
Ketamine might help prevent suicide - andrewl
https://www.nytimes.com/2018/11/30/opinion/sunday/suicide-ketamine-depression.html
======
lostgame
I want to warn folks that the quality of street ketamine wildly varies and is
not a suitable alternative to these kinds of treatments.

I have had on and off issues with dependency on this substance mainly due to
my issues with depression and anxiety.

If anything, it works _too_ well for these issues, and it’s incredibly easy to
get used to the relief from the constant onslaught of struggle that these
types of illnesses cause, just as I imagine an opiate would be relieving for
someone with chronic pain.

I would urge a sense of critical importance to the understanding that the
exciting part of these treatments is that in combination with psychotherapy
they could _cure_ , not _treat_ these issues.

Unlike someone with chronic pain, it can be used, along with certain other
properly-applied psychedelics like LSD, to help train the psyche into
functioning without it.

It’s not, however, something for everyone, and while it worked for me, please
excercise extreme caution in using this substance or recommending it to
others.

I’ve had friends who did it for years and still killed themselves. Two of
them.

So at the end of the day, I urge everyone with even the deepest-seated mental
issues like this - this kind of change has to come from within, and any
benefits an external tool provides should be for dedicated moments of healing
and/or a focus on the mind, and, for lack of a better word, spirit.

I can create a throwaway email account to answer any questions anyone may
have. Please don’t hesitate to reach out if you, or anyone close to you has
problems with this substance.

~~~
ineedasername
Very valid points. But keep in mind that ketamine therapy is generally
considered a treatment of last resort, for refractory depression, often after
even treatments like ECT have failed.

~~~
penagwin
I find this argument interesting. Going through depression myself, waiting for
an SSRI to be effective 6 - 8 weeks feels impossible if you want to end it all
RIGHT NOW. That's kinda the point of suicide, is to end the pain ASAP.

Here's the thing, the SSRI didn't work out for me, now I'm going to try
another medication, another 6 weeks before it's fully effective (It's not an
SSRI though). I don't know if I can wait that long.

I still haven't gotten to other tiers of treatment in terms of medication -
Antipsychotics, rMAOIs, etc.

Point is: I'm not sure a tiered approach for medication works well for
everyone with depression, it's too time sensitive.

~~~
freedomben
Yes indeed. 6 to 8 weeks is an eternity for someone who is deeply suffering. I
personally think we are way too stingy with medicines these days. I also had a
friend commit suicide while suffering from intense depression. He would no
doubt be alive today if he had been giving what he needed right away, instead
of being made to start with Prozac and then worked through a bunch of
different "starter" antidepressants. Just give people what they need. There
are worse outcomes than over-prescribing (death at one's own hand, for
example).

~~~
nickbarnwell
Sadly, we don’t know enough about the brain to have any idea which medications
are going to work or what it is people need right away. While you certainly
could sedate people to the point of utter apathy by giving every shmiel who
walks through the clinic doors high powered anti-psychotics it would be akin
to treating a broken toe with amputation.

First line treatments like sertraline and fluoxetine are used because they
take time to work and have generally tolerable side-effect profiles. E.g. in
the case of patients with undiagnosed bipolar disorder, you run a lower risk
of triggering a manic episode.

~~~
TheAceOfHearts
Why shouldn't the person be allowed to make their own choice after being
properly informed of their options and having received their doctor's
suggestion?

~~~
monadgonad
It's unethical, just like if a patient demanded their leg be amputated for a
broken toe.

~~~
fragmede
If the broken toe was inside a concrete cast that no one could see into, and
there was no such thing as an X-ray machine, CT scan, MRI, or any other
machine that could be used to verify the toe being the part that's broken.

If the doctor didn't listen to, or at all believe at least half the the stuff
the patient actually said, and didn't need to.

If others had leg amputation performed and the leg grew back and on top of it
we had evidence that leg amputation caused long-term damage when performed for
other reasons. (Ketamine has long been used as an anesthetic precisely
_because_ the data we have suggests no long term damage from that dosage.)

If the patient had suicidal ideation and intent, because something hurt so
much and we had no way of doing anything other than leg amputation, then why
shouldn't we?

Until humanity manages to develop and deploy brain scanners that can actually
see how much physical and emotional pain a person is _actually_ in, then the
leg amputation analogy is lazy and unhelpful because we simply don't have the
same tools to address mental health because it's largely invisible.

Most doctors are still humans who negatively judge patients who drink heavily,
who frequently miss appointments, who can't manage to get lab work done, who
self-medicate with street drugs; those patients are judged as degenerates, not
deserving of their help because they can't manage to take a pill, that doesn't
seem to work for 6-8 weeks.

I mean, it's great that a hospital's ethic's board has reviewed the situation
and determined that the best course of action is for people to suffer because
they don't want the liability of, in this analogy, leg amputation, but in the
meanwhile, people are being discarded by the mental health profession.

~~~
ineedasername
But what treatment are you thinking of here? Ketamine? Maybe after more
research, trials and long term tracking of patient outcomes it can become a
front line treatment. For now there's a reason it's a treatment of last
resort. It's use in this way is not as well understood as traditional drugs.
Use as an anaesthetic is a one-off. As with most substances, chronic use
carries more complications. There's potential for cardiovascular issues. Also
cognitive issues like impairments in creating new memories, accessing old
memories, verbal memory, forgetting words, names... It makes sense to attempt
treatments with a lower risk profile first, not for legal liability but
patient well being. In the meantime there already is an immediate treatment
available for those at risk of self harm: short and medium term
hospitalization, which allows for more rapid trials of different medications
at higher doses because the patient is under regular monitoring. Yes it still
sucks, it's a crappy experience, but it is effective in getting most people
stable enough to wait for longer term treatments to reach peak effectiveness.

~~~
pstuart
> It's use in this way is not as well understood as traditional drugs

Traditional drugs are often a crapshoot anyway, and there's been plenty of
harm from them. In the end, it should be the patient's choice in what path to
take.

~~~
ineedasername
Yep, traditional drugs have their pitfalls too, but have had the advantage of
rigorous trials that something like ketamine has not yet undergone. I'm glad
it's an option, but there's really not a strong enough body of research for it
to make it a first-line option. Yet. I hope that changes.

And, in the end, it is the patient's choice, within a certain circumscribed
set of options. A good doctor works with the patient's needs. But it would be
a very poor doctor that jumped to riskier options and less proven options
first. The level of patient choice you're suggesting implies a level of
informed patient that is frequently not the case. I rigorously research every
single treatment option, discuss each one with my doctor, and we arrive at a
course of treatment. But my doctor has indicated that I am, unfortunately, in
the small minority in this respect. Your level of patient choice would invite
all sorts of bad prescriptions to patients ill informed and, often, self
diagnosed incorrectly-- a frequent issue leading patients to skew their
conversations with doctors towards that incorrect diagnosis. In theory, in a
perfect world, what you propose is fine. But we don't live in that place.

------
UI_at_80x24
I suffer from serious depression. I have tried to kill myself. It comes and
goes in waves.

I was able to try an experimental ketamine treatment in the hospital.

3 doses administered via IV every-other day. (Monday, Wednesday, Friday)

The first and third were failures for me. Nurses talking in the OR completely
distracted me and "stole" my awareness.

But the second one was perfect. I was able to feel nothing. I was able to shut
off my mind and enjoy the single most peaceful moment of my life.

As time & work permit I plan on doing this again. Especially now that I know I
need to be blindfolded and have ear-plugs in. (this sounds dramatic, but it's
what works for me)

It hasn't cured my depression, but it has given me hope. And that's more then
I have ever had.

~~~
sbenitoj
I can’t recommend The Body Keeps the Score by Bessel Van Der Kolk enough, I
wish this book had been out 10 years ago before my mom took her life.

Nonetheless, it’s been instrumental in helping me alleviate my anxiety and
depression. I read it a year ago and I can’t imagine going back to the way I
felt then.

Specifically I’ve done two forms of therapy — EMDR and Somatic Experiencing —
that were recommended (among many others) in the book.

~~~
comboy
Seems to have really good reviews. Is it something worth reading for somebody
without a depression or a trauma? Any insight that stuck with you the most?
I'm sorry about your mom.

~~~
sbenitoj
I honestly read the book just because I consider myself an autodidact and
student of human nature and it sounded interesting. While reading I realized
that the traditional psychotherapy I’d done since my mother’s suicide was
mostly just a way to cope with the tragedy rather than to heal from it (coping
is still better than nothing though IMO).

I’d say it’s still worth reading to better understand the people around you
who seem to act in almost objectively “illogical/irrational” ways, even when
presented with better solutions. Even though such behavior is typically self-
destructive, this book helped me to see the “logic” of it (Eg some obese women
are obese because they were abused as children and they unconsciously
overeat/eat junk food to make themselves fat and unattractive to potential
abusers, so without resolving that issue no amount of healthy nutrition
knowledge will help them, they’ll always regress).

It’s also given me more empathy for those around me, instead of feeling like
they’re doing things “to me” I’ve been able to keep the bigger picture in mind
and realize that people mistreating you is typically just a sign that they
have unresolved issues themselves (that doesn’t mean you just let it happen
without saying anything, but the increased empathy helps me handle the
situation better).

~~~
dan00
> Eg some obese women are obese because they were abused as children and they
> unconsciously overeat/eat junk food to make themselves fat and unattractive
> to potential abusers ...

I‘m not a big fan of these kind of „logic“ explanations. I think the
explanation can be a lot more straightforward, like by being treated worthless
your whole childhood you‘ve internalised this feeling and now continue to do
the same to yourself.

But yes, it‘s really helpful to somehow understand or least get an idea why a
person behaves in a certain way.

~~~
skrebbel
To my understanding, the logic is that there's a hormone called leptin which
strongly guides your eating patterns, cravings, energy, etc. Stresses and
traumas can affect your leptin levels, so particular stresses and traumas can
cause you to eat more. This makes evolutionary sense, since if you're in a
famine, or an ice age, you better stock up on as much food as you can. Move
slowly, digest slowly, don't lose any of it, because you never know when
you'll run out.

Sexual abuse traumas get interpreted by some bodies as the same kinds of
stress signals as famine, raising leptin, causing overeating.

So I guess the broader point is that some of the "unconscious logic" going on
inside us isn't just habits or odd personality traits, but actual chemical
processes.

Note that I got all of this knowledge from reading a Pop Sci weight loss book.
HN, let me know if you know better :-)

------
ninjakeyboard
I was a ketamine user for a long time. My use turned into a problem but I'm
realizing that my use patterns were basically: Use, wait until depression
returned, crave a cure from my depression, use.

In a clinical setting I'm sure that it's very helpful but for me the "crave a
cure" caused me to not getting around to dealing with my issues of depression
until after I had issues with ketamine that required intervention and left me
alone with depression again.

I hope other people never go down that path. She is a cruel seductress and the
draw of the sudden emotional changes is a lot to put on someone's psyche. If
they're suffering, and then suddenly they aren't and they feel happy for the
first time in a long time it's easy to make the association to powder = happy
and that's a very powerful association for an animal/human psyche to put
together.

For most people, street ketamine would scare the shit out of them but for
anyone else they might get drawn in to basically constant cycles of self
medication.

~~~
pitaj
How is a constant cycle of medication any different from using common
antidepressants like SSRIs? Sure, it would be great if we could cure
depression without drugs, but if that isn't possible, obviously medication is
important for those people to be able to live good lives.

~~~
fragmede
The illicit nature of street ketamine is what sets it apart from SSRIs, for
mainstream society. A random primary care physician (PCP) isn't going to send
a prescription for it over to the local CVS/Walgreens pharmacy for convenient
pickup over lunch. Which often means resorting to desperate measures, at heavy
markup, in order to procure any amount, with an unreliable supply.

Self-medication can be problematic because it's non-objective, but it can
easily lead to (psychological) addiction. The brain optimizes/skips a step -
not-being-depressed looks a lot like actually being happy when compared to
being depressed, so then there emerges this belief that the user needs to be
high on ketamine _constantly_ , which is when it becomes a problem.

GP post isn't arguing that no one should use ketamine, or any other medication
that works. They are giving first-hand perspective that ketamine addiction is
real, and having heard stories myself, I'm inclined to believe GP. It would be
great if ketamine had to be prescribed by a doctor to avoid addiction, _and_
that such a requirement didn't end up excluding those outside of mainstream
society (often because of mental problems like, say, depression).

FDA approval of ketamine for depression will go a long way to improving the
situation but for now one choice is to pay some $1500/session (not covered by
insurance), to a clinic run by medical professionals risking their license.
(Each session uses less than $20 of ketamine, so it's quite the markup!)

The other option is to buy street ketamine, which is a move of desperation,
but looks a lot better than committing suicide.

I don't understand the objection int the article about the possible necessity
of "booster" treatments though.

~~~
derefr
> A random primary care physician (PCP) isn't going to send a prescription for
> it over to the local CVS/Walgreens pharmacy for convenient pickup over
> lunch.

Most GPs won't write you a scrip for ADHD medication on a whim, either, but I
wouldn't describe Vyvanse as "illicit." They just "know what they don't know"
and so don't trust their own evaluation of you and think you should get a
professional evaluation by a specialist (i.e. a psychiatrist, in this case.)

They're usually perfectly willing to _continue_ prescribing after you've
gotten a previous scrip from a psychiatrist, though. I suspect ketamine would
be much the same, except that you'd need to get your scrip filled at the
pharmacy of an inpatient hospital (since that's where they'd have it in
stock), rather than the corner store.

It's the same story as, say, methamphetamine. _Scheduled_ drug—but that
doesn't mean you can't just get a prescription and get it filled. It's a lot
of work to _get_ that prescription (since methamphetamine is _also_ a last-
line treatment), but once you have it, any hospital pharmacy should have some
in stock.

~~~
fragmede
Where a future hypothetical ketamine prescription could be filled from, I
can't say, but clinics charging $1500/session have it in nasal sprays and
lozenge form, I'm hopeful that a corner store would eventually be able to fill
it easily once one of the pharmaceutical companies manage to package it up in
a form they deem lucrative. (Which will involve patenting some part of it,
possibly the delivery mechanism, since ketamine itself is past patentable
date.)

Depression is an insidious disease, and being able to fill it at the corner
store, rather than having to go all the way to hospital (which can be a scary
and frustrating experience) might make the difference between having the
medication, and not.

~~~
ninjakeyboard
Ketamine is hugely psychologically addictive though. It is like saying that
opioids should be available to everyone that is in any pain. The level of
addiction caused may be different because the opioid user has to contend with
the negative association with withdrawal as well as the allure of the high
itself, whereas ketamine is only one of those two. Dependence and addiction
are not the same and ketamine is powerfully re-enforcing. I don't mean to
trash this - I'm just trying to show a counterpoint and another perspective
because there WILL be misuse as soon as prescriptions become available, and
people (doctors) will not understand the degrees to which it can draw people
to misuse until much later. There is already a black market to supply to the
demand. If droves of people start acclimatizing themselves to ketamine, the
market demand will increase and the black market will be there to fill that
new demand, just like it did with heroin/fentanyl when pain was over-treated
with opioids and droves of mom's and yuppies suddenly thought heroin sounded
like a pretty good idea because they had already lost their opioid naivety.

So in turn, I put forward that we should hope a discovery of the mechanism of
action and a way to put it to use without ketamine. Ketamine's action itself
is assumed to _not_ the primary mechanism of action but rather a metabolite is
(the experience has a part of it I'm sure - it's pretty fairly a psychedelic
but the yin to LSD's yang) and scientists are working to find a drug that will
have the same effect without the psychedelic dissociative qualities of
ketamine (and it's monstrous allure which some people notice and fall for -
but many don't)

Seems to me that only certain personalities thirst for ketamine after
experiencing it. But that will all come to view in time because the black
market is ready to supply to an increase in demand and it will happen that way
once people start diverting ketamine. The black market will compete in that
market. It will offer a product of similar quality (most clandestine on the
street is close to 100% purity) but will find its competitive advantage is
price and availability.

------
theptip
It's very interesting that the most impactful and potentially revolutionary
psychiatric drugs currently in trials are both illegal recreational drugs,
MDMA and Ketamine.

I do wonder how many regular users of these drugs are (consciously or
subconsciously) self-medicating, vs. purely using hedonistically. Although I
can imagine the line is quite blurry.

Scott Alexander has talked about these drugs from a psychiatrist's
perspective; his article on Ketamine gives a lot more technical speculation
about its mode of action, plus links to academic papers, for anyone that's
interested in digging more:

[http://slatestarcodex.com/2018/11/08/ketamine-an-
update/](http://slatestarcodex.com/2018/11/08/ketamine-an-update/)

~~~
BurningFrog
> It's very interesting that the most impactful and potentially revolutionary
> psychiatric drugs currently in trials are both illegal recreational drugs

History will not be kind to the War on Drugs. Aside from the millions of lives
it directly destroyed, it also set back several fields of science 50 years.

------
Simulacra
I suffer from depression and anxiety. I take medication for it but the one
thing that has helped more than anything has been cannabis. Unfortunately it's
also hindered me quite a bit. I'm intrigued by this study but also
suspicious... It seems a lot of "illicit" substances are being touted as
possible depression aides, such as shrooms and MDMA.

~~~
Broken_Hippo
"I'm intrigued by this study but also suspicious... It seems a lot of
"illicit" substances are being touted as possible depression aides, such as
shrooms and MDMA."

I've done MDMA multiple times. I'm over 35. I did it recreationally with my
spouse. I know the recreational doses and the theraputic doses are the same.

And boy, did it solve some stuff in my brain. All positive. I'm better
equipped to deal with anxiety and depression than I was before. I was.. OK.
With myself, with things, and so on. The next day and week or so after, it
felt like by brain had been rinsed off, massaged, and gently put back in
place. Now, this slowly lessened, but I was able to deal with stuff. It is
really hard to explain: Like finally getting glasses and being amazed with how
clear things were. I can only imagine how this would be in a clinical setting,
with someone guiding your brain to deal with things you needed to deal with.
Also, I found I like myself. That's not nothing.

Now, I've never done Ketamine, but I imagine results are similarly helpful for
folks this is a good match with especially when you are in a clinical setting.

~~~
simonsaidit
Yes it can really work wonders but it’s also easy to use recreational. Had a
friend who only does cocaine as he loves being in control and hated on mdma...
he is also the most negative person I ever knew and would usally end up in a
fight anytime he walked out the door... he blames his ptsd. One time we got
him to do mdma anyway and he changed to the most positive guy over nite...
sometimes accused us of being negative suddenly even though that used to be
his middle name. It had that effect for 1-2 months untill he was back to his
old self.

------
alexnewman
I hate providing any negative news for stuff that works for people butt...
More and more trials are showing that if you block ampa, ketamine's acute
depression curative properties are completely diminished. Aka, it might work,
but it's probably not the right drug

[https://clinicaltrials.gov/ct2/show/NCT02911597](https://clinicaltrials.gov/ct2/show/NCT02911597)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487269/)

~~~
derefr
IIRC (I forget where I read this), ketamine does one thing
pharmacokinetically, but its main metabolites—norketamine and
dehydronorketamine—have their own entirely-different pharmacokinetics (which
aren't just less-potent versions of ketamine's.)

I don't know about "not the right drug"; but it might turn out to be
considered a pro-drug.

------
NPMaxwell
Weird factoid about Ketamine: it seems to require being paired with the smell
of a male to work: [https://www.scientificamerican.com/article/sex-matters-in-
ex...](https://www.scientificamerican.com/article/sex-matters-in-experiments-
on-party-drug-mdash-in-mice/)

~~~
oliveshell
_In mice._

(Just pointing out that, as useful as rodent studies are, this isn’t a result
that can be generalized to people.)

~~~
NPMaxwell
Have you seen any tests of this with people? Or heard any first hand
witnessing about ketamine and males? I hear it is considered a drug to take
when going to clubs.

Which reminds me of another quirky result: caffeine promotes wakefulness in
fruit flies:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757164/)

Without specific selective pressures, traits persist through species

~~~
oliveshell
No, but from the article you linked:

 _“Gould doubts that the sex of the person administering the drug affects how
well it works in a depressed patient, but it 's never been tested.“_

It seems to be related to stress response, which the mice were experiencing in
the presence of male handlers. One would assume the same issue isn’t present
in humans unless they become anxious and stressed when men are around.

That said, it does have interesting implications for the drug’s relationship
with stress; e.g., it might have stronger subjective effects in folks with
high stress or stimulation levels at the time of administration.

------
DanBC
This isn't a particularly good article. Psychiatrists in the UK are cautiously
optimistic about ketamine, and things like TCMS, but they're worried about the
widespread off-label prescribing in the US, especially when that's decoupled
from other measures such as talking therapy or psycho-social interventions.

> The suicide rate has been rising in the United States since the beginning of
> the century, [...] And yet no new classes of drugs have been developed to
> treat depression (and by extension suicidality) in about 30 years, since the
> advent of selective serotonin reuptake inhibitors like Prozac.

Lack of access to new drugs is common across countries, yet many countries
have seen falling rates of suicide. What's different about the US?

> After her suicide attempt, Louise’s psychiatrist suggested she try ketamine.
> She agreed, and received an infusion intravenously. Within hours, her sense
> of well-being improved. The hospital discharged her. Back home, she
> discovered that going to the market was no longer a “herculean task.”
> Getting her car washed wasn’t an insurmountable chore. “Life was better,”
> she said. “Life was doable.”

This is _exactly_ the kind of thing that was being said about prozac - these
are wonder drugs that make you better than well, and the current drug
licencing rules are outdated because Prozac should be available to everyone
not just ill people.

Ketamine will end up being moderately useful to some people. It will save a
few lives. It's probably not a wonder drug.

The article makes no mention of the low risk paradox. Most people who die by
suicide will have been assessed as low risk of death by suicide shortly before
they died. I'm curious if these people would be given ketamine or not. And
that's the people who were seen by MH professionals before they died.

> Here’s a sobering fact: Some studies indicate that suicide risk peaks soon
> after patients have been discharged from a medical facility.

This is a well known phenomena, which is why NCISH in the UK includes this in
their ten ways to improve safety in MH services
[https://sites.manchester.ac.uk/ncish/](https://sites.manchester.ac.uk/ncish/)

"Patients discharged from psychiatric in-patient care should be followed up by
the service within two to three days of discharge. A care plan should be in
place at the time of discharge."

~~~
derefr
> Lack of access to new drugs is common across countries

They didn't say "new drugs", they said "new _classes_ of drugs." The point
they were trying to make was that innovation (by big-pharma researchers, at
least) in the anti-depressant space has stalled.

------
alexashka
I think the article is confusing someone who's at the tail end of their life,
and no longer interesting in continuing, with depression among people who'd
otherwise go on to live a radically different life.

The two are not the same and treating anyone who is done with living as
depressed or needing psychiatric intervention is short sighted.

I'm all for helping people who want help. Some people don't want help - they
just don't want to break the hearts of those who care about them.

Suicide is not some grave sin and there is no God watching over us. It'd help
to realize some folks get dealt a hand they don't want to play out to the
bitter end. The stigma around somebody choosing to act as they see fit,
including suicide, really needs to be released. Not so much for the folks who
go through with it, but for those around them, that feel guilt, shame and all
kinds of negative emotions as a result.

I do wonder if normalizing suicide as an option would cause exploitation based
systems to implode. Imagine those miserable sweatshop workers. If they said
you know what - I'd rather die than live like this, they'd actually have
leverage to significantly improve their living conditions.

------
Confiks
Great television programme, in Dutch, about using ketamine in the treatment of
depression (and additionally, about using GHB in the treatment of narcolepsy):
[https://www.npostart.nl/dokters-van-
morgen/30-10-2018/AT_210...](https://www.npostart.nl/dokters-van-
morgen/30-10-2018/AT_2103629)

------
roguecoder
As a long-term treatment it's being considered as an alternative to
electroconvulsive therapy, not SSRIs. It is still a dangerous drug with
potential side effects, but that power to harm is exactly what doctors are
exploiting to help.

For deeper dives into mechanisms, Mayo is doing interesting research into the
biomarkers for ketamine responsive versus non-responsive patients:
[https://www.mayoclinic.org/medical-
professionals/psychiatry-...](https://www.mayoclinic.org/medical-
professionals/psychiatry-psychology/news/ketamine-exploring-continuation-
phase-treatment-for-depression/mac-20430307)

------
napban
I remember covering this topic in a poster presentation at medical school.
It's a perennial news article that, despite popping up on an annual basis, is
always presented as a crazy new idea.

The fact that ketamine is a street drug makes it a prime topic for click-bait
articles. It's a case of the usual bad science in media.

NYT is no better a source to cite for medical topics than the Daily Mail is
for Computer Science!

------
8bitsrule
IBT non-synthetic mescaline would prove to be a better choice. Medicinal on
this continent for a thousand years.

