The Never-Ending Story Bad Girl, I am glad that you brought up the Chowk Staff Statement. It indeed behoves us to keep the discourse at a high level. I wish you would tell Random to do the same. By the same token, you should try not to let your emotions get in the way of analyzing the significance of scientific data.

In my opinion, you are still misinterpreting the results of the breast cancer risk study. A dispassionate look at the facts would reveal that it significantly improves our understanding of risks of breast cancer development in women with a positive family history. There are important practical implications. Women with a positive family history would KNOW that they have a 39% risk of getting cancer, and a 61% risk of NOT getting cancer, if they choose not to undergo preventive removal. Given all the advances in breast cancer management (better chemo, improved surgical and cosmetic technique), they would KNOW that even if they did get cancer, their chances of doing well and surviving it are high. Based on this KNOWLEDGE, women would decide which option is in their best interest.

Medical decision-making is getting increasingly complex - it used to be that doctors made all the decisions for their patients. Thankfully, we are moving away from that paradigm - and patients can be active participants in their own care, basing their decisions on sound data and their own preferences or utilities. For some even a 90% risk would be acceptable, rather than losing their breasts, and for others even a 10% risk would be too high a price to pay, and risk-free mental peace gets the highest utility.

You are unnecessarily charging the issue of breast cancer surgery by using terms such as mutilation, and in the process are sounding somewhat incoherent. No one, for example calls the removal of a colon, prostrate, or testes mutilation, if they are done for sound medical reasons. Undescended testes that are not cancerous are removed as standard procedure all the time, because the risk of cancer in them is extremely high. You are also obviously poorly informed about scientific research (both bench and clinical) in the area of breast cancer. There have been numerous advances in the field of genetic susceptibility (as outlined by Aamina Ahmed), prevention, early detection, cosmetic results and cure. Mortality from breast cancer is sharply down. The research of one of my senior colleagues, Dr. Judah Folkmann, at Children’s Hospital, Boston, involving starving the cancers of their blood supply, by using angiogenesis inhibitors, is particularly exciting - and a potential new frontier in the war against cancer. This idea in fact arose from the patients who underwent spontaneous regression, and may be the mechanism that explains it. Believe me, some of the best minds in the world are turning every corner and stone that they can turn, burning the midnight oil, in order to find a cure (I think you are seriously underestimating the brain power here). And no Umair, they are usually not surgeons, although Dr. Folkmann happens to be one.

Only the most uninformed individual would claim that billions of dollars of money have gone into research with diddly squat. Infant survival, child survival, health indices, life expectancy, post-cancer survival have improved, even in the most impoverished of countries. Your food and environment point in promotion of health is of course valid. But there is an interesting point to be made here. Major improvements in the health of European and American populations were seen earlier in this century, BEFORE modern day medicines, antibiotics and vaccines were available. They are mainly attributable to improved nutrition and environmental conditions. However major gains in health in developing countries have also been made (infant mortality rates and child mortality rates halved, life expectancies significantly improved) - these have been made WITHOUT improvement in environment and nutrition, and are mainly attributable to modern day medical technology (antibiotics, vaccines).

Incidentally, as a hypothetical, if you were to get breast cancer, would you go for cancer removal, or just hope that nutrition and a good environment will do the trick?


ON ALTERNATIVE MEDICINE

You mention several anecdotes of individuals living for longer than they were told to live and doing well on one or the other herbal medicine. There are two major flaws in this kind of reasoning.

1) Because there is tremendous biological variability in humans, no one can say for sure when a PARTICULAR individual will die of a specific disease. One can only ESTIMATE based on group probabilities or odds - so you may get quoted a probability of 99% chance of death at the end of one month based on how a group of 100 individuals with similar levels of disease did - the odds are overwhelming that you’ll be dead at the end of the month, but remember that there will be that one person who will make it. Hence the miracle.

2) Just because someone was on a particular medicine and they did well doesn’t prove a causal association - its like saying she ate blue cheese last week and wore a green dress the next day, and she ate blue cheese again yesterday, and was wearing a green dress today - therefore eating blue cheese makes her wear a green dress the next day. In order to prove that a specific medicine/procedure works in improving health you have to randomly assign individuals to different therapies and see if one group does better than the other. Have you ever wondered why the practitioners of these alternative therapies do not evaluate them in a scientific manner - no, why should they, when the likes of Deepak Chopra can reliably fool gullibles like you and make millions. They are an industry just like any other - the only difference is that they operate without any regulation. In fact, the ultimate coup in pulling wool over the naïve public’s eyes is that many of these products are made by the very pharmaceutical companies the poor consumer loves to hate. This is what baffles my mind - that people like you are so skeptical of conventional medicine, which uses hard science to back up its approach to improve health - and suspend disbelief when faced with charlatans touting magical abilities, without any basis in fact.

Thankfully, many scientists are now keenly pursuing studies of alternative therapies. We realize that it is important to remain open to the possibility that some may work, although most are probably surviving solely through the power of suggestion (placebo effect). If they truly worked, the pharmaceutical companies would have isolated the active chemical long ago, and gone to roost with the patent. Echinacea (touted to boost immunity), for example, has been totally debunked, as has garlic extract, acupuncture for low back pain or neuropathic pain. On the other hand, moxibustion corrects breech presentation, and yoga relieves stress, and carpel tunnel syndrome.

The power of suggestion is indeed an important tool in making people feel better, and no physician underestimates its importance. In this respect, Medicine becomes an art, as well as a science. But that doesn`t mean one should have blinders on their minds when one evaluates the cold hard facts.

In response to your ``….and let them acknowledge, at least, the association of cancer with environmental pollution and toxicity and life-style factors -- the huge increase of chemicals in our internal and external environment; the consumption of high fat, processed, de-natured foods; stress, stress, stress; lack of excercise; smoking and alcohol``

Where have you been lady? Haven’t I gone blue in the face saying ALCOHOL and TOBACCO are the biggest preventable cause of sickness and death. Let them ACKNOWLEDGE? What do you mean ? PHYSICIANS and SCIENTISTS have PROVEN that these things are BIG risk factors for poor health including cancer. They are the ones who are constantly imploring the public and industry to change their behavior.

Re: Zehra

You bring up the important point of competition and secrecy in scientific research. Regrettably this is true and a major problem in medical research conducted by the industry, and disturbingly also slowly gaining ground in academia. It is an example of capitalism gone haywire. A lot of soul-searching is going on in academic institutions around the world about how to counter this trend. One sure way would be to increase the amount of ‘no-strings attached’ governmental and private funding of academic scientists and institutions, on the condition that any fruit of the research cannot be used for profit.


Anita

The Never-Ending Story Re: Bad Girl

``i did not misunderstand the article. i was merely pointing out the COMPLETE and UTTER failure of medicine to come up with a better option to reducing the risk of breast cancer other than mutilation of women`s bodies -- something that has a long, mysoginistic history and obviously hasnt changed that much.``

Dear Bad Girl,

I am glad that you are actively participating in this discussion and enlightening us with your reasoned comments on the deliberately misognynistic tendencies of the medical and scientific community. I am sure some more thought and activism on your part will bring about a miraculous better option to reduce the risk of breast cancer for those who have to live with this fear daily.

While I have your attention, and for the benefit of all Chowkwallahs, I`d also like you to finally explain your relationship to Random.

Anita

The Never-Ending Story Re: Random

``...that when a doctor takes the Hippocratic oath,... discharge their duties with the supreme purpose of promoting the health of their patients...``

Absolutely agreed. That is the supreme guiding priniciple by which I live my life.

Regarding scientific evidence to show that homeopathy, ayurvedia, high dose vitamin C chemotherapy, you say:

``The positivist way in which most doctors pose these inquiries (`convince me in a language I`ve been trained in`) makes one wonder if its even worth the effort. Despite this I would initially point you to the work of Gary Null, a nutritionist who has done extensive work on all of the above.``

Come on now, do you expect all of us to ``BELIEVE`` that these things work! Are you saying scientific evidence isn`t necessary in this regard? Since you seem to be aware of the work of Gary Null, and most Chowkwallahs may not have access to it, why don`t you summarize the evidence you have gathered.

Anita

An Evolving Conversation Futema,

You are right on target. The `Laila` here was suppressed intentionally, sacrificed to the logic of `keep it simple, stupid`. She made a lot of comments which were censored. She talked about early branching eukaryotes, organellar biogenesis, the origin of HIV, similarities between homo sapiens and chimps, and so on.

She also pointed out that in order to be a `good Muslim` and a `good scientist`, one has to compartmentalize heavily. But `Omar` really wanted this to be a dialogue between two believing Muslims. He feels that the wide gulf between scientists and Muslims believing in creation may be bridged if the two groups learn to trust, respect and talk to each other.

Anita

Tale of Two Totem Poles or Sofa & Charpoy Totem Poles Ikbal,

The idea of totem poles - with charpais and sofas as symbols of the class divide that we have carried with us, all the way to North America. Just brilliant!!

It must have been a particularly cold evening up north when you penned this, my pardesi friend.

Anita

The Never-Ending Story Re: Ferozk

Feroze, your remarks on the functions of the AMA are right on. The AMA is an organization of physicians that primarily represents physician interests. About 40% of the physicians in the US belong to it. It does have a journal called JAMA (Journal of the American Medical Association) which publishes scientific manuscripts, and is very highly regarded in the medical and scientific community. It does not conduct its own research or evaluate procedures. However, it may endorse research or procedures that appear to be scientifically evaluated and beneficial to health.

For the record, I am not a member, neither is my husband. We do not like the AMA`s stance on foreign physicians, although that appears to be changing slowly based on internal activism by some determined FMGs. The Association of the Pakistani Physicians of North America is particularly well-organized and is developing a lot of political clout. In my opinion, they are probably the most well-organized Pakistani professional body in the US (would love your input on this).

As for Sohail`s being a member of the AMA, I would be most surprised. I doubt he`s a member of any organization - he`s too damn independent.

Anita

The Never-Ending Story RE: SR (#59)

``I do not advocate the free and unfettered use of mind-altering substances. It is my belief that the recreational use of drugs for the vast majority of people has very little potential benefit and many actually risk more harm. Drugs in society are an issue that is entirely too complex and cannot be simply described in black and white terms...``

Thank you Sohail, for clearly stating the above. I am now finally resting easy :)

Also, no need to apologize. You could hardly have predicted the fall-out from our little game of words. Hopefully, the gentleman in question has understood the message loud and clear, and this petty vendetta is behind us.

Re: Random (#56)

I think its your turn to pull some data off the shelf. On what do you base your contention that homeopathy, ayurvedia, `chelation therapy` (don`t know what you mean by this - physicians use chelation therapy to treat iron overload, for other toxin-binding binding etc. as standard procedure), high dose Vitamin C chemotherapy in Mexico etc. work better than placebo?

Anita

The Never-Ending Story RE: SR (#49)

Sohail sahab, yes, I was waylaid by work these last few days. However, I continue to maintain that your reading of the medical community`s position on substance abuse is somewhat inaccurate. Physicians and scientists have in fact led the effort to make policy makers realize that drug addiction is not just a social problem - it is a medical illness. It is not going to go away by putting people in jail - but it could be treating them. Below are excerpts from the AMA`s official policy on drugs (formulated 1997). As you know, the AMA is a pretty right wing body, and it would be I think correct to say that the majority of physicians are sick of the current mess, and would like to explore alternatives.

`` That the AMA encourage national policymakers to pursue an approach to the problem of drug abuse aimed at preventing the initiation of drug use, aiding those who wish to cease drug use, and diminishing the adverse consequences of drug use``

``That the AMA encourage the expansion of opioid maintenance programs so that opoid maintenance therapy can be available for any individual who applies and for whom the treatment is suitable``

``that the AMA encourage the extensive application of needle and syringe exchange and distribution programs...``

``That the AMA encourage the undertaking of comprehensive research into the potential effects, both positive and adverse, of relaxing existing drug prohibitions and controls and that, until the findings of such research can be adequately assessed, the AMA reaffirm its opposition to drug legalization..``

RE: the confusion between neurotoxicity and toxicity

Here is what I had said ``…neurotoxicity of psychoactive drugs, substance dependence (addiction) is not the only toxicity to consider - the mind-altering property of the drug itself is toxic, since it leads to impaired cognition and therefore increases the danger of violence/accidents involving self and others...``

I am distinguishing neurotoxicity (which you are quite correct in saying, generally refers to permanent neuronal damage), from other types of toxicity. The medical definition of toxicity is the effect of any drug which adversely affects physiological processes. Marijuana, opoids, alcohol, cocaine, LSD, X, all of these have acute toxic effects on the brain in that they alter cognition and impair judgement. Hence the medical terms, acute alcohol intoxication, acute LSD intoxication etc.

RE: burden of substance abuse problem

Chowk being Chowk, we`ve had some unique perspectives here: the excellent political analysis by Feroze and Random, the maternal/social perspective by Anne Shamim, the adventurer`s viewpoint from Sohail (allow me this much leg-pulling), the morally right position from Godot, and most importantly, the disease sufferers perspective from Kaneez Rahman.

A couple more words on the public health perspective.

It is apparent that from the vantage point of a public health professional/physician, that substance abuse (both legal and illegal) exact a huge toll on the individual and on society. Together, they represent the largest preventable cause of morbidity and death in the industrialized world, and will soon in the developing world because of unprecedented rates of smoking. The scope of the problem is huge and unimaginable - as billions continue to puff away.

In the United States, half a million die annually from smoking, 100,000 from alchol, 20,000 from other substance abuse. Alcohol and/or marijuana are implicated in the majority of fatal traffic accidents, about half of all falls in adults, about two-thirds of deaths during fires. Additionally substance abuse is a major risk factor for STDs and HIV.

Neurobiology has shown us that drug abuse and addiction are as much health problems as social ones. The drug addict is not a morally weak person unable to control his/her needs. On the contrary, the addict is a chronic disease sufferer who needs to be treated just like any other mental illness is treated - with therapy, not with incarceration.

Currently, the vast chunk (about 75%) of all federal and state governments drug budget goes towards policing, prosecuting, and incarcerating. There is no requirement for these guys to show that any of their programs work (they obviously don`t work). In contrast, all rehab programs are held to a very strict standard of showing ``cost-effectiveness`` for them to receive any funding. Clearly, the system is perversely twisted for all the reasons that people have already cited.

If we can as a society (politicians and the rest of the public) drastically change our view of addiction from that of a punitive, stigmatizing one, to that of a chronic relapsing medical disorder, some headway in tackling these problems might be made.

Ultimately, drug addiction is probably not a curable disease since all evidence indicates that the neuronal pathways are permanently altered. So, the adage `once an addict, always an addict` holds true to a large extent. This is no reason to lose heart. Diabetes and hypertension are not curable either - but they are definitely treatable, as is addiction. With therapy, and the right supportive environment, many addicts show a marked decrease in use, long periods of complete abstinence, and only occasional relapses, whcih can be managed by a variety of ways.

As always, I would be derelict in my duty, if I didn`t point out that prevention is almost always better than ...treatment.

RE: Sohail #53

Thank you for the testimonial, yaar.

Apparently some individuals have trouble recognizing that most of us do not pick arguments or engage in debates based on personal likes and dislikes and that the purpose of interaction on Chowk is not to support one`s friends and team up against others. It amazes me that Random should think that b/c you and I are duking this issue out here, we cannot possibly be friends with considerable mutual respect and admiration for each other - feelings that go beyond our Chowk personalities.

Re: Random

Hopefully, the lesson in this for you is not to view Chowk as an avenue for pursuing personal/tribal type vendettas - an `us` versus `them` parochial mentality. Chowk exists to provide all of us an opportunity to air our views, exchange ideas, have lively debates, learn from others, make new friends, and may be even crack a few problems. We should be focused on identifying with issues, not personalities.

Anita

Dissection of Evolution Theory S. Owais,

A couple of other questions come to my mind.

Since you have undertaken to teach us about molecular genetics, and apparently some people are actually giving your lesson some credence, please explain what do the terms `gene` and `new gene` mean to you. In other words, how different does one gene have to be from another for you to call it new?

Anita

Dissection of Evolution Theory S. Owais sahab,

This is a marathon effort, and for that you are to be commended. It would have been better received I think,if you had limited yourself to pointing out deficiences in the theory of evolution (such as the missing links in the fossil record), and provoked the biologists into trying to come up with explanations. Instead, you reveal a passionately partisan, close-minded and creationist agenda which is a turn-off. In effect, what you are saying is - since creationists are CORRECT, any other theory to explain the diversity of life MUST NECESSARILY BE INCORRECT. You can only win an argument with that kind of logic with the Taliban and their ilk.

A few general points-

In decrying the Age of Reason, you equate ``I was a chimp, therefore I am`` with a pessimistic and shallow world view. How so? To me this implies just the opposite - look where we started and where we have arrived. The potential for constant improvement - how can that be pessimistic?

Science advances by the process of falsification. Scientists accept the theory of evolution because it is to date the most rational explanation for the diversity of life - however, if it is demonstrably falsified, then scientists will no longer accept it. By the same token, scientific understanding of evolution continues to (yes, you guessed it) evolve, as new data become available. Why should one expect otherwise? This is the nature of science (pun intended). No scientist claims that science is perfect - it can be arduous, frustrating, conflicting, and slow, even plain drudgery at times - but it inexorably moves forward, asking questions, exploring further, refining our sense of the world.

A few specific points:

I do not know where you get your molecular genetic facts from. They are simply wrong. Any molecular biology text review would be extremely helpful. New genes can be created easily. We do it in the lab all the time!

The fossil record is incomplete in many ways, but it still provides overwhelming evidence for evolution in that life is organized from simple to more complex forms through millenia. So for example, fossils preserved from 3 to 4 billion years ago show only simple unicellular organisms, those from 500 million years ago show more complex organisms, those from 10 million years ago, still more complex, and so on. The same genetic code has been retained through all this time. With increased complexity, you have subtle changes in the way the code is organized, so that a chimpanzee is more closely related to humans than a rat, a rat more closely related than a frog etc. In fact, we can exactly time how long ago a primitive species diverged from its common ancestor by looking at an organism`s genetic sequence and studying the rate at which random mutations accumulate in the genome (molecular clocking). To me very fascinating is the fact that Plasmodium falciparum (the agent of malaria) appears to have arisen only about 10,000 years ago - just when the earliest human societies were formed.

Then there is the astonishing similarity of our mitochondria to bacterial organisms, with some of the proteins preserved almost intact.

Contrary to what you say, many transitional forms of life have been found in the fossil record.

Although not a fossil record, (but infinitely superior) frozen chimpanzee tissue may have led to the most recent exciting evidence of a link between the chimpanzee virus and HIV - ie. the chimpanzee virus is the ancestor and appears to be thousands of years old. So even HIV did not spontaneously arise - it appears to have evolved from a chimpanzee virus - and boy, this happened in front of our eyes, probably no earlier than 50 years ago!

Regards,

Anita

Dust and Color Re: SR

``...while talking about gender survivability you suggested that after age one year girls should out number boys. That would only be true if there was parity in numbers at birth. If I`m not totally mistaken, US figuers show that at birth we have 52 males for 48 females. (Why is that? I`ve never found an answer.) It takes almost twenty years of higher mortality in males before parity is reached. And then, of course, females progressively outnumber males...``

Sorry Sohail, I missed this yesterday. You are of course right in quoting this figures for the US. In fact, a sex ratio of 105 males to 100 females is a universal phenomenon (except where there is selective female fetus abortion by ultrasound) - presumably an evolutionary compensatory mechanism to counteract increased mortality among male children which is observed even in highly industrialized countries at every age after birth, but especially within the first month of life. Therefore, by early childhood, the number of males and females balance out. However, in South and East Asia, by the age of 1, there are many fewer female infants than male, with reversed mortality trends. I have the figures somewhere. Will dig them out when I get a moment.

Anita

The Never-Ending Story Re: SR

..``What we do with this life, in the end, may not even amount to a whiff of smoke in the face of wind. A hundred years from now there will be no trace of what we do today, and in four billion years the earth shall be a cinder and the sun a red giant. Yet none of that should concern us; ours is only here and now...``

Such fatalism Dr. Rabbani...? Followed by shairi from Ghalib, who if I may, lived and died more than a 100 years ago.

Sorry friend, just couldn`t resist the dig.

Re: Ferozk and AS

Agree with much of what you say - there are many players in the current mess. Would love to comment specifically on many of the issues you`ve raised, but time is short, and patients many...will try to find time later.

Anita

The Never-Ending Story Re: SR

``..Today`s atmosphere is no different from the medieval witch-hunts. No one is prepared to speak about the drug issue in a rational manner because they will be declared as `witches` and burnt alive...``

Sohail,

Your belief in a vast medical and scientific conspiracy designed to hide important truths from the lay public never fails to amuse me. I suppose, to each their own blind spots :)

So why have none of the docs sanctimoniously condemned KR for drug use, and gone on an anti-drug tirade that you would have expected, given the `war on drugs`?

I suggest that it is because the origins of substance abuse and dependence are extremely complex. This is not a black and white issue and many confusing threads are interwoven together. I freely admit that not all mind-altering drugs are equal, but more importantly not all drug users are created equal. Where biological phenomenon are concerned, nothing happens to a 100% of people a 100% of the times. There are undoubtedly many people who can occasionally use psychoactive substances and not become dependent (will discuss variability in addiction among different classes of drugs later). On the other hand, there are a huge number of people who do become dependent, most often at a time when adult identities are just forming, risk-seeking behavior is at its peak, and future costs are being discounted at a furious rate i.e. these decisions are not made in the best of circumstances using ‘adult-type’ mature and responsible thinking. The decision to initiate substance abuse among adolescents holds true for even the ‘legal’ psychoactive substances - alcohol and nicotine, despite intensive education.

To re-explore the issue of neurotoxicity of psychoactive drugs, substance dependence (addiction) is not the only toxicity to consider - the mind-altering property of the drug itself is toxic, since it leads to impaired cognition and therefore increases the danger of violence/accidents involving self and others. Yes, it is true that LSD and Ecstasy have little addiction potential (hope the science police isn`t after me). Unlike cocaine, amphetamines, opoids, alcohol, and nicotine all of which without fail increase dopamine levels in the nucleus accumbens of the basal ganglia, producing the desired euphoric effect which leads to reinforcing behavior, and therefore dependence ( this reinforcing behavior can easily be reproduced in animals as low as rats), neither LSD, nor Ecstasy are reinforcing. On the contrary they exert their hallucinogenic effect by binding to serotonin receptors. This is a very soundly established and well-known fact among the medical community, but I can’t see why this should lead us to advocate widespread LSD and Ecstasy use by ‘those who can handle it’. The fact is (referred to in my earlier reply) that hallucinogens have unpredictable effects. Bad trips, and extreme anxiety and paranoia can occur even in people who do not have predisposed personalities (adolescents of course do not wear their personality traits on their faces, or even have remote insight into them when they start substance abuse). Bad trips can also happen among those who have previously had good trips. An additional complication is that hallucinogen use is often in combination with other drugs. Why, just today (I am not kidding), I had to give advice on the infectious disease risk to a young child whose mother and boyfriend while under the influence of heroin, cocaine, and ecstasy had tied him down, stuck needles in his palms, forcibly evacuated his rectum with some home-made device and made him eat his own feces.

Your advocacy for legalization of drugs left me somewhat confused. Are you talking about just marijuana, or about all mind-altering drugs? A good case can be made for legalizing marijuana, although equally persuasive arguments can be made against doing so (would love to discuss this further with you, once you make your stance clear). With the notion that keeping marijuana illegal, while allowing alcohol and tobacco to remain legal smacks of hypocrisy, I completely agree. Contrary to what you say, many in the medical community are for making marijuana legally available for its many therapeutic uses (there is an extensive literature on this, some even NIH sponsored - again, no conspiracy :). In fact, a derivative called Merinol is FDA licensed and widely used for treatment of nausea and vomiting in cancer patients.

This is not to say that marijuana is completely harmless - it just compares favorably with alcohol and nicotine for long-term side-effects and has much less addiction potential. Acute intoxication with marijuana leads to impaired cognition and reaction time, short-term memory loss, and learning disability. The symptoms last for several hours beyond the ‘high’ - creating problems with driving (marijuana is certainly involved in many fatal accidents), school performance etc - again the adolescents being the most vulnerable. Additionally, marijuana also appears to depress the immune system, produce chronic respiratory complaints in heavy users, and may increase the incidence of oral cancer.

Re: KR

Tragically, bipolar disorder and drug abuse potential seem to be inextricably linked in so many creative people. I thought you would appreciate the poem below, written by Dr. Ronald Kwon in memory of his mother, who had a particularly bad case of all.

DANCING WITH ANTIPODES

There is a terrible beauty
In knowing, sensing, and touching the infinite
At times, this made you crazy
At times, you transcended the mundane
And brought us with you.

The intensity in your dance
Was the artistic price you paid for your passion
Earned with sorrow, privation, and heartbreak
Yet glorious moments overcame it all
And you brought us with you.

Now you are gone, and our loss is immense-
I could not tell the dancer from the dance,
I miss your brightening glance
And the force of eternity flowing through you
Bearing the burden you brought us.
------

Keep the pseudonym, and keep writing...

Anita

The Never-Ending Story Sohail,

I can`t let you get away with saying ``LSD is NOT neurotoxic by any stretch of the imagination...``

It depends on what the meaning of the word `neurotoxic` is. LSD can unpredicatably induce `bad trips` resulting in panic attacks in which individuals can be dangerous to themselves or others, obviously acting through its central nervous system effects. It also can induce prolonged psychosis, not just in individuals whose schizophrenia is under control, but in people who`ve never been diagnosed with the disorder.

Also, I take issue with your comparing the danger associated with doing CNS drugs, to that associated with driving, or sky diving, and concluding that the former is safer. This is a tough sell given that a significant proportion of traffic fatalities, and violent behavior are related to alcohol and/or drug use (by some estimates as many as half of all such events), and that sky or scuba diving are dangerous only to self, but have limited danger or cost to society.

Anita

Dust and Color Afrasiyab, I am happy to expound further, but wasn`t sure which part of the statement you disagreed with.

Here it is again:

``I feel that part of the reason that people in industrialized countries prefer female children over male, is the realization that in old age, a daughter is much more of an asset to disabled parents than a son is.``

As I see it, there are three parts to the statement -

The first part says that people in industrialized countries prefer female over male children, implying `as compared to non-industrialized countries`, although you are correct to point out that perhaps I wasn`t explicit enough in my statement. One cannot deny the strong preference for male offspring in South and East Asia. Yes, this is a generalization, but it is a generalization amply borne out by our social indicators. For example, the highly unequal sex-ratio of 110 men for 100 women in South and East Asia, as compared to about 107 women for every 100 men in industrialized countries (biologically, females have higher survival ability at every age, compared to males, given favorable circumstances exist, so one should expect to see many more females compared to males at every age after 1 month, if both sexes are treated equally by the caretakers).Interestingly, this preference for male children is evident in the number of children living, at a very early age. By the age of 1 year, there are many more male infants living than female infants in Pakistan, India, and China although biologically, it should be the other way around.

The second part of the sentence implies that when parents are of an old age, daughters expend more mental and physical energy in taking care of their parents compared to sons. Again, I base this on actual data from the US, but I admit that in the Pakistani realm, my observations are anecdotal. I just have never come across any son who personally takes care of aging parents (others are welcome to chime in, if they have observed something different). They usually rely on their wives - and as women become more and more independent, with their own jobs and activities, as well as responsibity to their own parents, this will become a big problem in Pakistan, especially since middle class life expectancies have gone up tremendously. This is the major reason why there is such a need for nursing homes in industrialized countries, and the situation among middle class Pakistanis is expected to approach the Western model.

The third part of the statement professes support for the idea that fertility decisions and gender preferences among offspring, whether consciously or subconsciously, have at some level, an economic dimension to them, and hence the word `asset`. There is a huge literature on this. I refer you to the writings of Gary Becker, Richard Easterlin, and John Caldwell.

Regards,

Anita

The Never-Ending Story Dear KR,

Beautifully written! Riveting!

Best of luck in staying clean and sober. Wish there was an AA-type organization in Karachi - how about forming one?

Anita