What advice would you give to a younger L. E. Modesitt, Jr. at the beginning of his writing career?
> I wouldn’t even try. I like where I am, but getting here was so unplanned that any advice given to me at that age likely would have ruined me or made the journey seem so impossible that I might not have even tried.
The smallest capsule of pregabalin/lyrica is 25mg. After reducing to that minimum, it still took months of further tapering by dividing capsules, before withdrawal symptoms ended in one elderly patient. Pregabalin suppresses nausea, which means nausea is a symptom of withdrawal, requiring ginger tablets or other anti-nausea assistance during tapering.
> An investigation by The Sunday Times has revealed that pregabalin has the fastest-rising death toll of any drug in the UK, based on figures compiled from official data across all regions. It is detected in a third of all drug-related deaths. In 2012, pregabalin was indicated in nine fatalities. A decade later, in 2022, the number had risen to 779, with almost 3,400 deaths in the past five years.
Yet sadly it is still on the market. Is there a number of deaths that are enough?
There is also this small 2016 study:
"Interference with neuronal development
Pregnancy outcome following maternal exposure to pregabalin may call for concern
ABSTRACT
Objective: To investigate pregnancy outcomes following maternal use of pregabalin.
Methods: This multicenter, observational prospective cohort study compared pregnancy outcomes in women exposed to pregabalin with those of matched controls (not exposed to any medications known to be teratogenic or to any antiepileptic drugs). Teratology Information Services systematically collected data between 2004 and 2013.
Results: Data were collected from 164 exposed pregnancies and 656 controls. A significantly higher major birth defect rate in the pregabalin group was observed after exclusion of chromosomal aberration syndromes, and when cases with exposure during first trimester of pregnancy were analyzed separately (7/116 [6.0%] vs 12/580 [2.1%]; odds ratio 3.0, 95% confidence interval 1.2–7.9, p = 0.03). The rate of live births was lower in the pregabalin group (71.9% vs 85.2%, p < 0.001), primarily due to a higher rate of both elective (9.8% vs 5.0%, p = 0.02) and medically indicated (5.5% vs 1.8%, p = 0.008) pregnancy terminations. In the Cox proportional cause specific hazards model, pregabalin exposure was not associated with a significantly higher risk of spontaneous abortion.
Conclusions: This study demonstrated a signal for increased risk of major birth defects after first trimester exposure to pregabalin. However, several limitations such as the small sample size, differences across groups in maternal conditions, and concomitant medication exposure exclude definitive conclusions, so these results call for confirmation through independent studies."
In theory, LLMs could review more sources for a personalized risk assessment. But a brief query on this subject yielded generic responses from multiple LLMs :(
I've seen AI recommended things like Fluoroquinolones (Avalox, Cipro, Levaquin etc), for UTIs.
The FDA itself says this class of drugs work no better than a placebo for UTIs, Sinusitis and Bronchitis. While they cause life altering side effects. They 'Flox' people.
My late wife's Journal was part of the evidence during a 2015 FDA hearing to get this crap off the market.
The bottom line is that AI can not be trusted for Medical Advice.
Be highly suspicious of a Human doctor recommending a drug in this class, that has so many Black Box Warnings.
The widespread use of Gabapentin and Pregabalin to treat neuropathy is off-label their original function as anti-convulsant and anti-psychotic meds. In addition to the documented negative side effects, withdrawal by elderly patients from extended use can be difficult, even with months of tapering. They can negatively affect memory and cognition.
> Gabapentin, sold under the brand name Neurontin among others, is an anticonvulsant medication primarily used to treat neuropathic pain and also for partial seizures of epilepsy.. is [ONLY] moderately effective: about 30–40% of those given gabapentin for diabetic neuropathy or postherpetic neuralgia have a meaningful benefit.
Those with peripheral neuropathy should audit the total amount of Vitamin B6 in their diet and daily supplements. Try to keep the daily amount below 10mg. There have not yet been lawsuits to add bottle label warnings, but Australian regulators have issued a safety warning.
> Vitamin B6 (pyridoxine) is in lots of multivitamin and mineral supplements that can be bought in supermarkets, health food shops and pharmacies without a prescription. Many people are not aware that vitamin B6 can cause peripheral neuropathy, which results in tingling, burning or numbness usually in the hands and feet. Taking vitamin B6 even at low doses can cause peripheral neuropathy but people are more likely to get it if they are taking more than one supplement.
Not that I know of? But, I have also not been watching that market for a long long time.
I am actually somewhat interested on building a small speaker thing that I can load a VXML document on and start adding use cases to it. Especially after considering how much I could save by dropping all of my current subscription stuff.
> Identify or find objects with Alexa+.. use the camera on Echo Show devices to identify objects and get help with daily tasks. For example, reorder pantry items by showing them to the new Alexa, ask Alexa to identify a type of plant and its care instructions and set reminders for when it needs to get watered, or get fashion or décor ideas. This new feature is particularly game changing for people who are blind or have low vision
This has so much potential, but it will require a workflow for Alexa to learn about specific objects and layout (of multiple objects) within the customer's home. Apple's "live audio descriptions of video" had similar promise at launch, but hasn't evolved beyond the launch demo, https://support.apple.com/en-ca/guide/iphone/iph32deb9296/18.... Could Alexa+ enable self-service RLHF on home video/images?
It's a testament to the latent market opportunity that Amazon has sold 500+ million devices, despite the obstacles that greet customers trying to customize Alexa for their specific needs. With open developer interfaces, Alexa could have been the "IBM PC" of voice AI, instead of just another walled garden.
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