Thursday, February 28, 2008

Seroquel is useful in weaning from a ventilator.
My letter is the second in the this list of today's Dallas Morning News Letters to the Editor. This was Ms. Allison's recent op-ed.

Wednesday, February 27, 2008

Saturday, February 23, 2008

Tom Maguire has a great blog post on Obama. He also has all the news that didn't fit an anti-McCain conclusion in the continuing gossip barrage of the NY Times.

Friday, February 22, 2008

Wellbutrin (bupropion)

Ron Rosenbaum has a post on the baseball steroid issue. A commenter talked about how Wellbutrin helped him but not so much the generic; which leads to some thoughts on Wellbutrin (bupropion). In the late eighties, a patient and I were considering his using Wellbutrin. "Is it a new drug?" he said. "Yes," I replied. "It must be better then," he said. Some truth to that. Another favorite patient story is about Wellbutrin. An older, wiry black man came for an appointment at the VA. "Doc, I usually don't take your medicine, but when I do it sure does make me feel peppy!" Some medications have deficiencies that, addressed, are useful to the manufacturer because they allow for a new formulation that works in the marketplace (and have patent exclusivity); such is the case here. Because of a slight increase in seizure risk, the drug is supposed to be taken multiples times a day at intervals; I hope God has better luck with his rule on adultery because these intervals and maximum individual doses were never followed by anyone coming to me on the drug, not that it seemed to matter. I have a patient who, when I was going to renew the drug as the SR (sustained release) told me to give him the IR, the immediate release or just the original formulation. The IR was available in generic but the patient wasn't concerned with price. Subsequently I was at a lecture sponsored by a rival, Forrest, and the presenter said that the registration trials for the SR and XL were not positive, in other words the drugs didn't 'work' but the FDA gave them licenses since the original Wellbutrin was allowed. These statements were consistent with my patient's claim. It is also likely that the brand name manufacturers original SR and XL products come closer to being likely effective than the subsequent generics which only have to demonstrate delivering within 20% of the branded product over a certain interval. In practice this usually means you get 80% of the amount of drug. So I would wonder if the commenter could do well on generic original Wellbutrin or the IR bupropion taken (more or less) under the original rules. Wellbutrin is a useful drug on the psychiatry consultation service. It helps older people who may be grieving over the loss of loved ones or their own health. There it may work at 150 mg a day and one needn't go to the usual 300 mg a day. Low Na+ from the SRIs in older people is often seen in psychiatry consultation and Wellbutrin does not have this side effect. It shouldn't however be used where there is end stage renal disease because the metabolism of the drug is prolonged.

Sunday, February 17, 2008

Was interested running into 'trespass' as the action of Adam in the Garden of Eve noted in Genesis. Currently this is in the presentation; the Bible passage is part of the liturgy for the First Sunday of Lent. 'Forgive us our trespasses as we forgive those who trespass against us' finally has a suitable context. Freud proposed an idea in Totem and Taboo which I imagine as like something out of 2001 A Space Odyssey: that the original human groups were like a monkey colony in which the father kept the sons from the females until the brothers would rise up and kill the father and then have the possibility of 'satisfaction.' The law of talion for this would of necessity be death for the perpetrator, the punishment specified in the Bible. Interestingly (to me), the ages of the first fathers noted in Genesis run into the 900s as if to say, 'We didn't kill them. Look how long they lived.' More generally a 'trespass' would be any stage, e.g. oral or phallic, psychosexual satisfaction of necessity accompanied by aggression, for instance the oral aggression of an infant who bites to destroy an object who frustrates him. The residue of the initial hypothetical murder is suggested to be religion which carries forward the laws of the father. No wonder 'Forgive us our trespasses' is so relevant to family life as it would deal with psychosexual urges both real and imagined.

Tuesday, February 12, 2008

Professor Volokh, linked left, with his fellow bloggers has been covering the case where a gun owner, or wishes to be a gun owner, is challenging Washington D.C.'s ban on gun ownership, D.C vs. Heller. The arguments for gun ownership and, even perhaps more, in clarifying the meaning of the Second Amendment are fascinating. If you can only read one, I recommend Lund's which is linked in this Volokh post. The JFPO, Jews for the Preservation of Gun Ownership amicus curae brief linked in a Volokh post is also fascinating. I believe you can see the related posts by going to 'related posts' at the foot of a blogpost.

Saturday, February 09, 2008

This really rankles. Echostar bid for DirecTV but Powell's FCC blocked the deal and I didn't get diddly for my stock in DirecTV. Now News Corp is 'soured on DirecTV' and Echostar has done much beter than News Corp stock.

Tuesday, February 05, 2008

Becker and Posner prove they're smarter than me on illegal immigration. I do think there needs to be a status of guest worker though additionally. A brief overview of how Mexican immigration came to be the way it is: In the thirties (the Depression), the Border Patrol would shoot to kill illegal immigrants. After WWII, we had a bracero program where farm workers could be registered legally to come here temporarily. That was shut off by the Democrats at the behest of unions. Texas culture being antiunion, we just continued the practice without the documentation; in a related practice see 55 MPH speed limit. Then voila'.

Sunday, February 03, 2008

Today's Gospel reading, the Sermon on the Mount, is perhaps the soul of Catholicism. At some link through Yahoo, there was the comment that the 'revolution' in Kenya started, as revolutions do, when economic fortunes are rising. The model is the French revolution. Why was that more violent, more destructive than the turmoil with Cromwell in England? There were some 223 Cistercian monasteries in France before the revolution. All were lost. Perhaps the difference is that in England Henry VIII had already revolted against the Catholic Church in the matter of sexual or marital morality. The English of Shakespeare's time were sexually liberal; so they didn't have that to rebel against. I suppose a current 'proof' of my hypothesis is how much more people are celebrating Mardi Gras or Carnival than Lent. (Extra credit for wondering what all of this has to do with Kenya).