![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by Phillipa on October 2, 2005, at 19:06:31
Okay it's me again. Today I was with my husband and ran into an aquaintance who is a Professor at a Medical School. He has a PHD in biochemistry. He asked how I was and I explained that I was still taking meds for anxiety/depression. He very nicely told me to wean off the meds as they were not good for me. He said it is mind over matter. And if he put a scope in my mouth to my intestines it would look like a pharmacy. He basically said meds will not make you well. Has anyone else ever encountered a Professor of Med School who would say something like this? It hurt me a great deal. I'm really trying to take this 5mg of lexapro that was just prescribed for me with my valium. Why does someone always make you doubt your decisions? It was hard enough to just be out and trying to walk and excercise. Thanks, Fondly, Phillipa
Posted by Racer on October 2, 2005, at 19:31:18
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
I really hate to hear that sort of thing, PJ -- and I have, believe me -- because it seems so cruel. "Gee, you should stop taking insulin for your diabetes, because it won't cure you." Same thing.
I don't know quite why this idea is still making the rounds. Szasz used to get a huge amount of press on it, through some rather specious arguments, and that may be part of it. If you didn't listen too closely, you could certainly find some seeming logic to it.
I'm sorry you got hurt, Ms PJ. You certainly don't deserve that sort of [expletive deleted]. Hope that helps.
Posted by 10derHeart on October 2, 2005, at 20:03:07
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
Hey Phillipa,
Oh my goodness, don't listen to this kind of doo-doo. Really. I've been there with other, similar *educated* *experts.* He didn't even begin to back up what he was saying and it doesn't make a whole lot of sense. He would see a pharmacy inside you?! Excuse me?! Does he recall how the digestive system works? Ironically, there are meds that might help him with this delusional thinking... I feel sorry for him, in a way.
You know, me and my smart @ss mouth sometimes, I'll bet I would have said, "You know, as we've been talking, I've examined your heart and soul with my own kind of 'scope,' and guess what? I found TONS of arrogance and ignorance, but alarmingly, I couldn't locate ANY compassion or kindness! Professor, you really need to see a doctor about that condition immediately !"
No, I am not the queen of tact. Makes my blood boil, actually, when people talk to others this way. I tend to get suddenly (maybe brutally) sarcastic. You just pay him no mind at all, dear, it's not even worth it.
((Phillipa))
Posted by lynn970 on October 2, 2005, at 20:07:59
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by Racer on October 2, 2005, at 19:31:18
I totaly agree with Racer. : )
One time I was having a horrible time with depression. I worked at a little private school. My boss told me to take three days off. She and I were very close. A teacher said to me, "Wow, it must be nice to take off." That made me so mad, as she judged me for depression.
A few months later I saw a friend give her St. John's Wort. You know, "If you spit into the air it will land on your nose." It makes me so mad when people say mind over matter or just snap out of it. I believe every single person on babble would snap out of it if they could. Noone enjoys going through the hell of mental illness. I pray that the professor is not spitting in the air. Maybe he means well, but he needs to do a little more studying.
Posted by KaraS on October 2, 2005, at 20:49:13
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by 10derHeart on October 2, 2005, at 20:03:07
> Hey Phillipa,
>
> Oh my goodness, don't listen to this kind of doo-doo. Really. I've been there with other, similar *educated* *experts.* He didn't even begin to back up what he was saying and it doesn't make a whole lot of sense. He would see a pharmacy inside you?! Excuse me?! Does he recall how the digestive system works? Ironically, there are meds that might help him with this delusional thinking... I feel sorry for him, in a way.
>
> You know, me and my smart @ss mouth sometimes, I'll bet I would have said, "You know, as we've been talking, I've examined your heart and soul with my own kind of 'scope,' and guess what? I found TONS of arrogance and ignorance, but alarmingly, I couldn't locate ANY compassion or kindness! Professor, you really need to see a doctor about that condition immediately !"
>
> No, I am not the queen of tact. Makes my blood boil, actually, when people talk to others this way. I tend to get suddenly (maybe brutally) sarcastic. You just pay him no mind at all, dear, it's not even worth it.
>
> ((Phillipa))
>What a great response!!!! I would love to have seen his face after someone had given him that come-back. I would also love to give him my illness for a little while and see how well he's able to talk himself out of it. Then he'd have some idea what a disservice he has been doing to those of us who are seriously ill.
k
Posted by Glydin on October 2, 2005, at 21:48:10
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
I urge you to bring out the nurse in you and think about yourself, others you’ve heard from struggling with mental illness and patients you may have cared for and use that litmus test. Can you find validity in what the doc said – even if he was a doc? I do not. That kind of thinking implies there’s a character flaw, weakness, lack of will and any other number of fallacies we have FOUGHT against.I’m sorry that happened to you and I hope you don’t believe it.
Posted by JenStar on October 2, 2005, at 22:07:56
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
hi Phillipa,
I both agree and disagree with him. I think SOME things are "mind over matter" -- things like sticking to a diet or exercise regimen, studying, beating a bad habit like thumb-sucking or hair-twisting, or cursing. Those things are fixable by oneself (usually). I even think that maybe some 'borderline' mental disorders can be cured by positive thinking/etc. alone -- maybe very mild depression, mild anxiety, mild social phobias.But I also think there are larger problems that are NOT fixable without some help. People who suffer from severe depression, anxiety or phobias need real help to improve. And so far it seems that the meds DO help...unless we're all struck with a collective case of "the emperor has no clothes" syndrome!
I believe that meds are overprescribed, and maybe people DO experience a placebo effect. But so far, the meds seem to help!
There are professionals (mostly those who have never suffered a severe or debilitating mental disorder, I presume) who think that people can/should cure themselves of all mental struggles. Maybe the med school wanted someone like him because they worry about meds being overprescribed, and wanted someone who could focus on a different, holistic, therapy-related approach to problem solving. It's hard to say!
If you trust this guy, and have a relationship with him, could you set up an informal appointment just to talk with him? Could you say, "You know, I was really upset the other day when you told me XYZ. The truth is I've been getting better on the meds, and I want to give them a chance. I really felt like I was headed for confusion or a setback when you said XYZ to me. Can we meet so I can learn more about your philosophy and why you said that to me? I think it's only fair that you owe me some time. It's difficult to hear such a quick, flip, 5-minute assessment of my condition and NOT be upset. I kind of feel that you "owe" me a bit more time to explain!"
If you don't feel like doing that, remember that he's only ONE person and one opinion. Even experts disagree. Although he's the director of that school, he doesn't know you or your situation intimately. It's possible he'd even change his mind if he knew it better!
I'd say keep doing what you're doing -- give it a fair try. If it doesn't work, then you can move on. But don't feel swayed by his "expertise" to drop a plan that you've committed to and has been suggested by someone you trust!
good luck! :)
JenStar
Posted by Emily Elizabeth on October 2, 2005, at 23:51:45
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
Grrr. That makes me angry. Also, remember he is a PhD in biochem, NOT an MD. He has no clinical experience. Perhaps he knows a little more abt meds and the human body, but I suspect he is talking way out of his area of expertise. He might as well been a history prof.
In the end, only you can decide what is best for you. Meds are not a perfect cure-all, but as long as you are making an informed decision and are using them responsibly, then they are worth a try. In fact, I think most babblers would be willing to shave a few yrs off the end of their lives if they could feel better for the years that they have. (not even saying that meds will cause that, just for the sake of argument).
His comment was flip and insensitive. Ignore it.
Best,
EE
Posted by SLS on October 3, 2005, at 9:12:33
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
> Okay it's me again. Today I was with my husband and ran into an aquaintance who is a Professor at a Medical School. He has a PHD in biochemistry. He asked how I was and I explained that I was still taking meds for anxiety/depression. He very nicely told me to wean off the meds as they were not good for me. He said it is mind over matter.
LOL
:-(
Let this person remain a student of biochemistry. I'm sure he is very good at what he does.
You need students of psychiatry to help make diagnostic and treatment decisions for you.
If you notice, I still consider a professor and a doctor to be students. The day they become satisfied that they know everything is the day they are no longer the best at what they do.
Even professors and physicians are humans. Sometimes, humans become very emotionally attached to a school of thought without fully considering the applicability or validity of others.
I find this professor's advice to you to be inadvisable to follow.
- Scott
Posted by rainbowbrite on October 3, 2005, at 9:57:06
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
PJ Ignore peole like that!
Thats so unfair to tell someone that. It seems to be something I come accross alot as well, and it has resulted in me being an in the closet med taker. But there is nothing wrong with taking meds! And that guy was out of line in telling you that IMO.
Try not to let it bug you, whatever makes you happy and helps you is the best thing to do.((PJ))
Posted by Bill LL on October 3, 2005, at 11:57:59
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by rainbowbrite on October 3, 2005, at 9:57:06
Thank God that this professor is not a physician!
Posted by CK1 on October 3, 2005, at 19:07:10
In reply to Re: Professor at Med School Says Wean off All Meds » Phillipa, posted by SLS on October 3, 2005, at 9:12:33
Phillipa,
I think that guy is an idiot. Phillippa, come on, you know you need meds or you wouldn't be trying them. Right? SSRI's, Benzos, MAOI's, etc. have all improved MILLIONS of lives. There are there over 20 million prescriptions written every year for SSRI's and, in a majority of cases, they make peoples lives better. Obviously, that guy doesn't understand depression/anxiety well enough to know that some people DO need these meds to function obtimally.
Phillipa, I realize you suffer from anxiety/depression. I'm just wondering why you're going to try Lexapro considering how many SSRI's you've been on before and none of them worked. After 2-3 don't work, you can bet that Lexapro isn't going to be much different, you know? After trying 4 SSRI's myself over the past few months and having them not work, I am getting ready to try Nardil. It's a much more effective AD and it has a 60-85% success rate for anxiety while SSRI's have a 15% success rate. And, I've heard from many people that the side effects are blown way out of proportion and are no worse than SSRI's. I would even try if if you're anxiety/depression is just mild. You might be amazed............but, I think you've tried enough ssri's (my humble opinion :).
On a different note, I have one major problem with this board! There seem to be very few success stories with meds leading many to become afraid of them. All I read about on this board is people having bad side effects, people not getting better, and frustration at everything that is going wrong in their lives. Come on, isn't there anything positive going on in anyone's lives?
Posted by linkadge on October 3, 2005, at 22:32:10
In reply to Re: Professor at Med School Says Wean off All Meds, posted by CK1 on October 3, 2005, at 19:07:10
I know this is a med board, but I think this guy is on the right track.
Linkadge
Posted by Ilene on October 4, 2005, at 0:11:09
In reply to Re: Professor at Med School Says Wean off All Meds, posted by CK1 on October 3, 2005, at 19:07:10
> On a different note, I have one major problem with this board! There seem to be very few success stories with meds leading many to become afraid of them. All I read about on this board is people having bad side effects, people not getting better, and frustration at everything that is going wrong in their lives. Come on, isn't there anything positive going on in anyone's lives?
The reason most of us are here is because of bad side effects, not getting better, and having a tough go of it. You might try the Social board for more upbeat postings.
I.
Posted by DanielJ on October 4, 2005, at 8:44:05
In reply to Re: Professor at Med School Says Wean off All Meds, posted by lynn970 on October 2, 2005, at 20:07:59
Mind over matter doesn't work when the mind isn't working correctly.
Mad dogs and college professors can also be classified as Quackpots
with little or no exposure to people with real mental illness issues.
There was one Professor who had a web site inviting all Schizophrenics
and Bipolar sufferer to give up their medications and go with his method.
Duh he described how after many years of therapy someone with
undifferentiated schizophrenia now was much better.
Well my son is one of those sufferers and after the correct anti psychotic
and AD combo was determined. Well he is back in High School with top
grades and few issues and has been that way for over 2 years. He "must"
take medications daily. Don't listen to this Guy, he is a theoritician with
no real world connections!
Posted by SLS on October 4, 2005, at 9:45:44
In reply to Re: Professor at Med School Says Wean off All Meds, posted by linkadge on October 3, 2005, at 22:32:10
> I know this is a med board, but I think this guy is on the right track.
>
> LinkadgeHmm.
If you don't need drugs, don't take them. That's a pretty simple principle to understand and follow.
Psychotherapy is sometimes all that is needed if the depression is not biologically driven. That's another pretty simple idea to work with.
How do you know when someone needs medication?
Never?
It is a tough decision to make. There are so many variables. That's why psychiatrists get paid the big bucks. That's why the competent ones are actually worth it.
The longer one goes without successfully treating major depressive disorder (MDD), the worse the depression gets and the more resistant to medical treatment it becomes. This is particularly true for people whom develop depression early in life.
Linkadge, it might be difficult to parse out exactly why your depression has become more severe and resistant to drug treatment. However, it does follow a pattern that has been observed and noted by psychiatry.
It does seem that people who have been exposed to a particular drug become more resistant to it over time if it is repeatedly stopped and restarted. If one is to discontinue medication, the more gradually the drugs are tapered, the lower the risk of relapse. Taper periods can be weeks to months long. During a slow taper, if a relapse occurs, you can quickly raise the dosage of the medication and recapture the antidepressant response. For those people who need long-term or indefinite treatment, the longer the time spent between an abrupt discontinuation and eventual relapse, the less likely they are to respond adequately to the same drug. This is probably less of a problem for people whose depressive episodes are separated by years than for someone who has demonstrated a higher rate of recurrence.
Linkadge, it is entirely possible that you suffer an Axis I and Axis II disorder comorbidly. The Axis II personality disorder might produce enough psychosocial stress to drive the Axis I mood disorder. The Axis I mood disorder might make it much harder to do the psychological work necessary to process psychotherapy. It might be an ideal multimodal treatment strategy to pursue both treatments concurrently.
- Scott
Posted by DanielJ on October 4, 2005, at 10:25:47
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
If it already has been determined by the Pdoc that a serious mental illness exists then the correct medication can be precribed. This determination may take weeks or even months.
My son could not function as a normal human being and this happened virtually overnight. It took about 3 months to get him under control
and another 3 to get him stabilized. His psychotic episode was severe and he relapsed a month later. He had therapy sessions as well but in his case the real elixirs were Zyprexa and Zoloft. Three days off these meds and it would be a disaster in the making.
Those who can communicate rationally with a Pdoc are probably more apt to be helped by therapy. In truth my son occasionally speaks at length with his psychiatrist now. We got a highly recommended therapist for a few sessions. My son didn't like him and I believe the feeling was mutual. We dumped him before he could do any damage and my son feels his talks with his Pdoc are productive and helpful. He is satisfied with his life thus far and doesn't feel the need for additional therapy.
Posted by gardenergirl on October 4, 2005, at 12:32:33
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
Posted by linkadge on October 4, 2005, at 14:10:47
In reply to Re: Professor at Med School Says Wean off All Meds » linkadge, posted by SLS on October 4, 2005, at 9:45:44
Its not that I don't think the idea of needing medication is wrong, I simply think that the current medications do more harm than good.
So I do agree with him when he says get off them, because well, I think they can to a lot of dammage to the brain.
Linkadge
Posted by Nickengland on October 4, 2005, at 15:24:18
In reply to Professor at Med School Says Wean off All Meds, posted by Phillipa on October 2, 2005, at 19:06:31
I think there is truth in the fact that indeed whilst the argument put forward that medication is the answer to go forward to treat mental illness, there is also truth in the fact that medications are not *the* answer to make you well alone.
Some of what the professor said, was perhaps not worded as what you would expect from someone of his background, but at the same time I think there is some middle-ground within what he was saying.
>...to wean off the meds as they were not good for me.
Some medications can make people worse rather than better, although one would have to be in a position to know if this was the case.
>He said it is mind over matter.
When the causes of the disease(s) are unknown, but there are biological things going on and genetic's involved, then it would be easy to say that in some respects when the person does not have such an illness of unknown causes. Also the mind would have to functioning to a good standard in the first place for it to be able to fix itself and problems around it. In certain fears it can be like the chicken and the egg factor, in some ways to break the fears it can be mind over matter but its a very loose term and it doesnt correspond well to other areas of mental ilness at all.
>And if he put a scope in my mouth to my intestines it would look like a pharmacy.
I long for the day when they can put some kind of scope into my brain and say "hey...thats the problem" lets it fix and *cure* it with X. But then its mind over matter right? lol
>He basically said meds will not make you well.
But if only these people could then tell you what would...
Medication when treating any mental illness will only treat the symptoms...I do not believe they can cure anything but only help you live with the illness better than how you did without the medication before. If genetics play a part in certain peoples illness's then taking no amount of medication on todays market from what I understand, be it antidepressants, anticonvulsants, antipsychotics etc are going to cure the genetic defects which caused the illness. The drugs will however at best help you to have more symptom control over the symptoms which you were currently suffering from.
What if you've tried all the medications and now you're getting no where? Medication may not be the answer to the problems...Therapy could well be.. Like Scott said sometimes a combination of both can produce the best possible outcome..
I remember once being told by a psychiatrist I should take prozac, just like a diabetic has to take insulin. At the time I could understand what he was saying, but the diabetic has a problem with *insulin* whereas I do not have a problem with levels of prozac in my brain. Funnily enough the actual problem I had was that I shouldnt have being taking the stuff in the first place as it was making me worse - but there was the psychiatrist saying how badly I needed it compared to that of a diabetic with insulin.. I was 17 at the time.
I guess in the future, I hope that the ways in which we are told to take drugs will correspond exactly with how our illness presents itself. Just like that of the diabetic and insulin. No one says to the diabetic its mind of matter and hopefully in the future when advances are made and more is known about the causes which brings newer treatments specifically targeted at them, people will not be saying such things. Just like many years ago, people said mental patients were to be locked up and left to die. It doesn't happen anymore and oneday people won't say things like this professor guy did I hope.
Support I believe is one thing that can truely make people get better no matter what illness they have. Having proper support from friends and family and the community around you, just knowing that people care gives you *hope* ~ and with that *hope* comes peace of mind that you will get better...it gives you that little extra that things will work out.
Africa, has some of the poorest deprived countires of the world, but an example of how hope can make you better is this. When someone gets sick in the village, the leader of the tribe will gather the people of the community, all the people will then go and visit the sick person. Can you imagine living in a small town where you got mentally ill and everyone came to visit you to "gee you up" so to speak. The encouragement of everyone being together and helping in itself would be truely amazing. Its just unfortunate that in the western world, sometimes the very people we turn to treat our illness give us the exact oppsite of what we really need to make us feel better..
I even read recently that whilst schizophrenia was once thought to be a degenerative disease, it is now thought that the brain can actually repair itself. This offers hope.
Also with medications and mental illness (here it shows schizophrenia) could actually depend which country you live in. If the professor was speaking to you (and you had schizophrenia) in India Colombia or Nigeria then he might have something to go on by..
"The World Health Organization conducted two long-term follow-up studies involving more than 2,000 people suffering from schizophrenia in different countries, and discovered these patients have much better long-term outcomes in poor countries (India, Colombia and Nigeria) than in rich countries (USA, UK, Ireland, Denmark, Czechoslovakia, Japan, and Soviet Union)despite the fact antipsychotic medication is typically not widely available in poorer countries."
>Why does someone always make you doubt your decisions?
I wish I could answer that question, but let me just say that alot of people here have the greatest faith in your decisions Phillipa :-)
Kind regards
Nick
Posted by SLS on October 4, 2005, at 19:51:00
In reply to Re: Professor at Med School Says Wean off All Meds, posted by Nickengland on October 4, 2005, at 15:24:18
Hi Nick.
:-)
> I think there is truth in the fact that indeed whilst the argument put forward that medication is the answer to go forward to treat mental illness, there is also truth in the fact that medications are not *the* answer to make you well alone.
Tell that to a lithium responder.
> Medication when treating any mental illness will only treat the symptoms...
I disagree with this characterization. When one responds robustly to an antidepressant, there is a global improvement of all symptoms simultaneously. This indicates to me that some core process or processes have been modulated by the treatment such that the illness itself goes into remission. I don't think that the word "cure" serves well to describe treatment success with mood illness. "Remission" seems more appropriate.
> I do not believe they can cure anything but only help you live with the illness better than how you did without the medication before.
You should see the difference in brain function between depressive episode versus remission as imaged by a P.E.T. scan. In relapse, most of the brain appears blue and inactive. In remission, the whole brain lights up yellow, orange, and red. This is virtually identical to the portrayal of a healthy brain. Semantics aside, this person no longer has to contend with any aspect of depression other than maintaining the effective treatment.
I have experienced a full remission. Depression was completely absent. I functioned as if I had no mood illness. I was unbound to begin putting my life and my psyche in order. It is a recovery process. Additionally, being free of MDD does not mean being free of other psychiatric problems. A completely healthy person must work to build a psyche and life that brings them happiness. Problems encountered along the way must be dealt with to overcome. They usually do not disappear by themselves. Why would anyone think for one moment that a drug will make such problems disappear? At best, a drug will bring a depressed individual who has been made incapable of dealing with these problems into a state of remission that will then enable them to. From effective treatment comes health. From health comes problem-solving capacity.
Looking into the future, I believe that our ever-expanding ability to look at how the brain functions through imaging techniques like PET, SPECT, and fMRI will allow for a biological testing protocol that will be able to identify effective drugs for each individual using an array of compounds as biological probes. In addition, genetic microarrays might be able to screen for deficiencies and excesses of particular gene products. This would help identify which genes are turned on and which ones are turned off. A gene-activity profile can be constructed to produce a matrix from which abnormal function can be characterized and treated.
Many of us were born at least 20 years too early.
- Scott
Posted by SLS on October 4, 2005, at 19:55:12
In reply to A lot of wisdom in this post (nm) » SLS, posted by gardenergirl on October 4, 2005, at 12:32:33
With all the posting I've done over the years, I guess I was bound to hit once.
:-)
Thanks.
- Scott
Posted by Glydin on October 4, 2005, at 20:20:30
In reply to Re: A lot of wisdom in this post » gardenergirl, posted by SLS on October 4, 2005, at 19:55:12
I have enjoyed your posts for years. I appreciate your ability to articulate well and I appreicate your knowledge, insight, willingness to share your life experiences, and compassion.
Posted by DanielJ on October 4, 2005, at 21:22:27
In reply to Re: A lot of wisdom in this post » gardenergirl, posted by SLS on October 4, 2005, at 19:55:12
I almost hate to add this one but why not. A person can spout technical jargon for paragraph after paragraph.write books on the subject and even "Do" the lecture circuit, but in my book there is only one criteria that is important and stands alone in the eyes of all who may seek to evaluate performances. One question perhaps two questions/ of Professors,Pdocs,Counselors and therapists et al
1. How many people have you really helped?
2. Is it important to you that these people are better off than they were?
Posted by grammy on October 4, 2005, at 23:31:10
In reply to Re: A lot of wisdom in this post, posted by DanielJ on October 4, 2005, at 21:22:27
The comment the biochemist made about getting off of the meds is the exact reason I got off my meds 2-3 times. I felt like I should be able to pull myself up by my boot straps and get well on my own, but I couldn't. It made me feel even worse to have to rely on medication to function so-called "normally". Also, when I got on ADs, people didn't talk about it like they do now, so I was in the closet. You know that song, "Nineteenth Nervous Breakdown"? That was me.
Each time I got off my meds, I relapsed into deeper depressions and more intense anxiety, until I finally had to get back on the medications. Sometimes, even after 16 years on ADs, I think I can get off of them and try again to function normally. However, I think back at how sick I was and I know I can't.
I sometimes wonder what I would've done if I'd have been born in a different era, before medications - it's scary.
Philippa, please ignore him. Carole
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