compensation that's sufficient to become enticing threatens informed consent, by becoming almost coercive to people who need money. That's most of us, but especially people of lower socioeconomic status. And those latter folks are precisely the ones who shouldn't be taken advantage of in medical trials.

Exactly. People will take risks for money that they wouldn't normally take if money isn't involved, and the more money the larger the risks they're willing to take.

In brief, herbs, when they work, are adulterated drugs.

No, they are "impure" drugs, but not "adulterated" because nobody added anything to make them impure. They grew that way from the start.

it’s very difficult to control lot-to-lot consistency with respect to content or active ingredients given how location, weather, soil conditions, rainfall, and many other factors can affect how the plants from which the medicines are extracted grow and therefore their chemical composition.
I take it ORAC is no fan of heirloom tomatoes. There is no toxicity known for a hemp (low THC sativa) plant. Use until desired effect. Millions of people every day have no problem dosing themselves (notably: arthritis, nausea, appetite, spastic colon) properly the old fashioned way. Herbalism indeed.

The adverse effects of loss of appetite and nausea are fixed with a little THC in the mix.

https://www.leafly.com/sativa/charlottes-web

https://www.youtube.com/watch?v=oxrKyjeClTk

they are “impure” drugs, but not “adulterated” because nobody added anything to make them impure

That distinction may matter in a legal context, but in a medical context, it's to-MAY-to vs. to-MAH-to. The patient is getting a drug in an unknown (to him) dose with unknown (to him) additional compounds that may or may not help with the delivery, and in some cases may interfere with it. If said patient ends up dead, it won't matter to him whether the product was represented to him as an herbal product or as a drug of claimed dosage and purity. The lawyers who take on any subsequent wrongful death case, of course, will care.

Thank you for giving this very, very careful and nuanced explanation. It really helps understands the strengths and limits of the trial.

Thanks for this! I watched the CBC coverage and nowhere was it explained that the CBD was in addition to the regular meds. It was presented as marijuana the saviour drug. And some irritating patient activists leading the way and science catching up narrative.
I'm not sure where the parents got CBD in Canada, my wife can only get Sativex here (a 50:50 CBD:THC med). If it is from the current medical marijuana dispensary world, who knows what they are giving their child.

No, they are “impure” drugs, but not “adulterated” because nobody added anything to make them impure. They grew that way from the start.

Now appears to be a good time to remind people how much I hate pedantry and how much it irritates the hell out of me. If the word "adulterated" bothers you so much, I'll just change it to "impure." The specific word used, as Eric points out, doesn't much matter for purposes of the idea, nor does it matter much in a medical context. The point is that there are hundreds, if not thousands, of compounds mixed in with the actual active ingredient of an herbal medicine.

abnormal results on liver-function tests” were more frequent among those in the cannabidiol group compared to the placebo group

It should be noted that only the kids who were also taking valproate (a seizure medication) showed elevated liver enzymes -- Something Vaproic acid can do all by itself.

And some irritating patient activists leading the way and science catching up narrative

What else would it be? Millions of people anecdotally know how it helps them. When a study is finally allowed it showed the users were right.

"counterintuitively, seizure frequency did decrease in the placebo group by 13.3%, compared to the CBD group, where seizure frequency decreased by 38.9%"

I agree this is a reminder of the importance of placebo groups, but I expect the placebo response in this case has more to do with trial participants stepping up their compliance with their usual meds during the trial as opposed to succumbing to bias on subjective symptom scores.

Gilbert @7: Speaking to the issues of lot-to-lot (or crop-to-crop) variability.
Are you a wine person? If so, are you familiar with the concept of terroir? (The idea that you can grow the same grapes in two different places and things like the mineral composition of the soil will affect the flavor of the wine.)
It's a lovely thing, in wine or in tomatoes or cheese. But you need to remember that while that variability is often wonderful, producing glorious vintages, it can also produce crap that's not even worth putting in a bottle.

If I gave you a glass of a clear beverage you'd want to know if it was pure water or pure ethanol or something in between. And if it's something where you can't tell the difference *before* ingesting it, then it's even more important to know how much you're getting.
And what's wrong with testing and labeling? In the recreational sphere it really broadens the market. Where some might say "I feel like a rose tonight" another might say "I'm feeling like a X% THC, Y% CBD tonight".

But medicine is all about precision.

It should be noted that only the kids who were also taking valproate (a seizure medication) showed elevated liver enzymes — Something Vaproic acid can do all by itself.

Where did you find this? Is it in the full paper?

I haven't seen the paper. but I assume that's where this comes from:

But some of the side effects may have been due to drug combinations, not CBD alone. For instance, kids in the CBD group who were also taking the epilepsy drug valproate were the only ones to experience liver problems as a side effect.

https://arstechnica.com/science/2017/05/marijuana-component-reduces-sei…

Some of those kids rotate amongst ten anti-seizure/epileptic drugs including phenobarbital -- None of which work. I'd think the next studies should be to treat those patients with only CBD and with a complementary inclusion of THC for suppression of nausea and increased appetite.

I would not be surprized if continuing the drugs hides the true effectiveness of the clean-acting CBD alone.

@ Gilbert,

Yes, valproate can raise liver function tests, and cause hepatic toxicity. That's why a baseline should be taken when you start it, and it should be monitored regularly for the first six months.

If you then add another drug and LFTs rise, it is more likely the second drug is the contributing factor. You have to consider if the problem comes from the second drug, or the fact the two drugs are combined before you decide how to change the treatment plan.

In this study, participants were in a four week baseline period before beginning the cannabinoid or placebo. In order to establish that baseline, and perform the regular checks during the trial itself, bloodwork is done. The LFTs of the patients who left the group (only 3, btw, with one from the placebo group) rose after starting the CBD treatment. The other nine patients completed the study in spite of the elevated liver enzymes.

What this means is there may be reason to believe that there is additional risk of adverse liver issues for patients taking CBD who are also taking valproate. The answer is dose adjustment. You cannot conclude that the problem is the valproate and not the CBD, or that CBD is automatically safe if the patient is not on valproate.

@Johnny: yes, the full paper does in fact note that the only patients who had elevated LFTs were on some form of valproate.

If said patient ends up dead, it won’t matter to him whether the product was represented to him as an herbal product or as a drug of claimed dosage and purity. The lawyers who take on any subsequent wrongful death case, of course, will care.

I take it, Eric Lund, that your statement is a generalization of all herbal medicine and not to intimate that could become the case with MMJ.

Otherwise, I challenge anyone to find one death attributed to cannabis** in ten thousand years of recorded history.

** Of course, not the synthetic 'legal high' THC which can be fairly deadly.

Orac, please, PLEASE cover this.

Open Access Journal, apparently 1.4 impact factor, case studies, alleging marijuana causing violence. ("Violence is a well-publicized, prominent risk from the more potent, current marijuana available. We present cases that are highly popularized storylines in which marijuana led to unnecessary violence, health risks, and, in many cases, both.")

The case studies include a handful of people who were shot by cops or others (Michael Brown, Trayvon Martin), the guy who shot up the Co. Planned Parenthood Center, the Boston marathon bombers, and OSAMA BIN LADEN.

One of their first sentences, "Marijuana intoxication results in panic reactions and paranoid feelings whose symptoms lead to violence " has a citation that turns out to be, something the NYPD Commissioner said. (something stupid).

I would tear this to bits, but I don't have the patience, stamina, nor knowledge to do it.
https://www.omicsonline.org/open-access/marijuana-violence-and-law-2155…

Can anyone explain why these studies, and everyone moving and getting in a queue to acquire charlotte's web, go after >95% cbd oil product offerings extracted from recreational marijuana strains vs the non-recreational strain, aka hemp, that naturally has that level of cbd. Currently you can buy 25-30% concentration cbd oil tubes produced from commercial hemp online w/o any medical marijuana referral/license required and for much less that equivalents produced by multiple solvent + other procedures applied to recreational marijuana.

Osama Bin Laden? What a bunch of maroons. You can't get marijuana in Pakistan or Afghanistan.

CJTX, if ORAC did a critical review of every dingbat article published in a pay to publish journal, he wouldn't have time for his day job, or sleep. All his blinking lights would burn out, leaving a dark void.

You can’t get marijuana in Pakistan or Afghanistan.

The lads at Wikipedia beg to differ

https://en.wikipedia.org/wiki/Cannabis_in_Pakistan
"Cannabis is widely used in Pakistan..."

https://en.wikipedia.org/wiki/Cannabis_in_Afghanistan
"Cannabis in Afghanistan has been cultivated for centuries..."

@Panacea - thanks for the info.

Johnny: Huh. I assumed it was forbidden, and also impossible to cultivate at high altitudes.

I would tear this to bits, but I don’t have the patience, stamina, nor knowledge to do it.

Author is a Professional Expert Witness grifter. Paper is basically an advertisement for his services. The litany of high-profile cases of police and vigilantes shooting black kids is so he can invent an encounter with marijuana for each of the victims, and argue that that encounter turned them violent and scary (and black) so that the police / vigilantes were compelled to shoot in self-defense. So the author is shamelessly self-whoring announcing his willingness to testify in the defense of uniformed lynchers in the future.

Any decent journal would only have published the piece with a label of "Advertisement", forcing him to resort instead to the negotiable standards of an OMICS dumpster.

CJTX:
We present cases that are highly popularized storylines

That is not a sentence intended to be read by scientists. The authors are writing for an audience of defense lawyers who need a simple narrative to absolve their clients (by blaming their client's victims).
I am going to hazard a guess that nine times out of ten, when someone is trying to pretend that marijuana causes violence, that person is an apologist for police violence or increased powers. The authors are advertising their services to cash in on future police violence.

You need to learn not to assume so much, grasshopper.

Given that there was a higher dropout rate for adverse events in the CBD group, how can researchers control for the possibility that the dropouts were somehow more likely to be unresponsive to the CBD treatment, thus making the average effect higher due to removal of low/no responders from the CBD group?
One scenario I can imagine is that those receiving a benefit from the CBD could be more likely to stay in the trial when experienceing side effects that those not receiving any benefit (I.e. Getting a treatment effect is "worth it" to stick it out, but if you're not seeing any benefit, you wouldn't consider it "worth it" to stay in the trial).
With the sample size, the difference between losing 9 patients in the CBD group versus 3 in the placebo group could make a difference.
Or is this something that researchers can control or account for?

"Unfortunately, medical marijuana has been co-opted as a “foot in the door” to try to legalize marijuana."

This is a logical consequence of (wrongly) classifying Cannabis as drug with no medical uses or benefits and using this in a legal circle jerk to justify its prohibition.

"The problem with this approach is that it necessitated massively overblown claims for marijuana’s health benefits..."

In a hypothetical sane world, one demonstrated medical use would be enough to trash that wrong classification. This didn't happen, so now you have Anslinger's Devil Weed with flipped sign.

Just a note: Sorry to all the regulars who got stuck in automoderation because they had been impersonated by a certain sock puppeteer and I have to make sure it's you before letting you post. I had visitors yesterday, and I was away from the computer for nearly 16 hours, which means a bunch of you didn't get your comments posted until just now. I'll try to keep a better eye out.

I will, however, mention that I'll be on vacation in early June. I haven't decided yet how much (if at all) I'll be blogging or whether I'll be posting "reruns" or a mix, but the time is fast approaching for me to make up my mind...

Can anyone explain why these studies, and everyone moving and getting in a queue to acquire charlotte’s web

It touches on JustaTech's "lot-to-lot (or crop-to-crop) variability".

The Stanley brothers' Charlottes Web is pretty standardized: It is tested, it is grown in a controlled environment, and propagation is through cloning.

Please have some good vacation time Dr Orac :)

Alain

madder (#4) says,

... but especially people of lower socioeconomic status. And those latter folks are precisely the ones who shouldn’t be taken advantage of in medical trials.

MJD says,

Q. Can monetary awards for trial participation increase the placebo effect (e.g., placebo currency) in people having a lower socioeconomic status.

If the answer is YES, placebo currency may be a confounding variable and should be eliminated to control the validity of the experiment.

Alternatively, if placebo currency (i.e., integrative medicine) has efficacy it may be a useful supplemental treatment for needy individuals having lower socioeconomic status.

Alternatively, if placebo currency (i.e., integrative medicine) has efficacy it may be a useful supplemental treatment for needy individuals having lower socioeconomic status.

Are you suggesting, like Chairman Mao, that sometning like acupuncture is good enough for the peasants? Because I thought you were just an idiot and a loon, but this would move you into the 'evil SOB' category.

PGP @24

I assumed

Go figure.

Could you try to learn from this one, please ?

Sorry to all the regulars who got stuck in automoderation

I WANT MY MONEY BACK.

@ Gilbert #16: What you posted in reply to my comment (which got moved to #17 because of the posts that went into automoderation) is called "shifting the goalposts."

That some of these kids rotate among a variety of anti-seizure medications has ZERO bearing on my response to you, or on the 3 kids who dropped out of the study due to increased LFTs. It only matters what the kids were on AT THE TIME.

And you can't wave your magic wand and say phenobarbital doesn't work when in fact it does, or that even if it actually didn't (which is a falsehood) that somehow magically means CBD is safe.

Citing an Ars Technical review of this paper which essentially says similar things to what Orac says without the insolence doesn't support your point in the least.

This study hasn't proven CBD can control seizures by itself. It only showed a reduction in the number of seizures the child had. Considering that seizures can be life threatening, simply jumping to a CBD only study as you suggest is premature. It is unethical to withhold treatment that works just to test a pet theory.

The authors believed the increased LFTs were due to a drug to drug interaction with valproate. They also believed since most of the kids taking valproate remained in the study, and also based further blood work, that this interaction was temporary. That needs more research; if so it simply means that most kids would be able to remain on valproate while taking CBD.

Odds are if these study findings are confirmed, CBD might become an adjuvant therapy for kids with Dravet syndrome who are not as well controlled on other drugs as they could be. We're years away from proving it works on its own and can be a primary therapy.

Also, we have no long term safety data on CBD alone, as the authors acknowledge (and you ignore). If something pops up with chronic use over time, that will limit its usefulness.

@ Gilbert #16: What you posted in reply to my comment (which got moved to #17 because of the posts that went into automoderation) is called “shifting the goalposts.”

I was not replying to your comment as I commented first. That's what #16 comes before #17 means. Though I saw your comment well before my moderation kicked out -- ORAC's tiered moderation methods to 'slow you down' I take it.

Moving goalposts. Hmm. I seem to recall that Charlotte Figi went from 300 seizures a week to one and that they had stopped all the other meds -- It was 2013 when I heard the story so I may be wrong.

Johnny (#34) writes,

Because I thought you were just an idiot and a loon, but this would move you into the ‘evil SOB’ category.

MJD says,

My comment about "placebo currency" was intended to bring transparency to the potential benefit of a post therapeutic-intervention for test subjects. :-)

Your respectful insolence is like holding a skunk by the tail, it's always unpleasant.

@ Alain (#32),

What's a nice person like you doing in a place like this?

Understand, you'll always be a pseudo-minion in Orac's dominion.

@ Orac,

If your VACATION, in the month of June, takes you to a foreign country will you be fully vaccinated?

In the absence of a response, we will assume that you are a closet antivaxxer.

@Gilbert: I can't help it if you don't pay attention. My #17 was posted before your #16. Perhaps you were replying to Johnny but you didn't make that clear. You still shifted the goal posts.

Charlotte Figi's ONE case isn't evidence of anything. What it did was spark interest in real research on the subject, which is now being done. Her case is still anecdote, not data, though if true I'm certainly delighted to hear she is doing better.

MJD: we don't understand completely why the placebo effect happens. Lying to patients is unethical, and right now we have to lie to patients to deliberately trigger the placebo effect. The effectiveness of doing that is dubious at best, and allows people to continue suffering at worst which is not cool.

But then again, you've proven time and again that ethics don't really concern you, so I'm not really surprised you'd advocate this.

Poking the bear is not funny. Better watch out he doesn't bite your head off.

@MJD:
The potential confounding factor presented by financial incentives to trial participation is a good reason to continue avoiding those incentives. And while I won't respond with quite the vitriol as Johnny did, I do wonder if you've thought through the ethics of your proposal to focus placebo treatments on the less fortunate, coupled with financial incentives for them to participate in clinical trials. You can't possibly be serious, can you?

I mean, just wow, dude.

Panacea (#40) writes,

But then again, you’ve proven time and again that ethics don’t really concern you, so I’m not really surprised you’d advocate this.

MJD says,

The other day an unhealthy-looking homeless man asked me for $ to get a smoke.

His teeth appeared like buttered corn as he smiled and gave a hearty thanks for the $.

In my opinion, the placebo currency-effect is real.

I can’t help it if you don’t pay attention. My #17 was posted before your #16

And I can't help it if you don't know how moderation works, I was replying to Johnny. Though I did see your comment was published first shortly after I subitted mine; I doubt you were ever in moderation.

Perhaps you were replying to Johnny but you didn’t make that clear.

Ohh. my bad. comment #15 was

Where did you find this? Is it in the full paper?

To which I replied

I haven’t seen the paper. but I assume that’s where this comes from:

I guess that is a little bit ambiguous to you. Again, #16 was submitted before #17 was posted. Silly.

Have a great and well deserved holiday, Orac.

MJD - If you are indeed proposing 'placebos for the poor', then yes, I stand by my statement that you are an evil sumbitch, and I've a feeling I won't be alone.

I really don't understand your post #33, and #39 didn't really help.

Well, fine. You got me Gilbert. I misunderstood who you were posting you.

Enjoy it. Everything else you said is flat out wrong.

You can’t get marijuana in Pakistan or Afghanistan.

I assumed it was forbidden, and also impossible to cultivate at high altitudes.

This is why you can't get kif in Morocco, either.

I've heard tell that some of the best and smoothest cannabis comes from arid conditions at moderate elevations. The plants thrive with plenty of water but the dry air reduces degredation of the cannabonoids as they are formed and the elevation increases UV which also enhance cannabonoid production. All and all, the same strain will come out better in Afganistan than in the muggy conditions of the southeastern US or even mexico.

Also, we have no long term safety data on CBD alone

Everything else you said is flat out wrong.

Panacea, you qualify for the *find a death after ten thousand years of recorded history challenge*.

According to one frequently cited study, a marijuana smoker would have to consume 20,000 to 40,000 times the amount of THC in a joint in order to be at risk of dying.

http://www.huffingtonpost.com/2013/09/03/marijuana-deaths_n_3860418.html

And that ^ is from carbon monoxide poisoning.

The answer is dose adjustment.

The "dose adjustment" is use until the desired effect is achieved as there is no toxic dose from the constituants of cannabis.

MJD,

this place, i enjoy.

Orac, that's a job requirement that he be fully vaccinated according to the standard of care. Never mind travelling (which may carry some recommendations).

Gilbert: while no one has died directly from an overdose of cannibis . . . yet . . . they have died from being under the influence, often while driving or some other mishap where they would not have died had they been sober.

I say yet because with the increasing levels of THC in the cannabis being produced today, once of these days we will find out what the lethal dose is . . . probably the hard way. Too much of anything is bad for you, even water.

And even the milder forms of pot our grandparents used in the 60's still had side effects. We know that chronic marijuana use in teenagers has adverse impacts on brain development. In sort, cannabis may be "safer" than many other drugs people use, but it is by no means benign.

I support legalization, by the way. The reasons for making it illegal were always bogus to begin with, and even with its known problems, alcohol and tobacco are worse in many ways.

But we're talking about using cannabis as medicine. A different standard applies. What I said about dose adjustment still stands; your blather about toxicity doesn't change the fact that we already know from the study under question that combining CBD and valproate can raise LFTs. That's worth knowing about cannabis, since many people combine it with other drugs. The likelihood that people who take it for medical purposes while taking zero other drugs is pretty low.

And this study still hasn't proven CBD safe or effective for anything, not even Dravet Syndrome. It's proven it may be effective . . . safe is still an open question, and only in a limited circumstance. More research is needed, especially since so many other studies of cannabis have been unconvincing.

Alain (#51) writes,

...that’s a job requirement that he be fully vaccinated according to the standard of care.

MJD says,

In an article from Lexology (2013) titled, Firing employees who don't get flu shots: what risks do hospitals face?, author Mark D. Nelson writes, "Hospitals, of course, have reached different decisions on how to balance the interests of patients and employees. As such, policies vary in the flexibility given to employees regarding non-vaccination and the resulting consequences:

Vaccination mandated with exemptions for medical contraindication, religious beliefs (discipline/other adverse consequences for non-exempted employees).

http://www.lexology.com/library/detail.aspx?g=d47d4235-8619-4bbe-aa16-e…

Q. Why are non-exempted employees singled out for punishment/other adverse consequences.

@ Orac,

Are you a non-exempt employee at the hospital?

My apology for the off topic question(s) about vaccination but it seems particularly-relevant knowing that Orac may be taking a vacation in early June, 2017.

@ Orac,

In the hypothetical:

If you are going to Mexico for some R&R, is it your responsibility, as a cancer surgeon, to protect your patients and determine the flu risk from the World Health Organization (WHO) before departing?

http://www.who.int/influenza/surveillance_monitoring/updates/latest_upd…

Please advise...

@Panacea #52

I suppose those are some good points.

MJD- you really are a bulldozer in a china shop - i assume Orac is intelligent enough to get any shots required for an overseas vacation like every sane person. He might be enjoying a "staycation". He might be going to Lost Wages or some other US tourist attraction. What business is it of yours?

You seem to be suffering from a fantasy that you can weasel out a confession that he hasn't had his shots (and therefore is a secret antivaxxer and hypocrite) . Not going to happen. Give it a rest.

Pretty pathetic.

Jane: not to mention MJD doesn't seem to know what non-exempt means.

Jane O. (#55) writes,

What business is it of yours?

MJD says,

It's none of my business, although, in the spirit of full disclosure it would behoove Orac to come clean about his vaccine history before any of us jump on his bandwagon.

Personally, I want to believe that Orac practices what he preaches.

@ Orac,

What say you?

Note: Verification of vaccinations, including those based on foreign travel, for the past 10-years will be adequate.

You seem to be suffering from a fantasy that you can weasel out a confession that he hasn’t had his shots (and therefore is a secret antivaxxer and hypocrite)

One might recall that this was a favorite of ol' Gerg's, as well.

Chemmom :Ok, ok. I'll stop commenting and lurk here quietly Right after this.

Narad: I wouldn't know about the drug scene in Morocco. Never been,and I'd be more interested in the wildlife.(Heck, I can barely tolerate tobacco.)

MJD: Do you understand seasons? Flu is more prevalent and virulent in winter and fall. Orac is travelling in summer. Even during 1918, there were very few outbreaks during summer-well, until late August-early September. So you're chicken littling about a very tiny risk to his patients and Orac himself. Not to mention that hospitals provide free flu vaccinations every year. Why do you assume Orac is too dumb to take care of himself?

This 'I am the only intelligent lifeform on the blog' posture of yours is getting beyond stale. It's even staler than Gilly's hippy-dippy 'I want all the drugs' policy.

OK, Panacea, an earlier study suggests the combination can be a problem. Maybe it does act like grapefruit does with some drugs:

The other major issue is the possibility of drug interactions—because CBD is a potent liver enzyme inhibitor it can increase the concentration of other drugs in the body. This means that when administered with other compounds, consequent effects on patients may be due to the increased exposure to those other drugs rather than the CBD itself.

https://www.scientificamerican.com/article/can-cannabis-treat-epileptic…

PgPig (#60) writes,

So you’re chicken littling about a very tiny risk to his patients and Orac himself.

MJD says,

I would never downplay a flu virus and recommend regular flu vaccinations, when available, independent of the season.

I'm surprised to read your comments, PgPig (#60).

I hope Chemmom doesn't put you back on a short leash after that outburst and/or effort. :-)

MjD - Think about it - why would anyone in their right mind waste one second of their time rummaging through their files to verify to a stranger in the "interwebs" that they have had their vaccinations?

I believe in Pap smears, but i wouldn't feel the need to prove to some random jerk that I've had mine regularly.

I assumed [Marijuana] was forbidden, and also impossible to cultivate at high altitudes.

I guess that rules out the usual explanation for the name of Hassan-i Sabbah's group, the Hashshashin.

I'm not our host, but challange accepted. Copied direct from my HMO website. True, honest and complete, you have my word on it, but, of course, how do you know? And just what exactly is this suppose to prove?

Immunization
Date
INFs 3yrs-adult (Influenza)
10/10/2009, 10/7/2007, 10/21/2006, 11/6/2005
INFs 4yrs-adult (influenza)
10/4/2008
INFs pres free 3yrs-adult (FLUARIX Quadrivalent) (Influenza, split virus)
9/9/2016, 9/17/2015
INFs pres free 3yrs-adult (Influenza)
10/17/2013, 9/14/2012, 10/11/2011
INFs pres free 4yrs-adult (FLUVIRIN) (Influenza)
10/21/2014
INFs pres free 9yrs-adult (AFLURIA) (Influenza)
10/19/2010
Tdap (ADACEL) (Tetanus, diphtheria, acellular pertussis)
7/27/2010
ZOS (Zostervirus live, shingles)
11/29/2016

Jane O. (#62) writes,

- why would anyone in their right mind waste one second of their time rummaging through their files to verify to a stranger in the “interwebs” that they have had their vaccinations?

MJD says,

Understood, let's all agree that Orac has and will always be vaccinated.

@ Orac,

If you miss one or many vaccines hereafter, you'll still have my/our full support.

Johnny (~#64) writes,

And just what exactly is this suppose to prove?

MJD says,

Good character from you Johnny and if Orac made such an effort we would all benefit knowing he's doing the right thing.

Gilbert: The possibility of a drug to drug interaction is present with every combination of drugs that exists.

Jane: regarding MJD. Agreed. he tries to come across as funny, and only manages to present himself as smarmy.

If Orac posted his vaccination information like Johnny, no, we would not all benefit. How is that information a benefit to any stranger? I assume he has done everything sensible and necessary (like normal people who are not antivaccine nuts) and i don't need to have this verified.

Christ you are paranoid.

Good character from you Johnny and if Orac made such an effort we would all benefit knowing he’s doing the right thing.

I disagree. I would suggest that if this quote reflects your actual belief, it proves you have a very low bar for persuasive evidence (which I believe everyone here already knows).

While my post above is a true and accurate copy of my shot records for the last few years, there is no way you could know that. If you accept it a face value, you are a foolish person (and no, I will not post my HMO login info so you can check up on me).

To answer my own question, all it proves is that I can look up which shots were given in a particular year and make up a few dates. If our host was to post his 'records', it wouldn't prove a darn thing either.

Your challange was a silly thing, and you should feel bad for posting it.

Jane O. (#69) writes,

Christ you are paranoid.

MJD says,

Having been publicly flogged by Orac as an "Anti-vaccine Zealot" and thereafter regularly placed in auto-moderation, it is my intent to provide personal comments that do away with such anti-vaccine rhetoric (i.e., judgmental insolence).

A respectful and productive conversation on the risk/benefit ratio of vaccines can only be accomplished in the absence of any form of insolence.

@ Orac,

Please consider renaming the much frequented Scienceblogs Respectful Insolence to "Respectful Judgment".

A smidgen of harmony and cooperation MAY ensue thereafter.

I don't know how many of those making comments here have any personal experiences with seizures or epilepsy,but I have lived with recurring/relapsing seizures for decades.In the last few years,they have been mostly atonic,and have gotten worse.I have several underlying genetic and medical issues,involving multiple systems.metabolic,autoimmune,and neurological.

In complex cases like mine,it can be very difficult to say what is the underlying cause of the seizures can be.Standard antiepileptic drugs can often cause more seizures, or make existing seizures worse.As with other conditions,such as MS or cancer,I think there is a lot in favor of a right to try here.Especially if we are talking about CBD oil derived from cannabis,with the THC removed,something I very much do want to try.

We all know there are too many scammers out there who just want to get high,and too many enabling doctors,with questionable credentials,that will gladly create a phony PTSD diagnosis for these scammers,but there can be legitimate reasons to try products derived from cannabis.Whether or not this is actual medical marijuana,is debatable.

Yes, it was first *assumed* that the infected machines were probably XP because, as it is no longer supported, it did not get an update.

Since then, analysis has shown the vast majority of infections were win 7 machines. Though they finally did roll out an update for XP. In fact, I'm suspicious -- NSA lost some tools; They want to implant new ones.

It should be noted that WannaCry was just the current payload of the exploit ETERNALBLUE. It may be that win XP is off the radar because they bluescreened before the implant could activate.

Meanwhile, EternalRocks—a separate self-replicating exploit also developed by the NSA and released in last month's Shadow Brokers release—is also being repackaged in active attacks.

https://arstechnica.com/security/2017/05/windows-7-not-xp-was-the-reaso…

And the beat goes on.....

Oh man, is my face red. I just commented on the wrong website; please ignore.

As for pot, "CBD is a potent liver enzyme inhibitor it can increase the concentration of other drugs in the body. This means that when administered with other compounds, consequent effects on patients may be due to the increased exposure to those other drugs rather than the CBD itself." (#61) -- makes sense then that there were side effects because the patients may have been effectively overdosed on their regular meds.

No worries Tim - I actually liked both of your comments.

e marijuana in Afghanistan and Pakistan

Whilst I have NO idea about it...
I'm sure that they have other more lucrative drugs sources to plant that bring in REAL MONEY

Hi, Tim: In essence, yes. Dosing and frequency of medications is based on the goal of maintaining a steady therapeutic serum level. If a drug to drug interaction causes something to take longer to metabolize, then it can cause a higher (or lower) than desired serum level, with the accompanying additive effects.

This is why people on coumadin shouldn't take St. John's Wort.

In this case, though, the issue is the effect on metabolism. Valproate is metabolized in the liver. So is CBD. In addition to potentially increasing the action and effect of valproate, the combination is stressing the liver somewhat, to the point where three participants in the study had to drop out, while nine others were able to continue.

So it begs the question; is the action of CBD in the liver somehow complimenting the action of the other anti seizure medications in a desirable way (making it useful as an adjuvant therapy), would it be useful on its own as a treatment, or is it simply going to complicate current therapies. The answers to those questions aren't answered by this study. More research is needed.

@Roger: my sister suffers from a very odd form of a focal seizure that causes arm, shoulder, and neck spasms, always the same side and direction. Overstimulation is a trigger; she often gets these when she is tired, when we've been to the movies or is under some other kind of stress. She also has fibro myalgia. She uses pot (medical marijuana is legal in our state, with a vaporizer, as I warned her not to smoke it) when she has a "fibro flare up" to deal with the pain. It works for that quite well, but puts her out like a light so she only does it at night when she's home.

It's had no impact on her focal seizures that we can see . . . and she keeps up with the research into medical marijuana (and is a skeptic herself) because of how the subject impacts her directly. She's well aware of the claims, doesn't think it helps her for that.

MJD @3: Clearly you have never taken a bioethics course, because pretty much lesson 1 is that you can not give anything of real value to study participants because it interferes with/negates their consent.
(Example: "I'm not sure about this study, but I really need to make rent this week." That's coercion.)

Too many parents who gave their children CBD oil which is in hemp and pot; stopped all their seizures and many stopped using their normal medications.

But if CBD is not POT then why did the DEA ban hemp and CBD oil?

If you're taking this site serious, consider a new source of information. You're being lied to; special interest have many interest in only curing symptoms and not disease.

It's the basis of corporate greed and crony capitalist. Why are you going to run yourself out of business? Money always wins; greed always wins.

The truth will remain elusive for the majority who rely on centralized sources of information. 90% of media is controlled by 6 corporations.

"Earth"

Are you sure? Have another look around you.

Fevers impair brain activity

dr. dolittle — Wed, 26 Oct 2016 22:06:07 +0000

Fevers impair brain activity

Image from ProjectManhattan (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

You probably already knew that fevers can cause some people to develop seizures. According to the National Institutes of Health, these so-called 'febrile seizures' can happen at temperatures of 102.2 degrees F and above and are most-often seen in children. The good news is that this type of seizure is usually short and does not often cause any long-term damage to the brain.

In a new study published in Physiological Reports, Researchers at Emory University (Atlanta, Georgia) and University of Western Ontario (London, Ontario) wanted to know how fevers affect brain function. What they found was that fevers caused some neurons in the gray matter of the brain to fail even after an action potential was initiated. These findings may help explain how febrile seizures develop as well as why some people may experience confusion and fatigue with a fever. They also found that younger animals tended to be more susceptible to these fever-induced failures than older animals as they experienced failures with only mild fevers whereas higher temperatures were needed before failures were seen in older individuals.

Sources:

http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seiz…

Pekala D, Szkudlarek H, Raastad M. Typical gray matter axons in mammalian brain fail to conduct action potentials faithfully at fever‐like temperatures. Physiological Reports. 4: e12981, 2016. DOI: 10.14814/phy2.12981

dr. dolittle Wed, 10/26/2016 - 18:06

Hillary Clinton is "medically unfit to serve" as President and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates!

oracknows — Fri, 19 Aug 2016 01:17:01 +0000

Hillary Clinton is "medically unfit to serve" as President and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates!

I’ve been debating whether to write about this for a while now, given that the first article that I noticed about it was first published a week and a half ago. Part of the reason for my reluctance is that it would be too easy for politics to be dragged into this more than I generally like. Of course, I don’t make a secret of my political leanings, but I usually don’t go out of my way to be an explicitly political blogger. I do, however, frequently write about areas where science and medicine intersect, and when I do I always come down on the side of science and rationality.

This brings us to a trope that has popped up in the media that Hillary Clinton is somehow “medically unfit” to be President. I first learned of this smear on August 10, when I found the latest e-mail release from the American Association of Physicians and Surgeons (AAPS), written by its executive director Dr. Jane Orient and entitled Is Hillary Clinton Medically Unfit to Serve? I thought about writing about it at the time, but unfortunately this Dug the Dog saw a squirrel. Next, I was made aware of an article by Martin Shkreli (yes, that Martin Shkreli) using his “expertise” as a pharmaceutical executive to claim that Hillary Clinton has Parkinson’s disease. Even though I was honored to appear as a guest rogue on The Skeptics’ Guide to the Universe and the topic came up, with Steve Novella delivering a forceful denunciation of such speculation, featuring Shkreli’s speculation as the “dumbest thing of the week,” still I didn’t write about it. Then, three days ago, the AAPS dumped another e-mail into my in box, this time in the form of a post by Dr. Gerard J. Gianoli entitled Is Clinton’s Health Less Important than Trump’s? That was the last straw. I made up my mind that I had to address the issue of the armchair diagnosing of the health of Presidential candidates, particularly since my good blog bud and fellow “Walking Dead” fan, Skeptical Raptor, took on the issue just the other day.

It’s not as though I haven’t done this before, of course, although it’s been a long time. The last time I discussed speculations about the health of a Presidential candidate was in 2008, when the issue of John McCain’s history of melanoma came up. I basically said that it was unlikely that his melanoma would recur, and time has proven me correct, as McCain is running for another term as senator this year and doing fine—physically, that is; politically is another question—as he approaches 80.

Finally, I decided that all this idiotic and uninformed speculation about Hillary Clinton’s health was getting on my nerves, as the speculation about Donald Trump’s mental health had done before. As I told Steve Novella on SGU, few people despise Donald Trump or as alarmed at the prospect of a Donald Trump Presidency as I have been, but even so I was profoundly uncomfortable with all the psychological diagnoses being thrown around about him, seemingly without much care. At first, I even thought that it had been a lot of this speculation about Donald Trump’s mental health that had lead Trump supporters to fight fire with fire with even more ignorant speculation about Hillary Clinton’s health, but I soon learned that the “Hillary Clinton is medically unfit to serve” meme had been appearing on Breitbart.com at least as far back as January 6, when a story entitled Law Enforcement Officials, Medical Professionals: There’s Something Seriously Wrong With Hillary Clinton’s Health was published.

Let’s take a look at some of these claims. First, Dr. Orient laid down an op-ed clearly designed to be picked up by as many newspapers as she could get it picked up in (given that it’s only around 700 words long) that consists mainly of a whole lot of JAQing off. After praising Trump for his bluntness and noting that some liberals are throwing around psychiatric diagnoses about Trump, noting, “...keep in mind that a lot of them think conservatives, Christians, and pro-life advocates are crazy too,” Orient lets loose the JAQing off:

There’s the photograph of Secretary Clinton’s difficulty walking up some steps. Now inability to climb stairs does not necessarily disqualify a person for public office. However, neither she nor people with her apparently anticipated a problem. The people helping her seem to be preventing a fall. Did she simply trip? Or was it a seizure or a stroke?

Videos widely circulated on the internet are, if authentic, very concerning. One shows prolonged, inappropriate laughter; another, strange head movements. In a third, she appeared momentarily dazed and confused, and lost her train of thought. Reportedly, she has a volcanic temper. (This is probably not new.)

A man who stays close to her, who is reportedly not a Secret Service officer, was photographed carrying something in his hand that purportedly might have been an autoinjector of Valium.

While we don’t have Mrs. Clinton’s medical records, it is widely stated that she experienced a fall that caused a concussion. Since then, she is sometimes seen wearing eyeglasses with prisms, as are used to correct double vision.

Evidence for these speculations? Almost none. Just a photo and some videos claiming “strange head movements,” a moment of looking “dazed and confused” (Orient’s age may be showing, given the obvious Led Zeppelin reference), and “inappropriate laughter.” There are, of course, also second and third hand reports where the primary witness is never identified, several of which can be found in this Breitbart.com piece and one of which Orient was cited by Orient in the passage above.

Meanwhile, another “brave maverick” doctor of AAPS, Dr. Gerard Gianoli, tries to provide Dr. Orient with tactical air support but only embarrasses himself spectacularly with some really stupid JAQing off:

What are the symptoms of increased intracranial pressure? The most common are headaches, visual problems, and dizziness/balance problems. We know that Ms. Clinton has had all three of these. Less commonly known are “brain fog,” problems with concentration, and short-term memory problems. Sounds familiar?

Asking:

Why has the media not been inquiring about Mrs. Clinton’s health records as aggressively as they did when GOP candidate John McCain had skin cancer? What do her visits to ophthalmologists and neurologists show? Has she had any neuropsychological testing, as is routinely done in traumatic brain injury cases?

Actually, the media didn’t really inquire that aggressively about John McCain’s skin cancer. Rather, it was a couple of really far out left-wingers who gained notoriety for using McCain's history of successfully treated melanoma to drive a narrative that McCain was a “dead man walking” (which, obviously, he wasn’t, given that he’s alive and well eight years later), much the same way that it has been Martin Shkreli and Jane Orient who have been driving the false narrative that somehow Hillary Clinton is “medically unfit to serve.”

This is all incredibly thin gruel that leads Orient to wildly speculate further:

Concussions often cause traumatic brain injury, which might not be visualized on standard CT or MRI. Many of our veterans who experienced blast injury from improvised explosive devices suffer from it. These are some symptoms: difficulty thinking, attention deficits, confusion, memory problems, frustration, mood swings, emotional outbursts, agitation, headaches, difficulties with balance and coordination, and seizures. Many veterans with such an injury cannot hold a job or interact normally with their families.

Obviously, it would be very dangerous for a person subject to symptoms like this to be dealing with foreign leaders or making critical decisions. The President of the United States may have to make world-changing decisions on a moment’s notice. For example, should we launch nuclear-armed missiles? And if the Commander in Chief is confused, who will make the call?

To be honest, I’d be much more worried about a perfectly healthy Donald Trump having access to the nuclear missile codes than even a Hillary Clinton with post-concussive syndrome. (Sorry, I couldn’t resist interjecting a little of my own politics there.) I’d also point out that when the President is incapacitated, the Vice President assumes the powers of the Presidency. Be that as it may, what do we have here? Again, nothing other than speculation.

Here’s some of what we do know about what happened. In December 2012 while she was still Secretary of State, Hillary Clinton, ill with a gastrointestinal virus and dehydrated, fainted and hit her head, suffering a mild concussion. After Christmas, she underwent an MRI for unclear reasons (there was a quote about this possibly being “follow-up MRI, that probably would not have happened for regular people” and the routine for a concussion in a patient who recovered rapidly after a few days and hadn’t suffered a skull fracture doesn’t generally include followup imaging). This found a blood clot known as a cerebral venous thrombosis. She was treated with anticoagulation and recovered. Neurosurgeons interviewed for the story agreed that this sort of clot was uncommon after a concussion with no associated skull fracture and was a potentially life-threatening condition for which treatment was indicated. Clinton was treated, and, by all accounts, made a complete recovery.

At this point it’s not inappropriate to note that Dr. Orient’s organization, the AAPS, is a an embarrassingly quacky physician organization that I first discussed ten years ago. (Has it really been that long?) Over the years, I’ve documented how the AAPS, through its house organ the Journal of American Physicians and Surgeons (commonly abbreveated JPANDS), has abused science with hilariously bad studies purporting to demonstrate that abortion causes breast cancer (it doesn’t); that administering multiple vaccines at one visit is not safe (it is) that with respect to DDT and the Zika virus the best strategy is to spray, baby, spray (it isn’t); that shaken baby syndrome is a “misdiagnosis” for vaccine injury (it isn’t); and that President Obama uses neurolinguistic programming to get Americans to do his bidding (he doesn’t). The AAPS is also all-in for a large number of antivaccine tropes.

It’s not too surprising that Jane Orient would like Donald Trump. After all the AAPS is explicitly opposed to any form of government regulation of health care; considers the FDA and Health Care Financing Administration to be unconstitutional; is utterly opposed to Medicare, viewing it as immoral; urges physicians not to participate in Medicare; describes public health programs as "tyranny"; and liberally quotes Ayn Rand. Basically, the AAPS believes that the free market will fix everything that’s wrong with health care. Well, not exactly. Rather, the AAPS believes that the free market, coupled with removing pretty much any restrictions on how doctors practice medicine, be it evidence-based guidelines, board certification, maintenance of certification, peer review, or even state licensure will return medicine to a golden age in which doctor knows best and can do whatever he thinks best for his patient. Of course, it doesn’t matter to the AAPS that such a golden age of medicine never existed.

The leadership of the AAPS, including Orient, and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed "maverick" status and give the appearance of thinking that, like Ayn Rand's hero, they're "supermen" whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reining them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the "herd" could appreciate that! No wonder JPANDS has published several articles with titles such as Evidence-based Guidelines: Not Recommended, The Effect of Peer Review on Progress: Looking Back on 50 Years in Science (featuring another scornful dismissal of the "herd instinct" and "conformity" and a fair amount of exaggeration of how much scientific progress is due to "violent confrontation" of old paradigms and how much is due to the slow accumulation of knowledge), and editorials attacking evidence-based medicine. To the AAPS, scientific consensus is evil, and evidence-based guidelines are unacceptable limits on the autonomy of physicians, as are any government regulations or third party payer systems.

But what about the claim that Hillary Clinton has Parkinson’s disease? As Steve Novella points out, first of all, Shkreli is not a neurologist. He isn’t even a physician. Yet he thinks that because he’s been involved in drug development and clinical trials he can diagnose Parkinson’s on the basis of a video in which Clinton shows an exaggerated startle response that looks kind of goofy, which he calls dystonia. He also claims the video in which she trips is a “Parkinsonian freeze.” Dr. Novella, of course, is a real neurologist, and he tells us that none of these were dystonia, a seizure, or anything consistent with Parkinson’s. As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize. He also notes that it’s impossible to hide for very long and that Clinton has been in the public eye constantly for thousands of hours over the course of the campaign.

This brings us to Donald Trump. Four days ago, the New York Times published an article by Benedict Carey entitled The Psychiatric Question: Is It Fair to Analyze Donald Trump From Afar? The story starts noting an incident from history:

In the midst of a deeply divisive presidential campaign, more than 1,000 psychiatrists declared the Republican candidate unfit for the office, citing severe personality defects, including paranoia, a grandiose manner and a Godlike self-image. One doctor called him “a dangerous lunatic.”

The year was 1964, and after losing in a landslide, the candidate, Senator Barry Goldwater of Arizona, sued the publisher of Fact magazine, which had published the survey, winning $75,000 in damages.

But doctors attacked the survey, too, for its unsupported clinical language and obvious partisanship. In 1973, the American Psychiatric Association adopted what became known as the Goldwater Rule, declaring it unethical for any psychiatrist to diagnose a public figure’s condition “unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

Supporters of the rule make the arguments that (1) most diagnoses made from a distance turn out to be wrong; (2) the labels themselves can cause real harm to the person and family members; and (3) the practice undermines the field’s credibility. All of these are very good arguments, every bit as good as arguments why physicians shouldn’t be “diagnosing” Hillary Clinton with a neurological disorder. The Goldwater rule is still a good rule, but unfortunately during the campaign there have been psychiatrists openly flouting the rule when it comes to Donald Trump.

What I find particularly troublesome is the disingenuous and downright slippery rationalizations made by some psychiatrists and psychologists making these “diagnoses.” For example:

Dr. Steven Buser, a psychiatrist who with his colleague, Dr. Leonard Cruz, coedited a new book, “A Clear and Present Danger: Narcissism in the Era of Donald Trump,” stressed, “We are careful not to make a clinical diagnosis here, to say that Donald Trump has narcissistic personality disorder.” The contributing writers include psychiatrists and psychologists, but Dr. Buser said, “We are focused on the image he projects, on TV, in tweets, in quotes.”

This is, to put it kindly, self-serving bullshit, and highly unethical bullshit at that. Dr. Buser should be ashamed of himself, but obviously isn’t. He should also take a goo, hard look at himself and ask himself how much of his “diagnosis” is due to his political dislike of Donald Trump, and I say this as someone who quite literally despises Donald Trump and opposes him more than any Presidential candidate who’s run in my lifetime.

In the end, as is often the case, my views tend to align with Steve Novella’s view. First, using psychiatric diagnoses as a form of political attack further stigmatizes mental illness. Arguably, this is going on both in the attacks on Hillary Clinton and Donald Trump. While the attacks on Donald Trump explicitly invoke mental illness, the attacks on Hillary Clinton imply that she is unfit due to “brain fog” or mental or psychological consequences of a concussion. I also agree that, if you’re a professional, you should be really, really cautious and circumspect about attributing diagnoses to people whom you have not personally examined and whose medical records and tests you have not personally reviewed. And, certainly, if you are not a professional, you should just stop with the armchair diagnoses altogether. That’s nothing more than embracing the Dunning-Kruger effect wholeheartedly.

The retort one will hear, of course, is that the President is the most powerful person in the world. He or she will have access to the nuclear codes and will command the most powerful military in the world. Surely, the voters have a right to know if a Presidential candidate has a medical condition that might seriously compromise his or her judgment. While this is a good argument, armchair diagnoses, be they from actual physicians with no clinical contact with the candidate or amateurs with no clinical expertise, do not actually address that argument, nor do they serve to prevent compromised candidates from acquiring power. That’s because diagnoses aren’t made that way. They’re still made through direct, hands on diagnosis by physicians who have the appropriate expertise. In the hands of amateurs like Shkreli, quacks like Dr. Orient, and disingenuous, self-justifying docs like Dr. Buser, they are political weapons, not diagnoses.

Hijacking medicine for political purposes serves neither medicine nor politics. It just becomes a tool for partisans to bring down their opponents. Skeptics should not succumb to the temptation to use medicine that way.

oracknows Thu, 08/18/2016 - 21:17

Categories

Medicine

I hate armchair/internet/whatever diagnoses with a passion.

It isn't just in politics: the other day I was reading a piece about UK cyclist Mark Cavendish (for those who don't follow cycling, he'd just won an Olympic silver, shortly after winning another 4 stages of the Tour de France, making him the most successful sprinter in Tour history, he's a bit good on a bike)), who can be very blunt in interviews, not suffering fools at all, and can give very detailed tactical analyses of a race...

Some berk took this as signs of Asperger's...

Immmm, no. Cavendish comes from a part of the UK which does have a reputation for plain speaking, he's been asked more than his share of stupid questions by journos over the years, and he lives and breathes cycling and, especially, tactics in races, which is why he's so good at it...

People trying to see MH diagnoses annoys me especially, given my clinical background.

Golly gosh!

This is now twice this week I've been the first responder: this must be sign of a conspiracy or that I am under the control of Orac or something...

Excellent post. May I add something else? Not only does this kind of pseudo diagnosis of politicians add to the stigma around mental illness, but it drives further the trope that being old is being unfit. What would the modern armchair arbiters of presidential health make of JFK? Or F.D. Roosevelt?

#2 Murmur, it could also mean you are Orac ;)

"Inappropriate" laughter? Show me someone who only laughs when it's "appropriate", and I'll see someone with a stick up his or her ass. Not someone I would wish to get to know further. I imagine HRC's personal and political history has provided many causes for "inappropriate" laughter. Look who she's married to, for starters. Add in all the muppets (foreign and domestic) she would have met as Sec of State: if you didn't laugh about it, you would go mad.

And now that Breitbart guy is atop Trump's campaign, it's only going to get worse from all angles.

I'm not a professional psychologist, although I have read quite a bit of the subject. However, I am not offering a diagnosis of Trump. I will however say that he shows signs in public of being grandiose, self-centered, greedy, vain and short tempered. Yes, there is a DSM or ICD diagnosis that contains all of those. No, I'm not going to "go there" and claim Trump has that disorder. Yes, I am going to say that based on those characteristics I would not want Donald Trump to be president. I would have said the same of Barry Goldwater and of Joe McCarthy. Put bluntly, Trump may or may not meet the medico-legal definition of "insane" but he certainly isn't the stable, rational, intelligent man whom I want at the helm of the ship of state. (not to mention the nuclear release codes.)

Just wanted to add that Dr Drew Pinsky has joined the fray, claiming that he is "Gravely Concerned for Mrs Clinton's health." (methinks Dr Drew is Gravely Concerned for Dr Drew's Ratings. )

After talking this over with friends, I've decided to write to all of these people and ask for their help. I'm pretty much a shut-in these days, and the thought of being able to just send off a video of myself and receive a diagnosis (and possible prescriptions, because Dr. Drew whatisname, who knows Clinton isn't taking the correct medication, is all about the right prescriptions) without ever having to leave my house or having any of them examine me is intriguing! I'd never have to worry about transportation to a medical appointment again!

(3) the practice undermines the field’s credibility.
I am not convinced that "undermining the credibility of psychiatry" is any reason to abandon a practice. If anything, it's a reason for more of it.

Slightly OT, but every remaining irony meter I had blew a few days ago blew when I read that AV kook Robert De Niro called AV kook Donald Trump "totally nuts" ( http://www.usatoday.com/story/life/people/2016/08/13/robert-de-niro-tru… ).

I like what Douglas Adams has to say about those who wish to rule, er, I mean lead us:

The major problem—one of the major problems, for there are several—one of the many major problems with governing people is that of whom you get to do it; or rather of who manages to get people to let them do it to them.
To summarize: it is a well-known fact that those people who must want to rule people are, ipso facto, those least suited to do it.
To summarize the summary: anyone who is capable of getting themselves made President should on no account be allowed to do the job.

Don't you think Trump looks tired?

What I find interesting is comparing the 2 attending physician letters for the candidates.

Dr Jen Gunter looks at the letter that is supposedly from Donald Trump's doctor, and rips it apart as unprofessional. (And, as a medical professional, I agree. It's very badly written. Sadly, I can also say that working in health insurance, I've seen letters just as badly written.)

Contrast that letter to the one Skeptical Raptor links to from Hillary Clinton's doctor. It's very professionally written, discusses her concussion and treatment, and states she is in very good health.

Just on the basis of the MD letters, I'd prefer Hillary over Donald.

@Mephistopheles O'Brien

*I* think he looks unhinged (not a psychiatric diagnosis, mind), but I like where you're going with this.

"What are the symptoms of increased intracranial pressure? The most common are headaches, visual problems, and dizziness/balance problems. We know that Ms. Clinton has had all three of these."

I have all three of these from time to time also. Maybe I am not fit to do my job! May I go on disability?

As for Trump and narcissistic personality disorder, I came up with that one on my own without hearing any of this nonsense first. I just did not go running to the press with it.

This idea that elections are won by dissing your opponent is beyond disgusting. I fear that this time we have reached the point of no return.

Personally, I think Trump has a totally non-clinical case of foot-in-mouth disease just from the huge number of ill considered, poorly thought out, and potentially dangerous remarks he has tossed out in his speeches and interviews.

My father and grandfather both had Parkinson's disease, but they were both very clear headed until they died in their 80's and 90's respectively.

My grandfather was a rather dour Baptist dairy farmer from Ohio and I barely remember him laughing, much less laughing inappropriately, but he did have a very dry sense of humor.

I also remember Gerald Ford got a lot of heckling for a couple of falling incidents, but I don't remember it being considered a disqualification.

@ MI Dawn, I just read that too and laughed at the style of the letter: https://drjengunter.wordpress.com/2016/08/16/im-a-doctor-these-are-the-…

I can only wonder what direction Trump's campaign will go in with Breitbart at the helm.

I don’t think you can blame people for trying to come up with something to describe the bizzare behavior and odd speech patterns that emanate from Trump. I also think the Goldwater Rule is a good thing. So...just what is appropriate when a public figure actually displays weird symptoms? Candidates usually release a letter from their medical doctor, but is it too much to expect the same for mental health?

Frankly, I’d rather have a Prez with a manageable medical issue that an undiagnosed and untreated mental illness.

@squirrelelite: I remember Gerald Ford very well, also. And his stumbles/falls were laughed off as "chronic clumsiness". No one questioned his fitness for the presidency based on those. But then, he was a WASP.

No one questioned RR's fitness, even though there were signs of dementia when running for his second term.

Strange how it's dangerous for a woman to (theoretically) show signs of problems, but never in a man.

@MI Dawn,

I agree about the double standard. I've seen a couple well written discussions of the narrow path Hillary has to tread .

Using my pediatric acumen, I will state both candidates are well outside my age range of comfort. They are are breathing, have a pulse and are perfused. Medically I will say nothing further.

Heheh.

@Chris Hickie: as a CNM, I'd go a little further and say that HRC is a well-developed, well-nourished woman who looks to be her stated age. Beyond that, I will say nothing without a physical exam or at least being in the same room with her and speaking to her (then I could asses some other things).

I would have nothing to say about DT as men were out of my field of practice completely.

Thank you for saying this.

"I remember Gerald Ford very well, also. And his stumbles/falls were laughed off as “chronic clumsiness”. No one questioned his fitness for the presidency based on those. But then, he was a WASP."

Ford was also an ex-athlete in good physical shape. But he was mocked unmercifully for alleged clumsiness.

"...both candidates...are breathing, have a pulse and are perfused."

Ha, what independent physicians have certified any of these "facts"? Can we confidently state the two major candidates are not alien robots simulating human physiology and feelings? Some observers have spotted false notes, especially regarding expression of human emotions.

Just raising some possibilities here.

@Dangerous Bacon: Isaac Asimov wrote about this in the short story "Evidence". Perhaps both candidates are from alien robotic cultures fighting for control of Earth.

Bornstein is a gastroenterologist. I regard such a specialty as being far to up-tract for a physician to Trump.
I would have thought it customary, when a physician intends to release actual details of someone's medical data, to address the letter to the person in question and allow that person to release the letter.

I suspect part of what is going on is diversion from the refusal of Trump to release his tax filings.

From the RationalWiki article on AAPS: "While purporting to have high regard for the Hippocratic Oath, "the sanctity of the patient-physician relationship, and the "practice of private medicine",[1] ..." Yet Orient is quite content to malpractice very publicly when it comes to HRC.

As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize.

This was how Billy Connolly was first diagnosed.

" As he points out, Parkinson’s is an “across the room” diagnosis that is easy for a trained neurologist to recognize.

This was how Billy Connolly was first diagnosed."

My dad was diagnosed after his GP happened to see him walking down the street.

There is a big difference between the lay person saying eg Trump is a narcisistict, power hungry, looney and a doctor saying it.

Listening to political experts/ news folk delve into the morass that surrounds the Orange One is like deja vu for me because of my experiences trudging through the various swamps of unreason I frequent.

It's as though Null logic and the Adamsian thought [process/ libel factory have gone mainstream.

I look upon the entire circus as just that, a circus. Three rings worth.
There is no Constitutional health requirement, otherwise, Grover Cleveland would've never saw the inside of the oval office, as well as 1/3 of other past POTUS'. Period. Some, so unhealthy as to shock one and all today. Indeed, FDR was so ill, he had a stroke so severe, his aides first thought he was shot in the head.
No, just severe hypertension and a CVA from hell, which leaked from his ears.
Indeed, it's dubious if Congress could impeach a mentally ill POTUS, as mental illness is neither a high crime nor misdemeanor and a mentally ill person may well be capable of acquitting the office of POTUS without a problem (hell, these days, it actually might help).
In the fiction of things, it comes down to the popular vote. In reality, it comes down to convincing the electors (most states don't have a statute to force an elector to abide by the popular vote).

As for stumbling on stairs, glazed looks, I've had more than a few of those on my part. I injured my back when catching my wife after her abdominal surgery, preventing a fall, but ending up with severe spasms in both legs, especially calves. So, doctor prescribed an opioid for pain and it did well as a "muscle relaxer" enough that the "muscle relaxer" he did prescribe was only taken at bedtime.
But, I sure had glazed eyes and the neurological issues with my legs made stairways problematic.
Fortunately, I retained dad's cane after he died, as it came in really handy in preventing more falls than I had after the initial injury.

In other personal news, I saw the orthopedist today, it was found that my shoulder wasn't separated, but the ligaments were stretched. PT should help with that.
Maybe that would be considered disqualifying me for POTUS in some eyes or something.
Personally, I think my career inclination and preferences, plus my disposition disqualifies me from the office. Maybe that's why I won't run. ;)
Or more accurately, I'm not interested in that aggravation. :P

Don't forget we still don't know if Reagan developed while he was still president.

re comments above- various

Clumsiness ?
Yours truly played much tennis, dancing, martial arts, etc over many years.
In April, I had an incident with stairs near an underground train and have been dealing with it since and have improved until I tripped over a cat ( please don't laugh, Narad) 3 weeks ago and have had trouble driving, because of the clutch but am somewhat better. The cat survived without obvious damage.

I doubt that ethnicity has anything to do with it.

Don't get me started on cats tripping me!
Ours did his usual antics as I returned from home earlier this week. I was using the cane to walk, leaning rather heavily upon it, lest one leg collapse unannounced.
He tore around me, clipping the cane *just* as I was leaning down onto it and placing it on the ground, tearing it from my grasp and spilling me straight down onto one knee on the nice, soft ceramic floor.
Once recovered and inventory showed nothing broken, but fairly bruised, I picked up the cane and shook the crook at him, "Stay the F out of my sight until I calm down!".
He sat in the window watching me for the next half hour, then came over for his attentions.
He did end up waiting another hour for food to be set down for him - I was in no way ready to bend to put that bowl down after that twisting impact with the floor!

Thankfully, he's been more careful since.

Oh, I've tripped over cats.

I swear I have never tripped over a cat before.

Even wearing 90 or100 mm heels or after having ingested various libations/ potions.

I did slip on a wet floor once to avoid stepping on a cat.

Cats are wonderful magical creatures, no?

Medicine, politics, and social media.. a living venn diagram of dysfunction. If politicians ran medicine, we'd have the best iron lung in the world right now, but nary a polio vaccine. If social media and popularity bandwidth wagon ran medicine, the CDC mmwr would be off the chart.

Cats have an evil side...I had a few that LOVED to seek attention just as I tried to go down the stairs, usually with my hands full. They would wind around my ankles purring. One, however, preferred to try to jump into my arms. The first time he tried, however, when I had both arms full of baby, was the first time I didn't catch him. The look of betrayal on his face...

Claiming your opponent is incapable is a great way of trying to re-level the playing field when your own candidate is a abject failure and startlingly weak. But why the vehemence?

Answer: http://www.nytimes.com/2016/08/12/opinion/pieces-of-silver.html?_r=0

It all comes down to rich people, like quack doctors and financial speculators, not wanting to pay more taxes. After all the high-minded language about what is best for the nation it all comes down to what is best for their bank accounts. Both craven and simple.

Ugh, Shkreli. He needs to go jump down an obuliette.

MOB @ 12: Well played. He does look tired, don't you agree?

I am not convinced that “undermining the credibility of psychiatry” is any reason to abandon a practice. If anything, it’s a reason for more of it.

I could once be counted on to defend psychiatry, but I must say I am not at all a fan of this business of locking people up who haven't committed a crime (attempted suicide is not a crime the last time I checked), something which I narrowly avoided. (Thanks, lone sane shrink!)

^ One might note that "It's my life and my business," in so many words, is not the best line to take when asked about one's feelings regarding suicide by the DMHP.

@JP - after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, "That was stupid. Going to do it again?" My response was, "Duh. It didn't work." Close enough. They released me.

Off topic (but about woo. Isn't woo always a topic here?): we went to the state fair this week and Mr Woo got talked into a fifty dollar rubber bracelet that "blocks radiation to allow detoxification and reduced inflammation." I couldn't hide my disdain, but he still offered to get me one, too, anyhow.

I am opposed to any third-party speculation about the health of Ms. Clinton or Mr. Trump. However, they are both 70. We have seen what time in the White House did to Mr GW Bush and Mr Obama. I think it is fair to ask all presidential candidates for an independent health screening and a list of their medications--regardless of age.

You really don't need to diagnose Trump with a mental illness or disorder to call him what he is: a colossal asshat.

I don't know why people need to justify labeling him with the former when the latter language will do quite nicely.

We have seen what time in the White House did to Mr GW Bush and Mr Obama.

TINW. Was it the same thing to both? What about everybody else? I mean, Obama wasn't 70. This really seems to need some more comprehensive data, no matter how primitive.

^ Should've been just "some" italicized.

Honestly though, who hasn't shown the strain of being POTUS, even if they only had four years in office?

Seriously, does anyone here think that having that job wouldn't be a tremendous strain, the late night awakenings due to a crisis, having to learn of, then speak to a nation after a mass shooting or other tragedy, heaven help those leading the nation in time of war!
Between that and the politics involved in all parts of the job, I wouldn't dream of wanting that job. It doesn't pay enough for the stresses involved and the BS inherent in the politics of the job.

As a Canadian, with no medical training whatsoever, I have become convinced from watching the news that your whole country is insane!

@Acitta #48, as a born US citizen, I have to concur. :/

I am diasppointed to learn that William Howard Taft did not in fact make a great sucking sound when removed from a bathtub.

@Narad, while amusing sounding, one can get stuck in a bathtub without being wedged in it.
Both my wife and I have (individually) been "stuck" in the tub, unable to rise from it, in one case, an injury that was being soaked prevented self-extraction from the tub.
In another, the kids had an excess of bubblebath residue in the tub, preventing regaining my feet and necessitating assistance from my wife, a small hoist and a skid jack.
OK, not really all of that, it just seemed that way as my feet slid like they were on oiled glass.
Funny now, but I very nearly broke my neck when I tried to stand up to exit the tub the first attempt. Even today, decades later and the kids long gone from the house, with homes of their own, I still ensure that the bottom of the tub isn't slicked down with bubblebath or conditioner (just about as bad).

As for Taft, well, he did break the bathtub ring, a porcelain price fixing ring. It's interesting that he'd break up such a criminal price fixing cartel, to suddenly find himself allegedly stuck in a bathtub... :)

Oh, for a bit more TMI, to this very day, I still take baths. It relaxes back muscles that are in spasm when I get out of bed quite effectively. A shower entirely fails to do that.
But, I do watch out for conditioner spilled in the tub. That crap's lethal!
For more amusing home accident anecdotes, get my wife on and ask her about my superman imitation on satin sheets, while making an amorous dive toward her. While it more resembled the landing of "The Greatest American Hero", my wife tells it humorously and accurately enough to bring the house down every time.
With a fair amount of effort, I did manage to repair the wall six feet away from the bed.

I have to agree - long distance diagnosis sucks, with some few exceptions One that I can think of is the profile a Dr. Brussel made at police request of George Metesky, the "Mad Bomber", who planted bombs all over NYC for too many years. It turned out to be stunningly accurate. The War Department also commissioned a psychological profile of Adolph Hitler.
With the major exception of exigent circumstance and no direct access to the subject, it is thoroughly unacceptable, unethical, and dangerous. I also believe that a professional publicly offering an unsolicited attempt at diagnosis is somewhere way out in the ethical stratosphere, where the air is mighty thin. It might pass in cases of "across the room" or augenblick (German for "blink of an eye") diagnoses, cases where the diagnosis jumps out at a knowledgeable practitioner. None of what's passing for diagnoses in this election rises to that level.

I too have "headaches, visual problems, and dizziness/balance problems" when I have migraines (not so much actual pain - acephalgic migraine). Or did three neurologists, a neuro-ophthalmologist, and a neuro-otologist who worked me up for a concurrent issue miss my elevated intracranial pressure and doom me to disability and death?

Much as I want to stay out of politics here, I do think that Trump's criticism of other people's appearances is prime chutzpah coming from someone who looks like a jack o' lantern left on the porch all winter.

@Wzrd1: A similar thing happened to my ex-husband (while we were still married.) His hip occasionally would go into spasm, due to a flag football injury where he was tackled *just* the wrong way. (And yes, I know you aren't supposed to tackle in FF - tell teenage boys that.)

Anyway, he'd taken a bath to relax some sore muscles, tried to stand up and realized he couldn't. He yelled for help, which I went to give him. Mind, I was 8 months pregnant at the time. Trying to life someone twice my (unpregnant) weight, with a very pregnant belly shifting my balance, was not an experience I want to ever repeat. However, we did finally manage to get him out.

FYI: if the footing is too bad, a number of towels thrown in underneath the feet and hips eventually will help.

@MI Dawn, my wife had gallbladder surgery and had a umbilical hernia repaired (c-section scar that is 30+ years old started to fail at the umbilicus) last month.
It was endoscopic surgery and hence, she returned home a few hours after surgery.
A few hours after that, she started to fall and I managed to catch her, injuring my back in the process and ended up with severe sciatica pain and spasms in both calves that literally pointed my toes downward and spasms across the arch of my feet, literally collapsing my arches. I'm on hydrocodone for the pain and it's effective against the spasms, so I'm only taking the "muscle relaxer" at bedtime.

The next morning, while I was at work, her legs gave out on her (she has a severe herniation of L5-S1 pressing upon the cauda equina (in the lumbar region, it isn't spinal cord, but the cauda equina (horse's tail of nerves bundled in a sheath).
I drove home from work after receiving an e-mail that she was on the floor, unable to rise. Not too bad, as the house is only four miles from my office.
It took a few tries to get her up off of the floor, as she lacks the leg strength to plant her feet firmly and she kept sliding on the tile floor. I finally placed her toes against my shoes and that gave enough purchase to lift her onto her feet.
Fortunately, she's not fallen since.
She also had an MRI of her cervical spine, viewing the dicom imagery, I couldn't find a single disc in her neck that wasn't impinging upon the spinal cord. Worse, the radiologist report later confirmed that.
Even worse, she has advanced osteoporosis. Something our former primary, back in PA, concealed and claimed had somehow cleared up. So, she's currently inoperable, lest the vertebrae collapse during surgery.
We're awaiting special dispensation from the insurance company to begin her injections to correct the osteoporosis.
She apparently had several vertebrae suffer fractures and heal and she currently has two fractures that are fresh.

Yeah, I'm getting accustomed to picking her up, either from a chair or from the floor. :/
Fortunately, I learned how to lift patients in a wide variety of situations, ranging from battlefield emergency moves through using bed lifts.
Laughably, once, I was working with a man who lifted weights on a regular basis and was quite muscular. He had trouble moving our weighted medical mannequins. Oddly, he entirely forgot all of his training in lifting an unresponsive patient and tried to manhandle the dead weight.
I used standard means to lift the mannequins, utilizing their articulating knees and hips, lifting them to chairs and medical litters with minimal effort.
Of course, moving an infantryman is easy - offer him a drink. ;)

@JP – after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, “That was stupid. Going to do it again?” My response was, “Duh. It didn’t work.” Close enough. They released me.

I was actually trying to work out if this meant that you were or weren't going to try it again, then decided that you are probably a lot smarter than I am.

@Narad, while amusing sounding, one can get stuck in a bathtub without being wedged in it.

I know; I've actually slipped backward and clothed into a dry tub while sitting on the edge and been stuck for several minutes while trying to figure my way out of the transverse-on-back-situation (as well as slipping during a regular shower, narrowly avoiding cracking my head, and having to resecure an upright stance).

This does not ameliorate my disappointment that the Taft story is bogus, though.

@JP – after a suicide attempt that failed in my twenties I was asked by my assigned physician if I might try again. The actual words, “That was stupid. Going to do it again?” My response was, “Duh. It didn’t work.” Close enough. They released me.

I was actually trying to work out if this meant that you were or weren’t going to try it again, then decided that you are probably a lot smarter than I am.

I wasn't quite sure about that anecdote myself.

Not quite the same, but I am periodically interrogated on the matter. "Not today, not tomorrow, but..." has worked. The question is what comes after the suspension dots. I'm down with Ken White here.

Dr. Gerard Gianoli is asking for medical record release, I am not a doctor but one thing I know for sure that no concussion will affect a person's integrity and we need someone to lead this nation in good faith. You however, Dr. Gianoli, did you act in good faith when you performed an unnecessary surgery and left me in a state of disability?

Long distance diagnosis is crap. It should only be done when there is no access to the subject. I can only think of two kinds of case where it belongs. One is when the patient is at a remote location where there is no one qualified to examine or treat, and the person at the other end accepts responsiblity. The other is behavioral profiling (Good riddance, Mr. Gibson.) of criminals and such. A brilliant profile helped in catching NYC's Mad Bomber of the '40s and '50s. The OSS had a psychiatrist profile Adolf Hitler and I'm sure it's been done on many others since.
Even if it's an across-the-room or an augenblick diagnosis, it's reckless and unethical to disclose it in public rather than privately to the subject. Not a lawyer, don't play one on TV, but I could posit circumstances in which there could be civil liability. Once you undertake to diagnose someone, anyone, to my mind it imposes confidentiality restraints if you're a practitioner, and imposes moral restraints on amateurs.
I was impressed by this quote cited on Dr. David Ramey's blog - “Before you speak, ask yourself: Is it kind, is it necessary, is it true, does it improve upon the silence?” - Sai Baba

#HillarysStools

“Not today, not tomorrow, but…” has worked.

I have decided to give myself a year or so and then I'll reassess. I don't plan on letting the shrinks in on this plan, though.

(This is no fun, though section 7 is better than the alternative.)

In happier news, my department wants me to take a year long leave of absence for "medical" reasons, so I am. The only thing left is to get the final form to the doctor and have him send it to Rackham.

(I gotta say that after recent experiences I miss my shrink back in Michigan.)

I respectfully disagree. Not being a physician, much less a neurologist or psychiatrist, I would be missing an observation about Trump that apparently is known to those in the field. It would now be appearing as a whispering campaign at the very least. The important point is that Trump's behavior -- both as political candidate and in the rest of his life -- is far off the charts for normality. Moreover, it's characteristics are known to the experts, and future behavior is predictable.

This description makes it easy for me to pigeon hole Trump as a potential catastrophe to America.

I can understand how reasonable people (i.e. readers of this blog) are annoyed with the phony attacks on Clinton's health, but they were already occurring and were going to occur in any case. It's the same political movement that continues to question the president's birthplace and commits so many other outrages. I would suspect that the only way to combat the attacks on Hillary is to refute them as has been done here.

This is not to suggest that the way to combat lies about Clinton is to make up lies about Trump, but the stories suggesting that Trump is highly narcissistic ring true, and we all have a large amount of data from his public pronouncements. Providing the public with the clinical term NPD may be a bit of a stretch, but it gives us a framework on which to hang Trump's bizarre reactions.

From my more lay point of view, the question is less about whether medicine is being hijacked, and more about which side is telling outrageous lies vs which side is telling the truth. In that regard, I suspect that the hostility to Barry Goldwater was taken beyond what was psychiatrically logical, whereas the concern over Trump's mind is legitimate.

Sai Baba

I take it that this is Sathya Sai Baba. A friend once brought over a giant haul from the (original) Powell's free-book box, to which all but one returned (The Holy Man ... And The Psychiatrist, just to remind me of the event).

In happier news, my department wants me to take a year long leave of absence for “medical” reasons, so I am.

Good. I remain dumbfounded by the atavism of the State of Washington's laws here.

I remain dumbfounded by the atavism of the State of Washington’s laws here.

In all fairness, most states have something similar in place.

Part of the reason for the outpatient commitment is that I've been hospitalized a few times in the past year, and at least one of them was involuntary.

In Michigan, though, my paperwork was changed to voluntary right away, and I was able to defer my hearing indefinitely, so it was a non-issue.

Sorry for borked link; the last two fingers on my hand are not working, due to ulnar palsy I didn't know I had and thus never got checked out. Unable to use my left hand much at the moment.

Let's try this. (PDF)

The whole experience did give me the occasion to ominously use the word "asylum" when a friend of mine suggested that maybe I needed to go to the state hospital and that I would get better soon there.

Let’s try this. (PDF)

Or this (the link still had '.pddf'). I can't read the whole thing right at the moment, but I'll note that having a basis for doing something is different from doing it automatically.

I'm sorry but there's not a rational person that would look at Hillary and think she's healthy. Even Dr. Phil expressed his concerns.

Funny how all the radical Democrats talk about Trump as if he's a narcissist; as If he's run for president in the past; As if he's a career politician who's made his fortune of the taxpayers.

@ Panacea:

I feel that psychologists shouldn't diagnose anyone in this fashion...
HOWEVER every single person has ( some) ability to evaluate how others act, speak and perform and it is on this basis- social perception- that I think anyone can speak up.

I don't think that he has the skills for the job. He doesn't have the social skills for negotiation. He carries grudges to obscene lengths. * Y mucho mas*

There was that old test: would you like to have a drink with the candidate? ( Even if s/he doesn't drink ).
No way. Unless if I were writing something and needed material.

@ JP;

Hey, I'm glad to hear that you are out and about ( which might be a triple entendre). At any rate, I hope so.

Besides tripping over large, Indolent furry creatures, I am rather well.

Following political news recently resembles my usual activities surveying woo in all of its rancid glory.

As a case in point:

today good old Mikey ( Natural News) rails against the *elites* whom he places as a class separate from regular folks like wage earners, the unemployed and HIMSELF.

Yes, Mike is just a regular guy. Just like the other woo-meisters. They are on the side of the working/ average person, they understand all of the problems poor people and minorities have and what is more
They are your friends.

In this alternate reality, what they say IS.

Narad, the quote is verbatim from Dr. Ramey's page so I don't know whether his Sai Baba is your Sai Baba. Whoever said it, it's an ideal that I wish I could live up to.
Ramey himself is horse veterinarian in California, and while I'm not a horse person, his blog is entertaining, informative, and woo-free.
Here's the URL: www.doctorramey.com

Hey, I’m glad to hear that you are out and about ( which might be a triple entendre). At any rate, I hope so.

Yes, don't worry, the places I have been in and the place I was on the docket for don't have Internet access (at least I assume so of the Eastern State Hospital) so it's a sure bet I'm not there. I have to live in "residential housing," though, for 90 days (halfway through) and am on something called an LRA for the same length of time, which says I'm not (ever) allowed to own firearms, that I can't drink or use drugs, that I have to follow a court-ordered course of treatment, etc.

I can come and go as I please, though. I did get in trouble once recently for being out late walking around, but I had been told when I got there that there was no curfew, and I had signed out saying I would be out late. Oh well. (They even called the police and the DMHP to go looking for me, but called them off.)

I can use the Internet at the public library (the technology at the house goes as far as radios, VHS, and a landline telephone) which is where I am right now.

One way to put this into perspective is to change the scale. Think of a local school board election. During the run-up to the vote, a local psychiatrist steps up at meet-the-candidates night and declares, "I've been watching Ms Smithjones for some time now, and it's my professional judgment that she's a borderline schizophrenic." I think you can imagine the consequences. If not a psychiatrist but a pediatrician, general surgeon, or a school nurse did it, it would be just as unethical, immoral, and possibly slanderous. Among other things, it is assuming a cloak of false authority, if done by a professional of any sort. To do it on a national scale is just as wrong as to do it in a village councilor election.
To my mind, if done to influence an election, it might reach the threshold of actual malice,the standard for proof of slander of a public person.
Besides all that, long distance diagnosis is nearly always just plain wrong.

(Sorry for the replicated posts upstream. Lately many things I have tried to post online seem to get lost in cyberspace.)

@JP, @ Narad

I was honestly saying I wouldn't try that method again. I was still very suicidal. Luckily, I guess, the inclination wore off before I found access to an adequate method that I was willing to use. I have dealt with periodic dark periods since childhood.

My theory has always been that it took them the 72 hours one would normally be on psych hold to get my kidney function where it should be. There were a lot of blood gas tests and high perfusion IV that kept setting off alarms (I think - this was the late 80s and I got pretty out of it for part of the stay there). I suspected my terrible health insurance didn't offer coverage for psych admissions and it further played a part in letting me go.

I’m sorry but there’s not a rational person that would look at Hillary and think she’s healthy. Even Dr. Phil expressed his concerns.

Dr. Phil? Ha. Haha. Hahaha. Hahahahahahahahahahahahaha!

Dr. Phil is not a doctor. So who cares what he thinks?

I suspected my terrible health insurance didn’t offer coverage for psych admissions and it further played a part in letting me go.

When I was recently involuntarily detained (for one thing, I didn't say that I regretted doing it because I have so much to live for, but rather I regretted that it didn't work) it was under the involuntary treatment act (ITA), so the state paid for it. Probably they decided that you weren't "dangerous" enough to detain; I'm guessing you used pills.

It's kind of a morbid discussion, but the attempt I made was considered "violent" (I think most things besides pills are), which probably factored into it, too. And the method in the back of my mind is pretty violent, too, especially if done correctly.

@Narad - that was a great read. I am honest about all of me. I have found that usually when I share things that I worry might sound crazy (!) I often end up seeing a very relieved face and hear someone say, "Really? You too?"

Well, maybe not about house chickens. But, once you get to know them, you realize they are like any other pet bird, and only get treated as less desirable pets because it is a lot harder to eat chicken if you believe it might have feelings and any kind of self-awareness or intelligence...

@JP - so glad to see you here!

"Mrs. Clinton's current medications include Armour Thyroid..."

Armour Thyroid is a brand name for natural desiccated thyroid (NDT) -- a prescription thyroid hormone replacement medication made from the dried thyroid gland of pigs.

https://www.verywell.com/hillary-clinton-thyroid-condition-3233019

It has natural ratios of T3 and T4. It is also 1950's standard of care. Coumadin, for the withered utters win!

@JP – so glad to see you here!

Thanks. I'm still not stoked about life, but I'm glad to see me here and not here. (Okay, I wouldn't be in the forensic wing, but still.)

All politicians exaggerate and twist facts to suit themselves, but Drumpf has repeated very dangerous lies that include descriptions of alleged personal experiences, such as "seeing thousands of American Muslims celebrating 9/11", that never happened. Is he fully aware that he is spewing blood libel, or does he actually hallucinate or confabulate memories of nonexistent events that justify his dehumanization of groups he dislikes? Only the latter would be proof of diagnosable mental illness, but either is an absolute disqualification for the Presidency.

(the technology at the house goes as far as radios, VHS, and a landline telephone)

JP, how did you end up the 1980s?

I am glad to know you are up for commenting again. I missed your unique sense of humor.

Owww. My comment above did not have anything to do with Mrs Woo's comment earlier. I just read it now.

Mrs. Woo, I'm sorry that you had such a hard time then. I think the 1980s were the best time for me. With the exception of VHS and landlines. Never going back there.

JP, how did you end up the 1980s?

I always thought of VHS as more of a 90s thing, but the technology still had it's heyday over 20 years ago.

There is cable TV though, which is immensely popular. I myself have been watching more TV than I ever have in my life; there's f*ck all else to do around the house. Well, except read. I started reading again with the Bible, for whatever reason.

(the technology at the house goes as far as radios, VHS, and a landline telephone)
JP, how did you end up the 1980s?

Now I am concerned that JP is stuck in a Philip Dick novel, like Ubik, with the entropic temporal regression.

The whole experience did give me the occasion to ominously use the word “asylum”

Oh for the good old days when we got to use the title "Alienists".

I am glad to know you are up for commenting again. I missed your unique sense of humor.

That is one way of putting it. At the "treatment and evaluation center" I was bright enough to claim that I was worse than Hitler, because "at least Hitler had ambition."

It is possibly behavior like this that had most of the "treatment team" convinced that I was dangerously delusional or something. Luckily there was one psychiatrist there (who I only saw on weekends) who was of the opinion that I wasn't delusional, just kind of a f*ck-up, and who managed to keep me out of Eastern. Kudos.

I always thought of VHS as more of a 90s thing

Perhaps it became mainstream then but I remember my boyfriend dropping $600 for a VCR while I was away at basic training. Early adoption is expensive. But cable was cheap then; it was also when MTV actually was a music channel.

...because “at least Hitler had ambition.”

That is freaken' hilarious but I can see where it would be problematic in certain situations. My brother-in-law has a similar sense of humor (and numerous medical problems) and he jokes with his physicians a lot. But even there he went a little too far with one of them and they wrote "disinhibited" in his chart.

Dr. Phule is an authority on medicine?
He has a PhD in psychology. Psychologist is a protected title. You must have the degree and the license. He has the one, but he doesn't have the other. He surrendered his license rather than face a professional conduct board for doing the just about the most unethical thing a psychologist can do in clinical practice - he had sex with a patient, and to compound the sin he hired her to work in his practice.
All that is besides the fact that he is an arrogant blowhard with a tenuous grasp on some of the things he is supposed to be advising about.

At least you didn't go there: http://jamesfetzer.blogspot.com/2016/08/hillary-clintons-teeth-tongue-h…

Where the Lord of Conspiracy points to a photo-shopped hole in Hilary's tongue and pronounces it an HPV-cancer biopsy.

The National Enquirer wouldn't even dare....

the technology at the house goes as far as radios, VHS, and a landline telephone

I have the complete Little Rascals/Our Gang hosted by Leonard Maltin on VHS. I could part with it.

@45 Narad
Last year there was a story going around the news media to the effect that the winners of presidential elections etc. died on average three years younger than the losers. But on a quick google none of the press articles I find bother to link or name the actual study they're based on.

I did find one saying US presidents live longer, but the comparison is with all other US men, which doesn't seem fair - for a start, people who die young never run for president.
https://jama.jamanetwork.com/article.aspx?articleid=201958

@jane:

Is [Trump] fully aware that he is spewing blood libel, or does he actually hallucinate or confabulate[?]

I believe he is a confabulist. He's a liar who believes his own lies and manufactures "evidence" in support.

Mr Trump's claim of Mexico sending rapists over the border is so utterly ridiculous that I'm amazed that no one has bothered to cite some facts to rebut it. If you know anything at all about Mexican "justice", then you'd know that given the tiny proportion of cases investigated, let alone reported, then you'd have to doubt that the Mexican authorities would even know who the rapists are.
If you want to know some actuality of sexual violence in Mexico, read this:
https://www.amnesty.org/en/latest/news/2016/06/mexico-sexual-violence-r…

George Meredith MD

In the year that preceded her run for the Democratic nomination, Hillary’s aides pressured her to go to the Betty Ford Clinic because of her alcoholism. Willful Hillary resisted, choosing instead to detoxify under the direction of an unnamed Internal Medicine detox specialist, working out of her Westchester home.

Curiously when her Internist Lisa Bandack MD released her medical record ( summary) last year, she neglected to mention Hillary’s alcohol rehab report. And the key liver function studies were likewise omitted from this personal physicians report. Go to the 2015 Bandack report and search for yourself….you will find no GGT, no AST, no ALT, no CDT, no AUDIT (alcoholic screening questionaire), , no serum alcohol level....Hillary and her doctors chose to hide these things from us. ...

Remember, Hillary provides cover for a vast narco trafficking network and as such she has the connections.....judges, prosecutors, DEA, DOJ, IRS, electronic media, etc....money and political power enough to steal this election.

And, were she to win this election, her temper tantrums, so well known to her staff and her secret service detail....her temper tantrums would place Planet Earth at considerable risk …..,.that WE THE PEOPLE should insist on a blood alcohol level, should she, in a drunken rage, decide to push THE NUCLEAR BUTTON

George Meredith MD
Virginia Beach

First, ethanol abuse is a rather well known phenomenon within the beltway, both among republicans and democrats.
Indeed, Nixon, toward the end of his administration, had any National Command Authority instructions quietly shunted away from the usual channels, straight to a specific General's desk, just to avoid problems with "THE BUTTON".
Oh, for a factual thing, there is no damned button, there is a telephone when in the Oval Office. There is a nuclear football, for use when traveling and away from Air Force One's communications suites, but that's actually something that'd be rarely considered in today's modern world.

So, let's discuss some mythical release of all medical records. If you're a physician, you should be conversant with the US code involved in the health insurance portability and accountability act and the penalties for disclosing medical information of US citizens to the public, yes?
Worse, do you realize that there is no qualification for POTUS in regards to liver function? Or even ethanol consumption?
Finally, I'll use my wife as a primary example of your malfeasance. Her liver function numbers are all over the map, in a deleterious way, courtesy of cirrhosis.
Biliary cirrhosis, to be specific. She doesn't drink ethanol in any meaningful quantity. Indeed, it's become something of an in joke with our primary care physician, her liver function is horrific, whereas mine is well above normal and my ethanol consumption is quite legendary.

This shows you to be entirely unworthy of trust. Unworthy enough that, were you the very last physician on the planet, we'd never see you at all, we'd do without and likely have superior care.
"Remember, Hillary provides cover for a vast narco trafficking network and as such she has the connections…..judges, prosecutors, DEA, DOJ, IRS, electronic media, etc….money and political power enough to steal this election."
First, zero evidence to support such a vast and damning claim and worse, alleging that somehow, a candidate could force the entire electoral college to vote against the popular vote *and* national interest.

Now, I have a reading assignment for you.
Look up the word prostitute and consider how you've prostituted your education and career.

However, I also consider the other candidate, one clueless on every major policy subject thus far presented and one entirely clueless as to what a nuclear triad is, but is of known intemperate spirit as evidenced by his many, many, many outbursts. A candidate who has embraced multiple conspiracy theories and has turned an election into a sideshow.
Corporate Hillary is a far superior choice to Dumb Donald, a man worth far less than he inherited from his father, but proclaims that loss is a success.
One candidate has been a cabinet member. The other, gave odd and erroneous advice to one POTUS's staffer.

Now, do sod off, the grown ups are talking here.

I knew your name rang a bell George Meredith: http://www.deadiversion.usdoj.gov/fed_regs/actions/2003/fr0801.ht

I think you have a bit of a credibility problem.

Looks like Wzrd1's thyroid medication is talking again.

Ah, using the same level of ignorance that you approach engineering and explosive demolitions.
My "thyroid medication" doesn't do any talking, although my thyroid itself releases sufficient excess thyroid hormones to cause some anger management issues (to understate things greatly).
Hence, insufficient thyroid hormone blocking medication could and does create a problem, excess, not as much.

Thanks for reminding me! I'm due my second dose of the day of methimazole and my metoprolol. The former is the thyroid hormone blocker, the latter, a beta blocker for the hypertension caused by hyperthyroidism.
I swear, I'd forget my ass, were it not so firmly attached to me!

So, George Meredith , where's your proof that Hillary Clinton ever is or was an alcoholic or needed detox/dry-out ? Second , what in hell are you talking about with this "providing cover for a massive narcotics trafficking network" line ? How about some proof that doesn't originate in some wacky-land conspiracy theory blog or pseudo-news site ?

@DLC, that HRC was involved in some conspiracies, I have no doubt. She *was* SecState and there are always various operations that will never be admitted to.
That George had to come up with such odd things as wild claims, with zero supporting evidence and then add in some nefarious conspiracies that have no reflection in reality though, it's laughable.

Most true conspiracies exist only in that they're part of classified US government policies that promote US interests.
It's when people come up with odd conspiracies that have no basis in reason, fact or even generically promote US interests (or most commonly, are directly against US interests), well, those rightfully earn jeers.

As I outlined with Operation Ajax in 1953.
https://en.wikipedia.org/wiki/1953_Iranian_coup_d%27%C3%A9tat

Personally, with the 20/20 hindsight of today, I think that Truman refusing to authorize that operation was a very good decision. Alas, Eisenhower supported the operation and as a direct result, we have an Ayatollah running the show in Iran today.
And an angry Iranian government that still is waiting for an apology.

Wzrd1: When talk turns to conspiracies, I am reminded that
I have heard just about every claim about the JFK assassination, but none of them come anywhere close to the truth.
All I'm going to say about it is that it was mighty crowded on that grassy knoll, and Sam Giancana, Howard Hunt, and Rafael Cruz kept getting in my way.

A common defense mechanism, used repeatedly by hard core alcoholics, is to lie repeatedly, and to do so and without qualms. They lie, even when their self preservation does not dictate that they do so. They get so used to lying that it becomes a way of life for many alcoholics. And if they have enormous sums of money and power they can recruit hoards of others to do same, regardless of whatever oath these people may have taken. Witness the media thugs that currently associate themselves with the Former Secretary of State.

Consider:in the year that preceded her run for the Democratic nomination, Hillary’s aides pressured her to go to the Betty Ford Clinic because of her alcoholism. Willful Hillary resisted, choosing instead, to detoxify under the direction of an unnamed Internal Medicine detox specialist, working out of Clinton's Westchester home.

Curiously, when her personal Internist Lisa Bandack MD released Hillary’s medical record ( summary) on July 28, 2015, Bandark presented Hillary’s serum lipid and triglyceride studies, mammogram report and a host of other trivia. Bandack, however, cleverly neglected to mention Hillary’s alcohol rehab report. And key alcoholism studies were, likewise, omitted from this personal physicians “summary”. Go to the July 28, 2015 Bandack "summary" and search for yourself….you will find no CDT, no MCV, no GGT, no AST, no ALT, no BAC (blood alcohol level) and no AUDIT (Alcohol Use Disorders Identification Test).

Hillary and her doctors chose to hide these things from us. You should know that Hillary sits atop a vast criminal network, with which she and her narco trafficking cabal (judges, prosecutors, lawyers, private detectives, a variety of government agents, etc) have the power to steal this election. Furthermore, were they be able to steal this election, Hillary’s temper tantrums, so well known to her staff and her secret service detail, places PLANET EARTH at considerable risk …..,.THEREFORE WE THE PEOPLE, should insist on a blood alcohol level should she, in a drunken rage, decide to push THE NUCLEAR BUTTON

George Meredith MD

Virginia Beach
Major North American Flyway (Stopover) Refuges in peril.
The seasonal mudflats of Cheyenne Bottoms (Kansas state) wildlife refuge are vital spring over stops for almost 40 species of shorebirds. Six hundred thousand shorebirds fuel up each spring at Cheyenne Bottoms, prior to, for many, the long flight to, and stressful nesting on, the arctic tundra. And another 200,000 shorebirds use the "Bottoms" in the fall.
Sandhill and whooping cranes use Cheyenne Bottoms, and ten miles to the south, Quivira NWR, in both the spring and the fall as important stopovers en route to Texas, Louisiana, and Mexico, in the former, and to the Gulf Coast of Texas, in the later, bird’s case. Flint Hills and Kerwin NWR’s are but a couple hours away. These three federal, and one state, refuges are vital areas for resting and recharging for five tribes of Canada geese, and an increasing number of snow, blue and Ross’ Geese, gadwall, pintail, mallards, ring necks, lesser scaup, greater scaup, ruddies, buffleheads, blue wing teal, green wing teal and expanding flocks of redheads and widgeon.
Seaboard Farms pork production division, based in Shawnee Mission, Kansas, is planning to build a new $110 million pork processing plant to be located near Elwood, Kansas. Seaboard is about to build or contract almost 400 confinement hog operations with 3.6 million hogs scattered over 45,000 square miles of beautiful Western Kansas. Oxygen robbing nitrates, blue baby syndrome, phosphates, pfisteria, listerosis, coliform bacteria, fowl cholera, botulism, hydrogen sulfide, ammonia, and carbon dioxide gases, heavy metals, screw worms, green flies and acid rain are all directly related to these massive pork packing plants and the hundreds of confinement hog operations that are needed to support them. Seaboard’s Elwood Plant and its 400 "family hog farms" would endanger not only Cheyenne Bottoms, Quivera, Flint Hills, and Kerwin NWRs, but also the Cheney Reservoir, the El Dorado Reservoir, the Equus Bed Aquifer, the Ogallala Aquifer, the Arkansas River, the Smoky Hill River, and Kansas River, and almost every municipal water supply from Tribune in the West, to Wichita and Kansas City in the East.
•.Read what John Meisner, water quality engineer for the USFWS says about Seaboard’s threat to these four vital stopover refuges.

•Larry Zuckerman, Director of Kansas Wildlife and Parks Pure Water for Kansas program: "Wake up, Wichitans, on Water", Wichita Eagle, Monday, April 27, 1998, regarding Seaboard’s threat to Central and Eastern Kansas’ water supplies and wildlife refuges.
•Wichita Eagle editorial writer Denny Clemments has correctly summarized (Seaboard’s) threat to water quality in Central and Eastern Kansas. Wichita Eagle editorial, "You Go!" May 30, 1999.

•Contrast these opinions with the ProSeaboard spin that Kansas Governor puts on all this. Kansas Governor signs Hog Bill (Corporate Piggery) (read full text of the bill (321,http://www.ink.org/)

Seaboard Farms has used (Korean, Malaysian and especially Japanese) soft money, corporate welfare money, and, I contend, tens of millions of narcodollars to corrupt all four branches of government in an all out effort to smooth the way for their $110 million dollar pork processing plant in and associated confinement hog operations.
•(Oct-Nov 1998) W.J. Clinton prevailed on Carol Browner and the EPA to radically relax their clean water standards to accommodate his goodtime buddies in the confinement poultry and swine business. See what Scott Dye of the Missouri chapter of the Sierra Club and the Citizens Legal Environment Action Network, or Clean, have to say about this Clinton brokered cozy arrangement.
To understand the politics of confinement hog operations vis a vis these vital mid-continent refuges, the reader must understand that:
•The U.S. Commerce Department gave Kansas Governor Bill Graves $9.6 in Industrial Revenue Bonds for "industrial development" in the state of Kansas.

•Graves in turn has given the $9.6 million to his "best bud", Rick Hoffman, CEO of Seaboard Farms, who spent, in turn, some of the money to construct "high tech" (hog) waste lagoons for his confinement hog operations in southwest Kansas.

•Hoffman then gave approximately $2 million back to Graves in soft money for his reelection/slush fund care of the Republican Party of Kansas. And Hoffman paid for Graves’s second inaugural ball. And, many agree, in one way or another, shared some of this same federal IRB (Industrial Revenue Bond) money, as well as other illicit monies, with Kansas attorney General Carla Stovall.

•"Be Open": Attorney General (Carla Stovall) brought troubles on herself (vis a vis "kickbacks" on tobacco settlements), Phillip Brownlee, Wichita Eagle, March 11, 1999.

•Graves and Stovall have bent over backwards to facilitate the construction of this Seaboard pork processing plant in Elwood. Many locals suspect that Japanese, European, Chinese, corporate welfare, and tens of millions of narcodollars have been/will be funneled into the Graves-Stovall-Clinton coffers on behalf of Hoffman and Seaboard. The Japanese (Nippon Industries) own Texas Farms, and Premium Standard, two other giant confinement hog operation. Clearly, the Japanese do not want these (toxic) confinement hog operations in their backyards.

•Eighty five percent (85%) of the "pork product" that comes out of Seaboard Farm's massive Guymon (Oklahoma) packing plant goes to their Asian customers. These "pork products" are routed through Japan. The Japanese take the prime cuts and then resell the remainder to Malaysia, Indonesia, Thailand, and South Korea at a handsome profit. Seaboard, Tyson, and similar operations pollute our air and water resources. And corrupt all four branches of our government so that they can have a front for their massive cocaine transshipment enterprises.

The High Plains Journal (the farmer-rancher paper) published in its July 24, 1998, issue: "Seaboard’s quickly gaining ground as opponents fume...everybody in the (pork producing) industry is asking the question, ‘What is the Seaboard secret and how do I replicate it.’" (National Pork Producers) Council CEO Al Tank (said).
•Insiders believe that laundered narcodollars have been used to fund Seaboard’s rapid, "vertical growth."

• Hear what Texas County, Oklahoma natives say about the source of this cash and how it is being laundered. Interviews with Texas County (OK) Democratic Party Chairman Brett Fowler. And with Julia Howell, neighbor to one of Seaboard’s confinement hog operations in Texas County. (See Empire of the Pigs, Time Magazine)

•To gain further insight into the Clinton- Lasater- Hoffman modus operandi
http://www.dcia.com/mission.html
Oklahoma Governor Frank Keating protected George Bush from BCCI accusations while at Justice and Treasury
The spotlight keeps returning to Dave Walters, former governor of Oklahoma, friend of Bill Clinton and Dan Lasator. Ambrose Evans Pritchard in his book is quite clear about an incident when Strassmier was detained by law enforcement in Oklahoma. The chain of calls which came to Strassmier's aid began with calls from the office of Governor Walters!
This is very significant. It is known that present governor of Oklahoma, Frank Keating, was personally appointed by George Bush to positions in the Treasury and Justice Department that related to protecting Bush from allegations of involvement with B.C.C.I. and S&L looting. Now it is learned that the previous governor, Dave Walters, was involved up to his eyebrows in Mena like activities in Oklahoma with the same cast of Mena characters. In fact it was Dave Walters who introduced Dan Lasater to Bill Clinton!! Walters was involved with Lasater in the ANGEL FIRE cocaine scandal in New Mexico.
• Listen to cross country trucker, Chris Carson, talking about, thanks to Clinton's NAFTA, how easy it is to clear customs in Laredo, Texas. And how Clintons pals at the Arkansas based Stephens Trucking are periodically bringing swinging pork from 5 packing houses in Mexico up through Laredo (and Juarez) and other ports of entry to the Guymon, Oklahoma (distribution center) based Seaboard Farms. And how it's a "straight shot" up from Laredo to that Seaboard packing plant in Guymon. Question: have Clinton and Hoffman found a replacement for Mena (Arkansas) and Angel Fire (New Mexico)?

•"Mega Corruption at the Border", Jaime Dettmer, Insight Magazine. Three senior U.S. Customs officials are targets of federal probes -- including Pacific Regional Commissioner Rudy m. Camacho. Graft is so common there even is a price list for federal cops on take. Slowly, surely and relentlessly, the southern states of America are being drawn into the cocaine economy. As with every law-enforcement agency, the whole culture at Customs frowns on those who break ranks. The service is a small one - some would say claustrophobic - and everyone knows everyone else. Inspectors are recruited locally and seldom are rotated outside their state. That is part of the problem, say Customs internal-affairs investigators.
•"Growing Drug Corruption Panicking Agency Chiefs". Jamie Dettmer, Insight Magazine. Millions in dirty money have been used to corrupt law-enforcement officers on both sides of the border while Clinton administration pals at Customs freeze like deer in the headlights and pretend all is well. Nonetheless, Customs Commissioner George Weise opted to continue his "see-no-evil, hear-no-evil" posture toward persistent allegations of widespread border graft...Weise and Alan Bersin, the U.S. attorney in San Diego, boasted that the lack of indictments showed that all is well with U.S. law enforcement along the frontier. Bersin dismissed as "rumor, innuendo, speculation and half-truths" all talk of systemic or widespread narco-related border corruption.

Attention Wzrd1 Identify Yourself! Stop hiding behind your Internet Logo

Youv want proof of Ms Clinton's Criminal Past? Start with the above. Then go to the 99 complainents that HRC had bumbed off by thugs like you

Major North American Flyway (Stopover) Refuges in peril.
The seasonal mudflats of Cheyenne Bottoms (Kansas state) wildlife refuge are vital spring over stops for almost 40 species of shorebirds. Six hundred thousand shorebirds fuel up each spring at Cheyenne Bottoms, prior to, for many, the long flight to, and stressful nesting on, the arctic tundra. And another 200,000 shorebirds use the "Bottoms" in the fall.
Sandhill and whooping cranes use Cheyenne Bottoms, and ten miles to the south, Quivira NWR, in both the spring and the fall as important stopovers en route to Texas, Louisiana, and Mexico, in the former, and to the Gulf Coast of Texas, in the later, bird’s case. Flint Hills and Kerwin NWR’s are but a couple hours away. These three federal, and one state, refuges are vital areas for resting and recharging for five tribes of Canada geese, and an increasing number of snow, blue and Ross’ Geese, gadwall, pintail, mallards, ring necks, lesser scaup, greater scaup, ruddies, buffleheads, blue wing teal, green wing teal and expanding flocks of redheads and widgeon.
Seaboard Farms pork production division, based in Shawnee Mission, Kansas, is planning to build a new $110 million pork processing plant to be located near Elwood, Kansas. Seaboard is about to build or contract almost 400 confinement hog operations with 3.6 million hogs scattered over 45,000 square miles of beautiful Western Kansas. Oxygen robbing nitrates, blue baby syndrome, phosphates, pfisteria, listerosis, coliform bacteria, fowl cholera, botulism, hydrogen sulfide, ammonia, and carbon dioxide gases, heavy metals, screw worms, green flies and acid rain are all directly related to these massive pork packing plants and the hundreds of confinement hog operations that are needed to support them. Seaboard’s Elwood Plant and its 400 "family hog farms" would endanger not only Cheyenne Bottoms, Quivera, Flint Hills, and Kerwin NWRs, but also the Cheney Reservoir, the El Dorado Reservoir, the Equus Bed Aquifer, the Ogallala Aquifer, the Arkansas River, the Smoky Hill River, and Kansas River, and almost every municipal water supply from Tribune in the West, to Wichita and Kansas City in the East.
•.Read what John Meisner, water quality engineer for the USFWS says about Seaboard’s threat to these four vital stopover refuges.

•Contrast these opinions with the ProSeaboard spin that Kansas Governor puts on all this. Kansas Governor signs Hog Bill (Corporate Piggery) (read full text of the bill (321,http://www.ink.org/)

•"Be Open": Attorney General (Carla Stovall) brought troubles on herself (vis a vis "kickbacks" on tobacco settlements), Phillip Brownlee, Wichita Eagle, March 11, 1999.

A common defense mechanism, used repeatedly by hard core alcoholics . . . .

Not in my experience, George – leaving aside the weird intensifier – but that's neither here nor there. The more salient question seems to be what you would "diagnose" weirdly copying and pasting the same thing hither and yon as being a symptom of.

Hilary is mean!

I watched a documentary that gave testimony of the Arkansas State Troopers that used to drive her around! They were known to actually trade shifts, to take the night shift, in preference to driving around Hilary during the day.

She is allegedly highly condescending to policemen.

I think Trump might be the "better" candidate here.

@George Meredith MD

A bit 'wordy'. All that matters is Clinton is a bitter, withered old hag funded by narco-dollars and dabbling in pork futures

by the by, Trump is a bitter, withered old hag funded by narco-dollars and dabbling in pork futures.

His 'law and order' plank is morbidly reminiscent of Richard Nixon and his initiation of the millons being imprisoned for possesion of a joint.

He sounds right on track to have intercourse with the filipino butcher --

Duterte, who has seen about two thousand people killed since he was elected in May, made the remarks late Friday as he shrugged off the United Nations' concerns over human rights in his country.

"Crime against humanity? In the first place, I’d like to be frank with you: are they humans? What is your definition of a human being?

https://www.yahoo.com/news/drug-users-arent-human-says-philippines-dute…

They say good fences
Make good neighbors

For you my friend
This might be true

But you still gotta put
The boards on the windows
To the soul inside of you

That t.v. in the corner
That's their greatest tool
They poison you mind
When you're a child

With their fear
And their guilt
And their rules

They teach you that you're just a number
As they program you in school
So by the time you're out
In their world on your own
You've been trained not to bite
The hand of the cruel

Wake up!

Don't believe that the system is failing
Don't believe that the planet is dead

They'll keep all the food for their fat fucking bellies
And the starving will kill or be fed

And they'll try to turn me against you
So divided,we'll turn to them
Because anything strong cannot be conquered from without
Before first being conquered from within. -- Shooter Jennings, Wake Up.

They say good fences
Make good neighbors

For you my friend
This might be true

But you still gotta put
The boards on the windows
To the soul inside of you

That t.v. in the corner
That's their greatest tool
They poison you mind
When you're a child

With their fear
And their guilt
And their rules

They teach you that you're just a number
As they program you in school
So by the time you're out
In their world on your own
You've been trained not to bite
The hand of the cruel

Wake up!

Don't believe that the system is failing
Don't believe that the planet is dead

They'll keep all the food for their fat fucking bellies
And the starving will kill or be fed

And they'll try to turn me against you
So divided,we'll turn to them
Because anything strong cannot be conquered from without
Before first being conquered from within.

-- Shooter Jennings, Wake Up.

One and the same.

Gilbert, it was a crappy poem to start with. Italics don't make it any more artistic or meaningful.

From the Poem: They’ll keep all the food for their fat fucking bellies/ And the starving will kill or be fed

Is that why you have to eat squirrels?

I apologize for the repeat, Old Rockin' Dave; I didn't think the first one went through as it kept saying 'spam'.

I didn’t think the first one went through as it kept saying ‘spam’.

That was the Crappy-Poem-Filter [CPF 2.0] that is in development holding you up. Apparently yours was just good enough to go through after a long deliberation!

I've said above that I don't do or support long-distance diagnosis, I do believe that Dr. Meredith has some issues, one manifestation of which is stringing together conspiracy beliefs in a paranoid-sounding manner, and trying to push them into a discussion where they are unwelcome and obtrusive.

That "Doctor Meredith" wants to know my identity, when this moniker is actually in the DBIDS database as a team leader is humorous and his astroturfing conspiracy theories long debunked as well,

Let's summarize his rant.
Hillary Clinton is an alcoholic, from his singular attestation alone, plus specialized testing not performed on patients without a valid medical reason, i.e.; liver function testing and alcoholism specific testing that even I've never received.
Then, via his singular attestation, Hillary Clinton has a vast Army, Navy, Air Force and Marine Corps sized command to lie for her. Something typically only within the financial grasp of nations.
Followed by his singular attestation of some mythical "narco" empire, something the Bush clan would know a great deal about.

Yeah, I doubt that "doctor" has any medical certifications, let alone a degree. I am unaware of any board that would risk their reputation on such an individual.

Yeah, I doubt that “doctor” has any medical certifications, let alone a degree.

The license was revoked quite a while ago.

Without bothering to research, I imagine over mental fitness issues.

^ Oh, right:

Hillary Clinton is an alcoholic, from his singular attestation alone, plus specialized testing not performed on patients without a valid medical reason, i.e.; liver function testing and alcoholism specific testing that even I’ve never received.

It's loonier than that. He should be demanding a radiology report from an abdominal ultrasound, if that's the trip. Morphology trumps.

Heh, if he has the hots for Clinton and mythical ethanol abuse, he'd really love me and my legendary consumption of ethanol.
Amounts consumed previously only attributed to those living in Asgard. ;)

Without bothering to research, I imagine over mental fitness issues.

The documentation is incomplete, but I'm amazed that it took nine years from start to finish. Yay, Kansas?

I lost faith in state boards a long, long time ago. Self-policing is not something that they excel in, resulting in loss of licensure being reserved only for the worst of the most egregious worst.

Heh, if he has the hots for Clinton and mythical ethanol abuse, he’d really love me and my legendary consumption of ethanol.

Don't get too swell-headed. You might start oozing into the subarachnoid space.

P.S. Wait, Lucy Kaplansky has a Ph.D. in clinical psychology?
Holy cats.

Hilary is no doubt an alcoholic, but try to make your points more concise Dr Meredith. That was a huge pile of crap that you just dumped here, without primary references to back up the information/crap.

@Ted Striker:

Hilary is no doubt an alcoholic

Supporting evidence DEFINITELY needed.

That's as bad as the rumors of Ulysses Grant's drinking.
The man was legendary for his intolerance to alcohol, on the few times that he did drink, he had no constitution to withstand it.
One hallmark of alcoholism is tolerance to ethanol.

"That was the Crappy-Poem-Filter [CPF 2.0] that is in development"

I'm doomed.

As crappy poems and dirty ditties are the extent of my abilities to creatively write, I'm just totally SOL.

Fortunately for me, I have other communications tools, including an extensive vocabulary, plus the ability to flawlessly utilize boolean terms and regular expressions give me great skills to achieve in life.

No, not all in combination, that'd just confuse the hell out of people. ;)
But, I think in boolean terms and regular expressions are also quite natural to me. As natural as my command of English in a non-poetic way.

For those unfamiliar with regular expressions.
https://en.wikipedia.org/wiki/Regular_expression
Neatest thing since the put the handle on the Popsicle. ;)
Learned when Google was still new and refined when managing a military installation's web filtering system.

I am anxiously awaiting what HRC conspiracy theorists will confabulate upon the news that Ms Abedin is now casting off her... I mean MR Wiener.

-btw- good for her!

I think it is obvious, Denice Walter. Hillary's not so much a carpet bagger as a carpet muncher.

Abadine has exchanged MR Wiener for Hillary's 14-inch strapon. It's nice that she 'came out' but I don't think she'll be staying with that rapidly withering old bat forever. She'll don a burka and start slumming herself out in Detroit or somewhere else equally receptive to her life-choices.

@ Julian Frost

Hilary Clinton drinking whiskey.

@Ted Striker, Jesus H Christ, she's in a room full of people with a drink in their mitts, that makes her an alcoholic.
Very well, Jesus himself obviously was, he hang with drunkards and worse.

Whatinhell is a photo op again?

Gilbert, thanks for showing one and all the level of non-support that you have for the LGBT community. It's nice to know that you'll insult a sizable minority, just to try to make political capital.
Because of you and assholes just like you, I abandoned the GOP.
The best part of you didn't run down your old man's leg, it stayed in the rubber.

Gilbert proves my point.

"the rumors of Ulysses Grant's drinking"

It was a bit more than "rumors'.

"By today’s standards, Grant could be considered an alcoholic, but he was able to control his addiction. As Grant biographer Geoffrey Perret explained: ‘The entire staff, as well as most of Grant’s division and corps commanders, was well aware of his drinking problem. [Brig. Gen. John A.] McClernand tried to make capital out of it and one or two other officers expressed their disgust at Grant’s weakness, but to the rest, it did not matter. A few were alcoholics themselves, but the main reason it was tolerated was that when Grant got drunk, it was invariably during quiet periods. His drinking was not allowed to jeopardize operations. It was a release, but a controlled one, like the ignition of a gas flare above a high-pressure oil well.'"

http://www.historynet.com/ulysses-s-grants-lifelong-struggle-with-alcoh…

Of course, Grant was a far better military leader than more sober predecessors.

That was the Crappy-Poem-Filter

Jack and Jill went up the hill;
Each with a buck and a quarter.

Jill came down with $2.50;
Do you think they went for water?

Looks like the moderator needs to update the CPF.

It partially works. I just tried posting some William McGonagall and it blocked it.

The CPF has a large database of known crap-poems, but has to use advanced algorithms for the original ones.

@136 Ted Striker

Hilary Clinton drinking whiskey.

That picture is clear evidence that Hillary Clinton held a glass of something. It's certainly not evidence of alcoholism. And, even if it was a glass of whiskey and she drank it, it's still not evidence of alcoholism but only evidence that she drank a glass of whiskey.

I will say the picture is evidence that people's faces, when frozen by a camera, often look very funny in ways we'd never notice just by watching them.

Indeed. By that criteria, I must be an alcoholic, because there are pictures of me at TAM mingling with my fellow skeptics at the Del Mar Bar and drinking beer. There is also a photo of me from my trip to London last September taking a drink of single malt scotch.

@Ted Striker #136, drinking whiskey is not proof of alcoholism. My mother enjoys the occasional glass and she is by no means an alcoholic. In addition, a lot of alcoholics only drink beer or wine, and never progress to "hard liquor".
Double fail on your part.
(The spelling whisky is generally used for whiskies distilled in Scotland, Canada, Australia, Japan and Europe, while whiskey is used for the spirits distilled in Ireland and America) - Whisky for Everyone

“An alcoholic is someone you don't like, who drinks as much as you do.” -Dylan Thomas

I was using the Mormon definition of the term "alcoholic".

[crappy poem deleted]

Gosh, Wzrd1 #137; I guess you're right. My apologies to Ms. Abadine and the entire LGBT community. I feel so... ashamed that I couldn't just leave it as Hitlary is rotten s**t.

The Ubiquitous Wallets of Christopher Dorner

Over here, over there, there's Dorners' wallets everywhere;

One on a bus,
And one in the street,
And one by a pier where the fishies like to meet.

At a park (there on the boulder),
And in a ditch there at the border,
And one in Big Bear survived a white-phosphor morter.

https://www.theguardian.com/world/2013/feb/13/christopher-dorner-wallet…

http://www.infowars.com/how-many-wallets-with-id-cards-in-them-did-dorn…

"I think it is obvious, Denice Walter. Hillary’s not so much a carpet bagger as a carpet muncher.
Abadine has exchanged MR Wiener for Hillary’s 14-inch strapon. It’s nice that she ‘came out’ but I don’t think she’ll be staying with that rapidly withering old bat forever. She’ll don a burka and start slumming herself out in Detroit or somewhere else equally receptive to her life-choices."
Gilbert, your comment is abominable, and I don't mean you're a yeti. As a member of the LGBT community, I absolutely condemn both your tone and your specific language. Further, your misogyny fills every line of your post. I pity anyone so hapless as to be in an intimate relationship with you. You are clearly many bricks short of a wall. You come across as someone as backwards and regressive as any I have seen in some time. To put it plainer, you are an unmitigated cesspool of bigotry.
As for your notpology, you only disgrace yourself more, while disclosing the untreated sewage you try to pass off as your thought process. There is no level of contempt so low that you would fail to be beneath it.

Oh, and Gilbert, your mention of Detroit in this context discloses another form of bigotry that you indulge in.

your mention of Detroit in this context discloses another form of bigotry that you indulge in.

And that would be what, exactly?

@Gilbert,

Try demonstrating your wit by reasoning it out for yourself.

I was also appalled by that comment, which was bad even your standards.

Gilbert?
Have you ever tried a fried-squirrel popsicle?

Ohh. Are there lots of Sharia law advocating muslims in Detroit?

Her closest adviser served as an editor for that same Saudi propaganda organ for a dozen years. The same one that in 1999 published a book, edited by her mother, that justifies the barbaric practice of female genital mutilation under Islamic law, while claiming “man-made laws have in fact enslaved women.”

...At no point in her long visit there, which included a question-and-answer session, did this so-called champion of women’s rights protest the human rights violations Saudi women suffer under the Shariah laws that Abedin’s mother actively promotes.

http://nypost.com/2016/08/21/huma-abedin-worked-at-a-radical-muslim-jou…

By 2015 many Muslim women in the Detroit area asked to be able to wear hijab in public places and in any identification photographs. Several municipalities are having to determine how to deal with producing identification photographs of Muslim women who are under arrest.

https://en.wikipedia.org/wiki/Islam_in_Metro_Detroit#History

Wear that hijab while being face-scanned? 'Mericans can't even wear a ball cap for that -- While I sympathize with the right not to be entered into an all-inclusive biometrics database, I can also see that, under this new 'tolerance', cops would be forgivin for noting "they all look alike."

@Gilbert, with no due respect, it's called freedom of religion. It's guaranteed by our very first amendment.
A little education for you.
https://en.wikipedia.org/wiki/Hijab

https://en.wikipedia.org/wiki/Abaya

My wife owns several abayas from when we were living in the Persian Gulf. She wasn't required to wear them, she didn't bother with the scarf, save on days that we had sandstorms (trust me, wearing a cloth on your head during a sandstorm is a damned good idea).
But, that modest token of respect for the local culture was thanked quite often and we even received sizable discounts in local businesses as a token of thanks for our respect for their culture.
It's called mutual respect, that can be built upon to become friendship.

Now, excuse me while I retrieve your gift from the cat box. Here's a cookie.

Gilbert, if you don't understand the difference between a hijab and a veil (tip: a hijab doesn't cover your face), then you are too ignorant to continue to participate in this conversation.

Also, I would note that these women are asking permission to wear more clothing, not demanding anything of anyone else.

"And that would be what, exactly?"
Wow, guy gets told off for crude bigotry and misogyny in no uncertain terms, and that's the part he responds to.
Try this:
http://www.snopes.com/2016/08/22/huma-abedin-muslim-journal/
and this:
https://www.washingtonpost.com/news/fact-checker/wp/2016/08/25/does-hum…
Hopeless. Witless too.

I don't know if what he said about Detroit was disparaging or complimentary.

Oh, some consider this an innovation of faith in Islam and hence, actually prohibited.
https://en.wikipedia.org/wiki/Niq%C4%81b

But, again, it makes sense in a high sun, sandstorm prone environment. The dust builds up in your hair and respiratory tract, which then behaves like portland cement.
In the hair, highly annoying, in your throat, life threatening.

@Wzrd1, so the niqab could be considered similar to the cowboy's bandanna.

The tradition now is, covering of a woman's "proud parts" and how they interpret it.
But, functionally, yes, it's an effective dust filter.

if you don’t understand the difference between a hijab and a veil (tip: a hijab doesn’t cover your face), then you are too ignorant to continue to participate in this conversation.

O'really?

A hijab ... is a veil traditionally worn by Muslim women ..., which usually covers the head and chest.The term can further refer to any head, face, or body covering worn by Muslim women

https://en.wikipedia.org/wiki/Hijab
It seems we're both tripped up by what constitues a 'veil', JustaTech #155. It's very chic -- very fashionable. I know I would choose to wear one while getting a mugshot taken.

My mother used to wear a scarf over her head in church. My wife rarely wore the hijab scarf over her head when we lived in Qatar. It wasn't required and when clear, why bother?

Mugshots are of the face. Are we now adjudicating crimes based upon hairstyle or something?
Hijab literally means modesty clothing, to cover a woman's "proud parts", which essentially would be cleavage, bustline and hair in that culture. Oddly, Muslim nations are able to book and identify women while permitting hair and boobies be covered, we're that inept?

As to your final question, Gilbert, Hillary covered it best at the time zippergate annoyed me enough to explain to my senator, Arlen Specter that, continue this, it'll be the Second Coming before another Republican holds office in this part of the state and at the time, I was a lifelong Republican.
She said, "That is between Bill and me".
Which, at the end of the day, is the simple truth of it.
And honestly, that places it entirely in the "it's none of my business" land.

Are are you so extremely fascinated with every other family's life in this land? Because, to be honest, if you are, stay out of our family business.
The ammunition saved will be my own. :P

That's a bit more than a bandanna, Julian Frost; It's ninja garb.

Btw, I always thought of hijab as being open-faced but that didn't seem to make sense in the aforementioned context of how to deal with mugshots -- I guess it messes up the profile veiw.

More interestingly, how does Abidine leaving her husband draw reflection that Clinton did not?

Wow, guy gets told off for crude bigotry and misogyny

def misogynist

A misogynist is a person who hates or doesn't trust women.

https://www.vocabulary.com/dictionary/misogynist

I'm no 'misogynist'. I've never been in the military (unless ROTC counts) though I don't hold the view that women ought to hang out in the barracks and make sandwiches, not even in gaming.

I have a very particular disdain for Clinton, all the way back to the days of the Waco massacre when it was floated around that it was Hillary who 'wore the pants' -- Thus the duo was referred to as Billary.

https://newrepublic.com/article/136411/donald-trump-finds-huma-abedin-i…

@Gilbert #166, uh huh, hair is 6000% out of 100% of the profile or some other bovine defecation. Even Helen Keller could be able to identify the difference in profile. You don't need to see hair and jugs to know what a facial profile is, trying to justify that only shows a higher probability of being a perve.
Culturally, seeing boob outline, hair or anything else is equal to wanting to see every other part of her, no matter how intimate. Only an intimate member of the family, such as sister, mother or occasionally, a brother would be allowed to see her out of hijab out of concern for her reputation.
As I said, it's a major cultural taboo.
As taboo as if you were to come to my house as a complete stranger and demand to see my wife naked. Trust me, you'd find the Sicilian-American part of me real quickly - and my old fighting knife.
Indeed, I found many traditions inherent with Arabian families and habituation's closely similar to my father's side of the family. Close enough to become very, very close to several families and even become honored as a brother to some.*

As for Billary, I remember it well. Frankly, I think that Hillary's set is larger and have more cast iron than Bill's set.
That merely makes her a politician's wife and politician. (See My Fellow Americans for that punchline)

I have precisely zero love for Hillary, she's a corporate Democrat. But, I loathe bovine defecation being served up as a sandwich. It's still BS, no matter how you dress it up.

*Close enough as brother that, when one young man's elder brother came into town to visit my very close friend, his elder brother made the grave error of making a slighting comment about "old man". I immediately picked him up (he was six inches taller than I), threw him into the pool and drove him to the bottom, holding him there until I could feel him ready to try to breathe water. I then got under him and threw him out of the pool of seven feet of depth.
His younger brother was laughing his butt off the entire time.
We became very close after that, my age no longer being a factor. ;)
Oddly, the women were out of hijab when I was around after that. Perhaps, I was fully accepted as brother once we tried to harm one another as brothers are wont to do. ;)

""Hijab literally means modesty clothing

Ahh,

an Arabic word meaning “cover.”

http://arabsinamerica.unc.edu/identity/veiling/hijab/

I guess the mugshot controversy comes when the order 'turn to the right' is given.. the profile goes generic.

Gilbert proudly declares, "I’ve never been in the military (unless ROTC counts) though I don’t hold the view that women ought to hang out in the barracks and make sandwiches, not even in gaming." This would be in reference to what, exactly? Do you have to be in the armed forces to be a misogynist? Or a gamer?
Now, how are you misogynistic? Deriding women you don't like as whores is misogynistic right on the face of it. If you don't understand that, you should go live someplace where women aren't.
Your hateful description of Hillary Clinton as a "bitter, withered old hag" is also classic misogyny. I think Donald Trump looks like last year's jack o'lantern, but that's only relevant in the case of his remarks about others' looks, and his own.
In your apparent world view, powerful men are "strong", 'decisive', "forceful", "masterly". Powerful women are lesbians with strap-ons. 'Your comment shows that you equate having a penis, especially a large one, with strength, and not having one with weakness. so that any woman who dares to show strength in their dealings with others must be a lesbian, and of course. have a strap-on. I surmise that your mention of a "14-inch strapon" says more about your sexuality than about Clinton and Abedine.
I wonder if you would put up with that kind of commentary about your mother, sister, or wife (whom if she exists I have deep sympathy for her sorrowful marriage), and if you wouldn't, why you would want to characterize others that way.

ORD: I wonder if you would put up with that kind of commentary about your mother, sister, or wife (whom if she exists I have deep sympathy for her sorrowful marriage), and if you wouldn’t, why you would want to characterize others that way.

His dimness has been on drugs since he was fourteen, so he's still mentally a fourteen-year-old who thinks girls are more or less pet rocks. He also can't seem to spell Abedin.

In your apparent world view, powerful men are “strong”, ‘decisive’, “forceful”, “masterly”. Powerful women are lesbians with strap-ons. ‘Your comment shows that you equate having a penis, especially a large one, with strength, and not having one with weakness. so that any woman who dares to show strength in their dealings with others must be a lesbian, and of course. have a strap-on.

Ahh, no. My veiw and my statement are specific to Clinton. But, wow; You came up with all that -- I've noticed that liberals like to lay back and then pounce with the political correctness trolling whenever a PC blunder is made. And they also are often parroting sheep who still bleat out Al Gore's An Inconvenient Truth as if it were factual.

While my response to Gilbert is rather dated, it's extremely late for me, I'm exhausted and in a fruckton of pain and taking an opioid for said pain, I'll respond to his Clinton is a lesbian nonsense.

First and foremost, I loathe the notion of her place in the POTUS race today, I'd have preferred a fossil to her, but, we've got what we've got and the choices are actually Trump the insane vs Hillary, the corporate Democrat.
Nowhere near six of one, half dozen of the other.

Now, here, in the real world, things are a lot more reality based than in your delusional version of the world.
Hillary is married to Bill, the king of zippergate, but I'm guessing precisely who holds Bill's Viagra.
As a user of said drug, courtesy of intensive beta blockers, I get a feel for such things. Hell, I'm ready to give my wife my entire supply, however, she poaches it, as it covers some symptoms of her menopause. So, honestly, we share.
TMI, tough shit.

So, Hillary is aggressive. She's a politician, that's natural. Hell, as a politician's wife, she has balls of her own, per "My Fellow Americans", which, in that part, is accurate.
Hell, it's one reason I don't go into politics, someone attacks my wife, I'd put a knife into his throat.

Big crap. She's a woman who has the temerity to go into *serious* politics.
Where you and I diverge on objecting is, I loath her very near GOP stance on multiple points.
I loathe Trump more, so it's a lesser of two evils.
Hell, given a choice, I'd put Bill in and double the guard, with special instructions.
Ain't got that choice, we got maniac Trump and Hillary.
I'll vote for Hillary.

For, to use your vernacular and knowledge base, she has her own set and Bill's at her disposal. That's fully five times what Trump, of short fingers can bring to the bed, erm, table.
This, from an accordionist, pianist and organist.
For the latter, feel free to range wild, it'll only give me a laugh.
As, in this castle state, yeah, it ain't pretty trying to violate the sanctity of the bedroom. :)

I'm perfectly able to play under your rules, I'll still win. :)

Do you *still*insist upon firing blanks?

OK. It was a crass comment. I see I'm not the only one, though--

the conservative Drudge Report ran the headline, "She's Had Enough Weiner! Huma Chooses Hillary." The headline ran with an image of the two woman together wearing similar outfits.

http://www.advocate.com/politics/2016/8/29/drudge-report-goes-hillary-c…

Well, after a few days**, I am rather pleased to observe that my stalwart colleagues at RI have shown Gilbert the blinding error of his ways illustrated whilst reacting to my note.

It's sometimes fun to plant a comment in order to get people to come out into the open with their various peeves and bents- including misogyny, homophobia et al.

I doubt that either woman is a lesbian BUT SO WHAT!
What's wrong with lesbians?

** I am in the midst of diverse projects including counselling adults and helping someone write.

AND before Gilbert reacts to that- I'll mention that I'm straight AND SO WHAT!

@Gilbert: the Drudge Report?!?!
The Drudge Report?!?! Are you serious?!?!

Denice Walter: "AND before Gilbert reacts to that- I’ll mention that I’m straight AND SO WHAT!" Right on!
To which I add, I'm not, and I know hate speech and crude bigotry when I see it.
Gilbert, if you think my reaction to your comment was "political correctness trolling" then you are denser than lead. I don't appreciate being anywhere near the receiving end of your crap. It has nothing to do with "political correctness trolling". It has to do with your delivering a deep insult to a good many people who have done nothing to deserve it, and I am one of those people. As someone who is a member of the LGBT community, I have been forced to put up with garbage like yours for years, but not any longer. Every member of that community deserves to have their rights and their place in society respected, and every one of us is one of mine.
Don't keep trying to excuse or justify yourself; you're only digging the hole deeper.
I suggest you go back to the folk who raised you and ask them to repeat your life lessons in common courtesy and polite discourse.

I’ll vote for Hillary.
Eww. There's always Gary Johnson.

Libertarian presidential candidate and former New Mexico Gov. Gary Johnson is newly in favor of mandatory vaccination

http://digital.vpr.net/post/reversal-gov-gary-johnson-now-supports-mand…

Well, nobody's perfect.

Only idiots vote for libertarians, Though I notice the resident dimbulb finally stopped lying about his political affiliations. Though if you're a sexist dimbulb, you should really own your sexism and your dimness. Seriously, go join your fellow trogs on reddit and go beat your chest there. At least on reddit, no one cares if you don't have brain cells. Here, you just drag down the tone.

Though I notice the resident dimbulb finally stopped lying about his political affiliations.

I've never lied about that. Everytime I raise a point of fact with you, you accuse me thus, " Oh, I didn’t know that. I just figured Gilly was lying again."

http://scienceblogs.com/insolence/2016/08/31/in-which-a-professor-who-i…

I've not lied but have been fervent in my support of libertarianism -- Have I not pointed out here before that "Dr. Paul cured my apathy?" I've only ever been riled up to vote twice in my life: both for Ron Paul in two primaries.
=====================

she poaches it, as it covers some symptoms of her menopause. So, honestly, we share.

I'd prescribe cannabis for both your wife's menopause and your back spasms, Wzrd1#171.

@gilbert, thanks but no thanks. We're badly allergic to it, as in instant asthma attack for her and me, with slightly worse symptoms.
Doctor raised her morphine ER dosage and prescribed quick acting morphine for breakthrough pain. I've got my hydrocodone, prescribed at half to one tablet, 10 mg and I've only needed to take a full 10 mg three times since I started them last month, mid month.
The first night, due to severe spasms and today, after shopping for food, picking up RX's and assorted other tasks.
I'll hold off on checking motor and transmission mounts, a spark plug and oil change.
I had a major burst of intracranial flatulence and forgot to check my coolant levels before taking my wife to her specialist's appointment in Shreveport. By the time we crossed the river on the way home, the temperature needle jumped instantly from merely running high normal end of hot straight to its pins.
I drove a block to the exit, jumped off, waited for a traffic light and parked the car. When I opened the hood, I observed a blue glow in the air and was bombarded by neutrons, gamma and x-rays from the coolant's hydrogen fusing.
Well, it sure seemed like that was happening, it wasn't pretty. Even the motor oil had boiled out of the valve cover.
At two hours, things had cooled enough that I could pour in the water that was kindly provided by the mechanics of the car lot we pulled into and at two and a half hours, the fuel injection system recovered from vapor lock.
Fortunately, after reading out the computer, two plugs are fouled, the oil level is OK, but the oil's suffered from severe viscosity breakdown and from the sound made when putting the car into reverse, either a transmission mount or motor mount gave up and quit.
Boy, am I lucky! That could've gotten real expensive, really, really quickly.

The cause of the coolant loss is a pinhole leak that I'm utterly unable to locate. Hopefully, when fall or winter arrives, the steam from whatever tiny leak it is will actually condense enough to see.

Yeah, I'm one of those backyard mechanic, who has done major repairs in his yard.
I'll just have to put the toolbox onto my wife's rollator.

" I’ve only ever been riled up to vote twice in my life..."
Having seen the thought processes you show us here, I am glad you don't see fit to vote more often.
I'm not sure which Doctor Paul you refer to, Papa Doc or Baby Doc, but Dr Paul Senor is the man who puts the "Aryan" in "libertarian".
If anyone wants to see a pretty good summation of libertarianism, try this link:
http://www.uwgb.edu/dutchs/PSEUDOSC/NoLibert.HTM

Your link convinced me, Old Rockin' Dave; I've decided to change my affiliation to 'minarchian'.

@ ORD:

Agreed.
You DO rock. All of the time.

I recall the old studies wherein (some) respondents attribute female success stories as being due to being a lesbian, 'not a real woman' or SIMILAR instances of bad thinking.

These creatures must be so freaked out about the prospect of a female president, PM or Chancellor ( oh wait, we have two of them already).

Is the real world mimicking Game of Thrones?

Thank you, Denice. Now if only you could tell my kids that.
If anyone cares, which I expect no one does, I will point out that I am cis-gendered (a clumsy formulation), I am not female, and I have a healthy sexual interest in in *both* major genders, not to mention an openness to the variations thereof

Yeah, I’m one of those backyard mechanic

Yea, I know what you mean. Back in the day, I've changed piston and rod with the engine still in the car, journal bearings, that sort of thing. I had a C-6 that would foul its valve body after a certain number of miles -- I kept a cleaned valve body to swap out on the side of the road (tranny fluid was collected by pulling a cooling line and discharging it into a three gallon waist bucket).

Speaking of cooling lines, "from the sound made when putting the car into reverse, either a transmission mount or motor mount gave up and quit.
Uh oh. Tranny is cooled by the same cooling system as the engine block. Sounds like a low/reverse band chattering (my sympathy); A problem that can arise from baked transmission fluid. If it were a motor mount then it would be the passenger side one if the fan is jumping into the shroud only in reverse -- You should be able to feel movement in the shifter when applying torque with any gear if it is a mount. But man, ford 429 mounts were always expensive for me even back then (had to get them from a company that supplied large 'rock' trucks (a giant dump truck).

No movement in the shifter, I'm thinking a motor mount. I feel the vibration of an impact when shifting to reverse on an inclined area (such as my driveway or some parking lots). It feels like a slight engine shift.
Add to that, it's a '96 Taurus, it's more than old enough for a motor mount to fail after an overheat.
I do have to drop the trans pan and pop in a filter & filter grommet, it's doing clipping when cornering and the kid that owned the car before me overfilled the trans in the mistaken impression that that'd help. I've had that happen a few times over the decades, new grommet, it stops sucking air from the lower transmission fluid pool and sucks the fluid through its filter.

Yeah, I'm familiar with marijuana usage for pain, however, when allergy is present, is it wise to try to widen the reaction into a far more severe reaction when an asthma attack is already present upon exposure? Repeated exposure triggering anaphylaxis might be something that I'd be willing to risk, save the cost of an epipen!

Besides, today, I've not needed a single hydrocodone. My wife is faring better as well, taking her morphine ER and not needing her immediate release thus far.
I'll also be laying down, as tonight is my "Monday" morning.*

*I frequently switch shifts from midnight to day on my "weekend", as I have learned the dozens of little tricks to move my sleep cycle without undue fatigue and stress.
A skill and rare ability even among military circles, but extremely useful when one could get a short notification order to travel halfway across the planet.

I suspect that when George Meredith MD shuffles off this mortal coil his epitaph will be "TL;DR".

From current evidence Gilbert is: dense as depleted uranium, homophobic, misogynistic, Islamophobic, a conspiracy theorist and a carrion picker.

But at least he can post about more than one topic, which is all we ask of our trolls.

thanks but no thanks. We’re badly allergic to it
Ahh well, Wzrd1, theres always kratom for pain -- No, wait; The DEA has emergency-scheduled it so they can start locking people up for those using it instead of bupenorphrin.

Way to go again, Pharma.

"We're all frankly feeling terrified," she says. "At a time when our nation is seeing the largest opiate epidemic crisis in our history, there's this cheap plant out there that's helping people getting off opioids, and now people are saying they are going to be forced back into active addiction."

http://www.usnews.com/news/articles/2016-09-01/deas-sudden-herbal-heroi…

Sergeant David Dasilma, a decorated Iraq war veteran, says he takes kratom about three times per week to treat pain in his feet, back, shoulder and head, the nagging result of injuries he experienced during his six years serving in the Army as a medic. He says kratom allows him to not take seven pharmaceutical drugs he has been prescribed, such as narcotics and muscle relaxants, which “turn him into a zombie.” ...

Dasilma, who was the 2009 non-commissioned officer of the year, says that the proposed listing deeply upsets him. He says he doesn’t suffer withdrawal when he stops taking it, and he doesn’t see it as an addictive substance.

“I’m not some crazy drug addict,” just a war veteran trying to experience less pain, he says. This listing is “taking away a right that I fought for—when I did my tour in Iraq—I fought for my right to be in America and help myself,” Dasilma says. “I’m not talking about snorting cocaine or doing heroin.… I’m talking about brewing some tea, and having a sip, and feeling better.”

http://www.newsweek.com/dea-list-kratom-schedule-i-effectively-outlawin…

No movement in the shifter, I’m thinking a motor mount...It feels like a slight engine shift.

If it is front-wheel drive then there is a mount up top that we used to call a 'dog-bone'. A bad bushing there can cause that if you're sure it is not a valve-body problem.

@JustaTech #189, all quite true.
I'm infamous for, when encountering an alt-right maniac at a social event, hearing the BS, ginning up a conversation to "learn more", being denser than the neutronium heart of a neutron star.
I'll then repeat back learned views, entirely incorrectly, but at a tangent that makes it obvious to every well balanced listener that I'm toying with the individual and sparing others the full range of their vitriol, while adding to their stress in the inability to successfully impart their views.
I'm able to keep that going for a minimum of 20 minutes, a maximum of 40 minutes, with the individual turning increasingly deep shades of purple. Eventually, I anticipate someone will experience a CVA or MI and I'll have to render first aid while awaiting the arrival of EMS.

But then, I never fully subscribed to Wheaton's law, on occasion, ya just gotta be. Something he discovered during gamergate..

There's a chance that Gilbert is salvageable, when exposed to those who have both shared similar life experiences and greater geographical ranges of life experiences.
And it really is far a better experience to deal with someone that is honestly mistaken in multiple areas to a bastard that gives a pleasant lie, while planning dastardly deeds. :)

That said, if I ever refer to carpet munching, it'd be in reference to one imbibing an excess of ethanol, while sitting upon the floor and awakening with one's tongue in contact with the rug, drool pooled about and carpet fiber in one's mouth. But then, that's something within my experience base from my youth. After a few times, I figured out, that wasn't any fun and found better ways to entertain myself that didn't involve such an undignified method of rest.
Although, that isn't the most unpleasant experience that I've experienced or others have.
May I introduce you to the longest free fall elevator as the longest elevator fall that someone survived and worse, the individual in question was injured?
https://en.wikipedia.org/wiki/B-25_Empire_State_Building_crash#Details
75 stories, ending up in the basement. While injured. That just *had* to be unpleasant!
Found that event while confronting some 9-11 truthers.
https://web.archive.org/web/20060317041607/http://www.guinnessworldreco…

OK, that was just an excuse to add tangential trivia, which might just come in handy one day. ;)

it’s doing clipping when cornering and the kid that owned the car before me overfilled the trans in the mistaken impression that that’d help.

If by 'clipping' you mean "falling out of gear" then that is a symptom of low fluid level -- Since it was 'used', the dipstick may not be the right one for the car. Naturally, high fluid levels can cause the fluid to froth up from contact with the moving gearworks, allowing air into the hydraulics of the valve body and causing the same problem as low fluid.

new grommet, it stops sucking air from the lower transmission fluid pool

The grommet around the filler tube??? I don't think that would matter--I've a mechanic friend, perhaps I'll ask him about it for you.

That should've been slipping, damnable autoincorrect!
And grommet for the transmission filter, it's sometimes called a gasket, but it's a rubber grommet.

That said, if I ever refer to carpet munching, it’d be in reference to one imbibing an excess of ethanol, while sitting upon the floor and awakening with one’s tongue in contact with the rug,

An officer does not drink. And if he drinks he does not stumble. And if he stumbles he does not fall. And if he falls then he covers his face so that no one will recognize him as an officer. -- Men of Honor

http://www.imdb.com/title/tt0203019/

Oops,

A Chief Petty Officer shall not drink. However, if he should drink he shall not get drunk. If he should get drunk, he shall not stagger. And if he should stagger, he shall not fall. And if he should fall, he will fall in such a manner as to cover up his rank so that passerbyers will think he is an officer.

Funny, that is not how I remember the dialogue... "cover his insignia" maybe? Damn now I'mma gonna have to watch that whole movie.

And grommet for the transmission filter

Ahh, I see (6 mins into this video)
https://www.youtube.com/watch?v=JWFB1ze7xiA

The new Focus RS sounds like a sweet ride; 2.3L duel scroll turbocharger 350HP 350foot-lbs All-wheel drive.
http://arstechnica.com/cars/2016/09/the-ford-focus-rs-the-blue-ovals-be…

Well, good luck with it, Wzrd1; If I were able, I'd get the new one so as not to drip tranny fluid in my eye.

Hillary has amnesia?

FBI Reveals Hillary Could Not Recall Briefings Due To Concussion, Clot

http://www.zerohedge.com/news/2016-09-02/smoking-gun-fbi-report-exposes…

Jesus H Christ! So, I'm now unfit for duty and should seek disability?
Unlike Hillary, I've injuries from IED's, as in multiple traumatic brain injuries.
Should I file now for my significant claims?
Or grow a set and realize, people get hurt and heal, kiddo?
As, my disability claim would be significant, far beyond VA levels, to significant levels, civilian side.
As I've had one trauma induced cataract replaced, wanna play? I've got a pocket full of million dollar quarters.
The other will get replaced either way, it'll only be a same time, same place pay-out.
Let's play.

Wzrd1: I’ve got a pocket full of million dollar quarters.

You have $0.25 coins that are actually worth $1,000,000?

Hey, I can wish.
I do recall a platinum 25 cent piece commemorative "quarter", still nowhere near worth a million bucks though.
The largest coin right now is a $100 face value, $1450 actual cost platinum coin from the US mint.

Particularly troublesome is the disingenuous and downright slippery rationalizations made by some psychiatrists and psychologists making these 'diagnoses'. “We are careful not to make a clinical diagnosis here, to say that Donald Trump has narcissistic personality disorder... We are focused on the image he projects, on TV, in tweets, in quotes.” This is, to put it kindly, self-serving bullshit, and highly unethical bullshit at that. </blockquote.
Ironically (?) Orac seems to have diagnosed an ethics disorder from a distance, without examining the patient. Which is to say he's taken as 'fact' the spin put on William Doherty's "Citizen Therapists Against Trumpism" by the NYT's Benedict Carey, which Carey took from his primary source, Columbia psych professor Paul Appelbaum. My guess would be that Appelbaum and Carey have an existing symbiotic source/reporter relationship, and Appelbaum rung up Carey, who hadn't heard of Doherty's website, with his concerns and Carey just took that peg without double-checking on the facts, or questioning Appelbaum's motives/ biases that might account for his dim view of 'anti-Trumpism'.
(That Orac doesn't mention Doherty, but only clips the Steven Buser quote from the NYT piece suggests his 'hot take' was generated quickly w/o further inquiry.)

Doherty was a guest on The Last Word With Lawrence O'Donnel

recently, where his roie was to criticize the various non-doctors (in this case, specifically David Plouffe) who have said stuff like 'Trump has NPD!'. (http://www.msnbc.com/transcripts/the-last-word/2016-08-29). So he was quite clear that his group's 'manifesto' is not a medical diagnosis and not about Trump as a real person, and that no mental health professional should go to either place long distance.

Focusing "on the image he projects, on TV, in tweets, in quotes”, is NOT BS, because it isn't a disingenuous excuse for diagnosing Trump. Doherty's group is doing ideology critique, not medicine.

[This is basically what scholars in contemporary film and media studies do – take intent and authorship off the table and concentrate on how the text works in society and culture. A classic example is "Gentlemen Prefer Blondes" which is knee deep in gender politics whether Howard Hawks intended them or not. Hawks himself was adamant that he was just trying to tell "good stories" and denied any deeper purpose or substance in any of his films. The fish don't see the water... So we don't talk about Hawks, we just talk about the movie.]

So the argument Doherty et al are advancing is quite different from that of the armchair psychologists. The latter, of course, is 'Trump's a wacko who'll make dangerously bad policy decisions.' In contrast, the Therapists Against Trumpism case is that the the proliferation of "the image he projects" spreads and normalizes a quasi-fascist ideology that is unheathy for the body politic. They're not worried about what he'd do in office, but the effect of his TV persona on our society.

Trumpism will undermine the emotional health of those seen as the “other” in America—both historically denigrated groups and those whose turn will come. And it will compromise the integrity of those who are seduced by the illusion that real Americans can only become winners if others become losers. The public rhetoric of Trumpism normalizes what therapists work against in our work: the tendency to blame others in our lives for our personal fears and insecurities and then battle these others instead of taking the healthier but more difficult path of self-awareness and self-responsibility. It also normalizes a kind of hyper-masculinity that is antithetical to the examined life and healthy relationships that psychotherapy helps people achieve. Simply stated, Trumpism is inconsistent with emotionally healthy living—and we have to say so publicly...

To repeat: Trumpism undermines the core of American democracy by promoting the idea of a single leader who will bring greatness to the nation by battling Those People. Democracy requires personal and collective agency so that we can work together across differences to solve problems and develop a shared way of life. Psychotherapists must be firmly on the side of democracy and work in solidarity with groups directly threatened by current and future versions of Trumpism.

Appelbaum appears to have taken this through an extremely distorting set of confirmation biases (to the extent I have to wonder about HIS political allegiances). Alas, Orac's take on the Buser quote is fourth hand, filtered through Applebaum and Carey's biases which not only strip the full context, but hang it on a very dubious peg. If anyone wants to consult a primary source, the Public Manifesto of Citizen Therapists Against Trumpism is here: http://citizentherapists.com/manifesto/

Can we not-psychiatric-MDs distance-diagnose Trump NOW? Pretty please? ... ... ...
[crickets]
Well, I am going to state in no uncertain terms that this man is ABSOLUTELY suffering from Narcissistic Pussy Disorder.

Well it happened.
Donald Trump is the U.S. President Elect.
"Congratulations".

@ Julian Frost
So much for the science of polling with these small sample sizes.

Epilepsy in sea lions

dr. dolittle — Sat, 22 Mar 2014 00:34:10 +0000

Epilepsy in sea lions

Credit: Image courtesy of Stanford University Medical Center, from ScienceDaily

According to a press release from Stanford University, California sea lions develop epilepsy from exposure to a toxin produced by algae called domoic acid. The animals develop seizures which can result in memory loss, tremors, convulsions and even death. The hippocampal region in the brain of the affected sea lions shows similar damage as humans with epilepsy, with losses of about 50 percent of neurons. Dr. Paul Buckmaster, professor of comparative medicine at Stanford was quoted as saying, "We found there was a loss of neurons in specific patterns that closely matched what is found in people. And there is synaptic reorganization — a rewiring of surviving neurons. This also matches what is found in humans with temporal lobe epilepsy." This form of epilepsy is the most commonly observed in humans and there is currently no cure. It usually starts following a traumatic brain injury, fever or lack of oxygen that causes an initial seizure and later on progresses to epilepsy with periodic seizures.

According to the press release, hundreds of California sea lions have washed ashore every year. The problem is with recent increases in algae blooms small fish that sea lions feed on, such as anchovies, accumulate domoic acid.

The hope is that understanding epilepsy in sea lions may lead to better treatments for sea lions and humans alike. Dr. Buckmaster said, "What we need is an interventional treatment — both in humans and sea lions. You’d give the treatment right after the brain injury, and that would prevent them from developing epilepsy. That’s the dream, but we are not there yet."

- See more at: http://med.stanford.edu/ism/2014/march/sealion.html#sthash.RlEXJgTI.dpuf

dr. dolittle Fri, 03/21/2014 - 20:34