SINNER, YOU BETTER GET READY

Booze + banjo =

THE “DISMAL SCIENCE” ISN’T ECONOMICS

Lately, I’ve been auditioning psychiatrists to perform what’s called “medication management.” The guy I met with last week asked what I was currently on. Xanax, I replied, 1.0 mg per day.

The shrink was not at all pleased. The entire benzodiazepine class of mood drugs was bad, he averred with surprising vehemence—they’re dangerous, they’re habit-forming. They have a high street value for a reason! If I was after a squalid “fix”, I’d have to locate a psychiatrist of less pristine integrity.

It got me thinking about our weird hierarchy of drugs. Xanax is basically pot. Adderall is basically speed. And a dozen types of pills that come locked beneath childproof caps are basically heroin.

Prescription medications are obviously more respectable than street drugs. But even within the prescription zone, there are divides.

At the bottom are uppers and downers with a high “abuse potential”. In my (regrettably broad) experience, shrinks are most enthusiastic about the newest, priciest drugs. Strattera is more respectable than Ritalin.

Lithium has been treating mental illness—though nobody exactly knows how—since 1870 (yes, the year Georgia was readmitted to the Union). But no one thinks taking lithium is sexy, or fun, or desirable except as a last resort. So it exists somewhere outside the hierarchy.

And it goes without saying that “medication management” is more respectable than drug dealing.

The internal contradictions in the hierarchy are fascinating. In terms of the risk of dependence, pot is a much safer bet than Xanax. The lengthy FDA pamphlet on Xanax (parodied here) could apply to wine. But if you confess to having so much as a glass of merlot at dinner, your shrink will likely make a disapproving note on his clipboard about your “addictive personality”—just before prescribing something that makes laudanum look tame. (A good friend is currently getting off Effexor. The withdrawal symptoms, which his doctor never bothered to warn him about, are sometimes immobilizing.)

“Habit-forming” is more respectable than “non-habit-forming”. But any medication that prevents you from going mad is ipso facto habit-forming.

“Yes, doctor,” one imagines oneself explaining at some gruesome point. “I understand that randomized tests have demonstrated that X isn’t pharmacologically habit-forming. But it prevents me from hurling myself off a bridge. And I’m afraid the impulse to live is rather hard to shake.”

It comes down to control. The psychiatrist wants as much of it as possible, but his authority is threatened by many factors. First, the Internet equips the discriminating patient with an arsenal of authority-undermining information. Second, the shrink himself doesn’t really know the mechanisms behind most mental illnesses, much less how the drugs used to treat them work. Third, many people being treated for psychiatric ailments have a greater depth of insight into those ailments than do the shrinks themselves. And a fifteen minute appointment where the prescription pad appears at minute 10 is hardly enough to rectify that. Finally, most psychiatric drugs (whether nicotine or Prozac) are available on the street—no prescription required.

Indeed, the precise function of shrinks is ambiguous. And they know it. So they’ve identified a spectrum of behavior called “self medicating”, and done so good a job rendering it taboo that we all know it’s bad without having to think much. In an age of self help, self empowerment, self evaluation, self sufficiency, self worth, self government, etc., it was really quite a coup to have gotten self medicating placed somewhere between incest and carjacking.

This is all by way of saying, if anyone knows a good shrink in town, please send along their number.

NEW MUSIC FROM DAMIAN WEBER

Everyone should listen to this:

APPLE FACTORIES TO GET OUTSIDE AUDIT

This, from The Daily Beast:

Following recent reports and protests over inhumane working conditions at its Chinese suppliers, Apple has asked an outside organization to audit its plants. Until recently the company has strongly resisted divulging information about its suppliers. The move is designed to forestall the kind of public-relations disasters that hit Nike, Gap, and other companies. In fact, the auditor, the Fair Labor Association, was formed out of a task force created by President Clinton and apparel companies, including Nike, to help combat child labor. Critics say the association isn't independent enough, but other analysts say the move could result in greater transparency throughout the industry.

There’s nobody more annoying than someone who believes that Apple is some sort of humanitarian enterprise—messianic in its ambitions, and spotless in its virtue. Stories like this should remind us that Apple is a corporation with interests, stockholders, and an advertising strategy so effective that it doesn’t even seem like an advertising strategy.

DOCTOR’S ORDERS: A MODEST PROPOSAL

WINE (ˈwīn)

WHY IS THIS MEDICATION PRESCRIBED?
Wine is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Wine is a hydroxyethane-based medication. It works by exercising a depressant effect on the central nervous system. It has a complex mode of action and affects multiple systems in the brain, the most notable one being its agonistic action on the GABA receptors.


HOW SHOULD THIS MEDICINE BE USED?
Wine comes as a liquid to be taken by mouth. A glass is taken two to four times a day. Fortified wine is taken once daily, usually in the morning. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take wine exactly as directed. Your doctor will probably start you on a low dose of wine and gradually increase your dose.

Wine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Do not stop taking wine or decrease your dose without talking to your doctor. If you suddenly stop taking wine you may experience withdrawal symptoms such as seizures; shaking of a part of your body that you cannot control; headache; blurred vision; increased sensitivity to noise or light; change in sense of smell; sweating; difficulty falling asleep or staying asleep; difficulty concentrating; nervousness; depression; irritability; agressive behavior; muscle twitching or cramps; diarrhea; vomiting; pain, burning, numbness, or tingling in the hands or feet; a decrease in appetite; or weight loss. Your doctor will probably decrease your dose gradually.


OTHER USES FOR THIS MEDICINE:
Wine is also sometimes used to treat depression, sexual inhibition and anhedonia (the inability to experience pleasure). Talk to your doctor about the possible risks of using this medication for your condition. Wine may be prescribed for other uses; ask your doctor or pharmacist for more information.


WHAT SPECIAL PRECAUTIONS SHOULD I FOLLOW?
Before taking wine:

* Tell your doctor and pharmacist if you are allergic to whisky, gin, vodka, tequila, or any other medications.

* Tell your doctor if you are taking marijuana (Tetrahydrocannabinol), cocaine (Benzoylmethylecgonine) or heroin (Diacetylmorphine). Your doctor will probably tell you not to take wine.

* Tell your doctor if you have or have ever had depression; if you have had thoughts of suicide or harming yourself; if you use or have ever used street drugs or have overused prescription medications; if you smoke; if you have had seizures; or if you have or have ever had lung, kidney, or liver disease.

* Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. Wine may harm the fetus. If you become pregnant while taking wine, call your doctor.

* Talk to your doctor about the risks and benefits of taking this medication if you are 65 years of age or older. Older adults should receive low doses of wine because higher doses may not work better and may cause serious side effects.

* If you are having surgery, including dental surgery, tell the doctor or dentist that you are taking wine.

* You should know that wine may make you drowsy. Do not drive a car or operate machinery until you know how wine affects you.


WHAT SHOULD I DO IF I FORGET A DOSE?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.


WHAT SIDE EFFECTS CAN THIS MEDICATION CAUSE?
Wine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

* Drowsiness
* Light-headedness
* Headache
* Tiredness
* Dizziness
* Irritability
* Talkativeness
* Difficulty concentrating
* Dry mouth
* Increased salivation
* Changes in sex drive or ability
* Nausea
* Constipation
* Changes in appetite
* Weight changes

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

* Depression
* Memory problems
* Confusion
* Problems with speech
* Unusual changes in behavior or mood
* Thinking about harming or killing yourself or trying to do so
* Problems with coordination or balance

Wine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].


IN CASE OF EMERGENCY/OVERDOSE:
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

* Drowsiness
* Confusion
* Problems with coordination
* Loss of consciousness

AHFS® Consumer Medication Information. © Copyright, 2011. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

DEM TZADIK'S ZEMERL

Another little song recorded on my new USB microphone:

THE GRADUATE STUDENT'S LAMENT

Here’s a little song I put together a few months ago, and recorded yesterday using a new USB microphone I got. It’s all pretty uneven—the recording, singing and playing. Nowhere near as polished as this. Nevertheless, I hope you’ll find the lyrics amusing.